Successful Mechanical Thrombectomy for Isolated Internal Carotid Artery Occlusion in a Patient with Monocular Blindness: A Case Report

Abstract

We report a rare case of isolated internal carotid artery occlusion complicated by central retinal artery occlusion that was successfully treated with mechanical thrombectomy for internal carotid artery occlusion. A 59-year-old man visited the emergency room because of right monocular blindness. Magnetic resonance imaging showed multiple acute small embolic infarctions in the right frontal lobe, and magnetic resonance angiography revealed right internal carotid artery occlusion without the associated occlusion of the circle of Willis, which indicates the patency of the anterior and middle cerebral arteries. An electrocardiogram showed atrial fibrillation. Therefore, we performed mechanical thrombectomy with a stent retriever under continuous manual aspiration with a balloon-guiding catheter and confirmed complete recanalization, anterograde flow in the right ophthalmic artery, and retinal brush. The procedure was completed without complications, and the patient noticed an improvement in visual acuity immediately after the procedure. When a patient with atrial fibrillation complains of monocular blindness, it is important to consider internal carotid artery occlusion due to cardioembolism, to perform an examination promptly, and to consider early treatment, including mechanical thrombectomy.

Keywords: central retinal artery occlusion; isolated internal carotid artery occlusion; mechanical thrombectomy; monocular blindness.

Fig. 1

A. Magnetic resonance imaging (MRI) shows multiple acute small embolic infarctions in the right frontal lobe. B. Magnetic resonance angiography shows right internal carotid artery occlusion without the associated occlusion of the circle of Willis.

Fig. 2

A. Common carotid angiography (lateral view) reveals a tapered occlusion of the right internal carotid artery (ICA) after the bifurcation. B. Vertebral angiography (lateral view) demonstrates the patency of the right ICA distal to the posterior communicating artery. C. Vertebral angiography (lateral view) under continuous manual aspiration with a balloon-guiding catheter shows right ICA recanalization. D. I nternal carotid angiography (lateral view) reveals complete right ICA recanalization (TICI 3), ophthalmic artery anterograde flow, and retinal brush. ICA: internal carotid artery

Fig. 3

Fundus photography shows a cherry-red spot in the right eye, which confirmed CRAO.