Department of Interventional Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Cardiovasc Intervent Radiol. 2010 Aug;33(4):714-9. doi: 10.1007/s00270-009-9775-4. Epub 2009 Dec 24.
The purpose of this study was to prospectively evaluate the incidence of retinal emboli during carotid angioplasty and stenting (CAS) and to correlate emboli with clinical findings and transcranial Doppler (TCD)-detected cerebral embolic load. Between 2001 and 2005, 33 CAS procedures in 32 patients (23 [72%] male, 19 [58%] symptomatic, mean age 72.5 years [range 54.6 to 83.9]) scheduled for CAS were included in this study. Bilateral fundoscopy with retinal photography was performed by an experienced ophthalmologist immediately before, immediately after (fundoscopy only), and 1 day after the procedure and again at long-term follow-up (mean 37 months). Visual field testing was performed before CAS and again at long-term follow-up. TCD-detected cerebral emboli were stratified to five procedural phases: wiring, predilatation, stent placement, postdilatation, and cerebral protection device (CPD) use (if applicable). To establish correlation between TCD data and retinal embolization, Mann-Whitney test was used, and P < 0.05 was considered statistically significant. All procedures were performed successfully. In five of 33 procedures (15%), new retinal emboli were found. Two of the procedures with emboli had small retinal infarcts. Three of five were performed using CPDs versus seven of 28 that had no retinal emboli (P = not significant). Two of four patients (50%) with previous radiation therapy to the neck had new retinal emboli versus three of 29 patients (10%) who had no previous radiation therapy (P = 0.038). None of the other patient characteristics was associated with retinal embolization. In 30 (91%) of patients with an adequate acoustic temporal window for TCD monitoring, there was no statistically significant correlation between TCD data and the incidence of retinal emboli. No visual field defects were found. On long-term follow-up, all retinal emboli and retinal infarcts had resolved. Retinal embolization during CAS is not uncommon, and it occurs in both protected and unprotected procedures. Most retinal emboli are clinically silent.
本研究旨在前瞻性评估颈动脉血管成形术和支架置入术（CAS）过程中视网膜栓子的发生率，并将栓子与临床发现和经颅多普勒（TCD）检测到的脑栓塞负荷相关联。在 2001 年至 2005 年间，32 例 33 例 CAS 手术患者（23 例[72%]男性，19 例[58%]有症状，平均年龄 72.5 岁[范围 54.6 至 83.9]）纳入本研究。由经验丰富的眼科医生在手术前、手术后即刻（仅眼底镜检查）和手术后 1 天以及长期随访（平均 37 个月）时立即进行双侧眼底镜检查和视网膜摄影。在 CAS 前和长期随访时进行视野测试。TCD 检测到的脑栓塞分为五个手术阶段：布线、预扩张、支架置入、后扩张和脑保护装置（CPD）使用（如适用）。为了建立 TCD 数据与视网膜栓塞之间的相关性，使用了 Mann-Whitney 检验，P<0.05 被认为具有统计学意义。所有手术均成功完成。在 33 例手术中有 5 例（15%）发现新的视网膜栓塞。其中 2 例手术中有小的视网膜梗死。在有栓塞的 5 例中，有 3 例使用了 CPD，而在无栓塞的 28 例中，有 7 例使用了 CPD（P=无统计学意义）。在有颈部放疗史的 4 例患者中有 2 例（50%）出现新的视网膜栓塞，而在无放疗史的 29 例患者中有 3 例（10%）出现视网膜栓塞（P=0.038）。其他患者特征与视网膜栓塞均无相关性。在 30 例（91%）有足够的 TCD 监测声学颞窗的患者中，TCD 数据与视网膜栓塞的发生率之间没有统计学上的显著相关性。没有发现视野缺陷。在长期随访中，所有视网膜栓塞和视网膜梗死均已消退。CAS 过程中视网膜栓塞并不少见，且在有保护和无保护的手术中均会发生。大多数视网膜栓塞是无症状的。
