Subscribe to RSS
DOI: 10.1055/a-0972-9886
Kaliberreduktion der A. ophthalmica in der Magnetresonanzangiografie bei Patienten nach retinalen arteriellen Verschlüssen
Reduced Caliber of the Ophthalmic Artery in Magnetic Resonance Angiography in Patients after Retinal Artery Occlusion
Zusammenfassung
Hintergrund Retinale arterielle Verschlüsse (RAO) werden durch embolische Verschlüsse der retinalen Arterien verursacht. Ein Schlaganfall in der Anamnese wird bei bis zu 20% der Patienten beschrieben. In einer Blutflusssimulation anhand einer Magnetresonanztomografieaufnahme eines Patienten mit RAO gingen 90% der aszendierenden Emboli mit dem Blutstrom in die Hirnarterien. Andere embolische Quellen, wie arterielle Plaques in der A. ophthalmica, kommen daher auch als mögliche Ursachen für RAO infrage. Ziel der Studie war, Kaliberreduktionen der A. ophthalmica in der Magnetresonanzangiografie (MRA) zu untersuchen.
Patienten und Methoden Eine prospektive Fallserie von 9 Patienten mit neu diagnostizierter RAO, die in der Ambulanz erstvorgestellt wurden. Eine MRA des Gehirns mit Einschluss der A. ophthalmica und des Karotissiphons wurde bei allen Patienten durchgeführt und von einem erfahrenen Neuroradiologen beurteilt.
Ergebnisse Vier von 9 Patienten (44,4%) hatten eine Kaliberreduktion in der A. ophthalmica, 2 nur auf der Seite der RAO und die anderen 2 bilateral. Einer dieser Patienten hatte auch eine hochgradige Karotisstenose, die sowohl in der MRA als auch Karotissonografie gezeigt werden konnte. In der Kontrollgruppe wurden keine Kaliberreduktionen der A. ophthalmica diagnostiziert.
Schlussfolgerung Kaliberreduktionen der A. ophthalmica sind in der MRA bei etwa der Hälfte der Patienten mit RAO diagnostizierbar und weisen auf stenookklusive Veränderungen der A. ophthalmica als mögliche Thrombosequelle für RAO hin.
Abstract
Background Retinal artery occlusion (RAO) is caused by embolic occlusion of retinal arteries. Previous strokes in the medical history were reported in up to 20% of patients. According to data from a computational blood flow analysis based on magnetic resonance imaging of a patient with RAO, about 90% of ascending emboli are washed into the brain, leaving speculations about further embolic sources for RAO, such as plaques or stenosis of the ophthalmic artery. The aim of this study was to examine the reduced caliber of the ophthalmic artery in magnetic resonance angiography (MRA).
Patients and Methods An analysis of a prospective case series of 9 patients with newly diagnosed RAO, presenting at the outpatient department. Magnetic resonance angiography of the brain, including the ophthalmic artery and carotid siphon was performed in all patients and evaluated by an experienced radiologist also specialised in neuroradiology. Outcomes were compared to an age-matched control group of 9 patients without RAO.
Results Four of 9 patients (44.4%) had a reduced caliber of the ophthalmic artery, two only at the side of RAO and another two bilateral. One of these cases also had a severe steno-occlusive disease of the internal carotid artery in the MRA, being in accordance with the results from duplex-sonography of the internal carotid artery. None of the patients in the control group had any signs of stenosis of the ophthalmic artery.
Conclusions Reduced caliber of the ophthalmic artery in MRA is present in almost half of patients with RAO and indicates that steno-occlusive disease of the ophthalmic artery could be a possible source of emboli, causing RAO.
Publication History
Received: 20 February 2019
Accepted: 25 June 2019
Article published online:
25 October 2019
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Stuttgart · New York
-
Literatur
- 1 von Graefe A. Ueber Embolie der Arteria centralis retinae als Ursache plötzlicher Erblindung. Albrecht von Graefes Arch Ophthalmol 1859; 5: 136-157
- 2 Hollenhorst RW. Significance of bright plaques in the retinal arterioles. JAMA 1961; 178: 23-29
- 3 Hayreh SS, Podhajsky PA, Zimmerman MB. Retinal artery occlusion: associated systemic and ophthalmic abnormalities. Ophthalmology 2009; 116: 1928-1936 doi:10.1016/j.ophtha.2009.03.006
- 4 Schmidt D, Hetzel A, Geibel-Zehender A. et al. Systemic diseases in non-inflammatory branch and central retinal artery occlusion – an overview of 416 patients. Eur J Med Res 2007; 12: 595-603
- 5 Dunlap AB, Kosmorsky GS, Kashyap VS. The fate of patients with retinal artery occlusion and Hollenhorst plaque. J Vasc Surg 2007; 46: 1125-1129
- 6 Leisser C. Risk factor analysis in patients with retinal artery occlusion with respect to transesophageal echocardiography. Spektrum Augenheilkd 2014; 28: 118-120 doi:10.1007/s00717-014-0218-5
- 7 Weger M, Stanger O, Deutschmann H. et al. The role of hyperhomocysteinemia and methylentetrahydrofolate reductase (MTHFR) C677T mutation in patients with retinal artery occlusion. Am J Ophthalmol 2002; 134: 57-61
- 8 Wong TY, Larsen EK, Klein R. et al. Cardiovascular risk factors for retinal vein occlusion and arteriolar emboli: the Atherosclerosis Risk in Communities & Cardiovascular Health Studies. Ophthalmology 2005; 112: 540-547
- 9 Wang JJ, Cugati S, Knudtson MD. et al. Retinal arteriolar emboli and long-term mortality: pooled data analysis from two older populations. Stroke 2006; 37: 1833-1836
- 10 Leisser C, Kaufmann TA, Feltgen N. et al. Distribution of internal carotid artery plaque locations among patients with central retinal artery occlusion in the Eagle study population. Graefes Arch Clin Exp Ophthalmol 2015; 253: 1227-1230 doi:10.1007/s00417-014-2804-2
- 11 Babikian V, Wijman CAC, Koleini B. et al. Retinal ischemia and embolism. Etiologies and outcomes based on a prospective study. Cerebrovasc Dis 2001; 12: 108-113
- 12 Hwang GJ, Woo SJ, Hwang JM. et al. Reversal of ischemic retinopathy following balloon angioplasty of a stenotic ophthalmic artery. J Neuroophthalmol 2010; 30: 228-230 doi:10.1097/WNO.0b013e3181dc2078
- 13 Schumacher M, Schmidt D, Jurklies B. et al. Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial. Ophthalmology 2010; 117: 1367-1375 doi:10.1016/j.ophtha.2010.03.061
- 14 Schultheiss M, Härtig F, Spitzer MS. et al. Intravenous thrombolysis in acute central retinal artery occlusion – a prospective interventional case series. PLoS One 2018; 13: e0198114 doi:10.1371/journal.pone.0198114
- 15 Hattenbach LO, Kuhli-Hattenbach C, Scharrer I. et al. Intravenous thrombolysis with low-dose recombinant tissue plasminogen activator in central retinal artery occlusion. Am J Ophthalmol 2008; 146: 700-706 doi:10.1016/j.ajo.2008.06.016