Sirolimus-Eluting Stenting of the External Carotid Artery for the Treatment of Ocular Ischemia

Abstract

Purpose:

To present a patient in whom severe external carotid artery (ECA) stenosis causing ocular ischemia was treated with a drug-eluting stent.

Case Report:

A 55-year-old woman with severe, diffuse atherosclerosis presented with impaired left ocular perfusion and amaurosis fugax. Duplex ultrasonography and angiography documented bilateral occlusion at the origin of the internal carotid arteries, bilateral subtotal ECA stenoses, and subtotal distal left common carotid artery (CCA) restenosis following endarterectomy. Percutaneous revascularization of the left ECA and CCA stenoses was performed using a short coronary balloon-expandable sirolimus-eluting stent and a self-expanding nitinol stent, respectively. The procedure was uneventful, and the ocular symptoms resolved. At 6 months, the patient remained asymptomatic, with angiographically patent stents.

Conclusion:

Drug-eluting stenting may be a novel option to treat symptomatic ECA stenosis.

Keywords

external carotid stenosis ocular ischemia percutaneous transluminal angioplasty drug-eluting stents

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References

Vitek

Morawetz

. Percutaneous transluminal angioplasty of the external carotid artery: Preliminary report. AJNR Am J Neuroradiol. 1982; 3: 541–546.

Reid

Irshad

Miller

. Endovascular significance of the external carotid artery in the treatment of cerebrovascular insufficiency. J Endovasc Ther. 2004; 11: 727–733.

Kearns

Hollenhorst

. Venous-stasis retinopathy of occlusive disease of the carotid artery. Mayo Clin Proc. 1963; 38: 304–312.

Klijn

Kappelle

van Schooneveld

. Venous stasis retinopathy in symptomatic carotid artery occlusion: Prevalence, cause, and outcome. Stroke. 2002; 33: 695–701.

Brown

Magargal

. The ocular ischemic syndrome. Clinical, fluorescein angiographic and carotid angiographic features. Int Ophthalmol. 1988; 11: 239–251.

Weber

Kirsch

Radu

. Angioplasty in a patient with ocular ischemia due to occlusion of the internal and stenosis of the external carotid artery. Cerebrovasc Dis. 2003; 16: 436–439.

Brigham

Youkey

Clagett

. Bright-light amaurosis fugax: An unusual symptom of retinal hypoperfusion corrected by external carotid revascularization. Surgery. 1985; 97: 363–368.

Countee

Vijayanathan

Chavis

. Recurrent retinal ischemia beyond cervical carotid occlusions: Clinical-angiographic correlations and therapeutic implications. J Neurosurg. 1981; 55: 532–542.

Boontje

. External carotid artery revascularization: Indications, operative techniques and results. J Cardiovasc Surg. 1992; 33: 315–318.

10.

Nicolosi

Klinger

Bandyk

. External carotid endarterectomy in the treatment of symptomatic patients with internal carotid artery occlusion. Ann Vasc Surg. 1988; 2: 336–339.

11.

Marx

Hreib

Choi

. Percutaneous carotid artery angioplasty and stenting for ocular ischemic syndrome. Ophthalmology. 2004; 111: 2284–2291.

12.

Babapulle

Joseph

Belisle

. A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents. Lancet. 2004; 364: 583–591.

13.

Windecker

Remondino

Eberli

. Sirolimus-eluting and paclitaxel-eluting stents for coronary revascularization. N Engl J Med. 2005; 353: 653–662.

14.

Dibra

Kastrati

Mehilli

. Paclitaxel-eluting or sirolimus-eluting stents to prevent restenosis in diabetic patients. N Engl J Med. 2005; 353: 663–670.