Effect of PCI on ophthalmic artery hemodynamics in patients with acute coronary syndrome

Purpose

We aimed to explore the effects of percutaneous coronary intervention (PCI) on the ophthalmic artery (OA) hemodynamics in patients with acute coronary syndrome (ACS).

Methods

A total of 73 participants (Group0: healthy controls, Group1: Patients with ACS underwent PCI < 3 months, Group2: Patients with ACS underwent PCI ≥ 3 months) were enrolled. Computed tomographic angiography images were used to construct three-dimensional models of participants' OAs. Numerical simulations based on computational fluid dynamics were used to acquire hemodynamic parameters.

Results

The angle between the OA and internal carotid artery in Group2 was significantly larger compared with Group0 and Group1 (P = 0.003 and P = 0.044). Hemodynamic simulation showed a significantly slower OA blood velocity in Group1 than in the control (P < 0.001) and Group2 (P = 0.033). Lower wall shear stress was found in Group1 than that in control (P = 0.040). Patients after PCI had a higher wall pressure than healthy controls (P = 0.012 and P = 0.004). Mass flow ratios were decreased in Group1 and Group2 (P = 0.021 and P = 0.002). The hemodynamic parameters of OA were correlated with several clinical indicators.

Conclusions

The OA blood flow velocity of patients with ACS after PCI initially slowed down, which increased the risk of plaque formation, and then showed an increasing trend. There was a correlation between OA hemodynamic parameters and clinical indexes related to cardiac stress. Ischemia-reperfusion injury and changes in blood flow status after PCI may affect OA morphology and hemodynamics, leading to ocular lesions.

Trial registration

ChiCTR2100050428.

Transient trochlear nerve palsy following percutaneous angioplasty

CASE REPORT

A case is presented of a 63-year-old man who suffered a unilateral isolated trochlear nerve palsy with vertical diplopia following an elective radial coronary angiography and percutaneous coronary intervention, which resolved spontaneously within 2 months.

DISCUSSION

Ophthalmoplegia following coronary percutaneous angioplasty is rare. Only internuclear ophthalmoplegia, III and VI cranial nerve palsy have been previously reported following percutaneous angioplasty. This is the first reported case of unilateral isolated trochlear nerve ophthalmoplegia following this procedure.

Iopromide-induced encephalopathy following coronary angioplasty

Non-ionic agents have pharmacological side effects, such as seizure, alteration of cerebral function, confusion, short-term memory loss, mental aberrations and ophthalmoplegia. In this report, we present two cases that developed contrast-induced encephalopathy following coronary angioplasty by the non-ionic contrast agent, iopromide (Ultravist(®)). As a result, we concluded that iopromide-induced encephalopathy may occur during angioplasty in patients with no particular predispositions. In addition to that, contrast-induced encephalopathy should be considered as a new-onset neurological disorder.