Orbital Infarction Syndrome as a Rare Complication After Mechanical Thrombectomy in Ischemic Stroke

Rapillo, Costanza M; Donati, Maria C; Renieri, Leonardo; Lombardo, Ivano; Addazio, Ilaria; Betti, Matteo; Capasso, Francesco; Capirossi, Carolina; Giacomucci, Giulia; Lamassa, Maria

doi:10.1097/wno.0000000000001659

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…OIS as a complication of mechanical thrombectomy has only recently been recognized and reported in literature. The common clinical picture of the cases published 2 3 8 9 10 is of a patient with acute MCA territory infarct with occlusion of terminal ICA and MCA with variable occlusion of the proximal ICA, subjected to mechanical thrombectomy, who subsequently developed painful loss of vision, eventually diagnosed as OIS. In only one 3 of the cases, the occlusion was seen covering the origin of the OA.…”

Section: Discussionmentioning

confidence: 99%

An Eye Opener for a Blinding Disease—Orbital Infarction Syndrome

Kaushik,

Acharya,

Pandey

et al. 2024

Indian J Radiol Imaging

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Orbital infarction syndrome (OIS) is a disease of rare occurrence owing to the rich orbital vascular anastomotic network. We describe a case of a middle-aged female who presented with an acute left middle cerebral artery (MCA) territory infarct with left terminal internal carotid artery and MCA occlusion, underwent emergency mechanical thrombectomy, and developed painful loss of vision shortly after diagnosed as OIS based on clinical and radiological findings. The rarity and severity of OIS, especially in the setting of mechanical thrombectomy, warrant radiologists to be aware of this entity to ensure preventive measures or aid in prompt diagnosis to institute timely treatment.

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Section: Discussionmentioning

confidence: 99%

An Eye Opener for a Blinding Disease—Orbital Infarction Syndrome

Kaushik,

Acharya,

Pandey

et al. 2024

Indian J Radiol Imaging

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“…Globally, more than 10 million people suffer a stroke yearly, with associated complications such as reduced motor function and neurobehavioral changes [ 1 , 2 ]. Stroke is broadly categorized as ischemic or hemorrhagic, with ischemic stroke (IS) being the most common (approximately 87%) [ 3 - 5 ]. IS is usually caused by arterial thrombosis, which can lead to cerebral infarction and neurological deficits [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

OL-FS13 Alleviates Cerebral Ischemia-reperfusion Injury by Inhibiting miR-21-3p Expression

Yang

Feng

Wang

et al. 2023

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Background: OL-FS13, a neuroprotective peptide derived from Odorrana livida, can alleviate cerebral ischemia-reperfusion (CI/R) injury, although the specific underlying mechanism remains to be further explored. Objective: The effect of miR-21-3p on the neural-protective effects of OL-FS13 was examined. Methods: In this study, the multiple genome sequencing analysis, double luciferase experiment, RT-qPCR, and Western blotting were used to explore the mechanism of OL-FS13. Results: showed that over-expression of miR-21-3p against the protective effects of OL-FS13 on oxygen-glucose deprivation/re-oxygenation (OGD/R)-damaged pheochromocytoma (PC12) cells and in CI/R-injured rats. miR-21-3p was then found to target calcium/calmodulin-dependent protein kinase 2 (CAMKK2), and its overexpression inhibited the expression of CAMKK2 and phosphorylation of its downstream adenosine 5’-monophosphate (AMP)-activated protein kinase (AMPK), thereby inhibiting the therapeutic effects of OL-FS13 on OGD/R and CI/R. Inhibition of CAMKK2 also antagonized up-regulated of nuclear factor erythroid 2-related factor 2 (Nrf-2) by OL-FS13, thereby abolishing the antioxidant activity of the peptide. Conclusion: Our results showed that OL-FS13 alleviated OGD/R and CI/R by inhibiting miR-21-3p to activate the CAMKK2/AMPK/Nrf-2 axis.

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Incidence of Orbital Infarction Syndrome Following Anterior Circulation Endovascular Thrombectomy

MacMillan‐Wang,

Alcock,

Trivedi

et al. 2024

SVIN

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BACKGROUND Orbital infarction syndrome (OIS) is a rare entity defined as acute ischemia of intraorbital structures. Its occurrence requires interruption of the rich collateral supply to the orbit from both the ophthalmic artery (OA) and branches of the external carotid artery. Three case reports have recently been published of OIS occurring after endovascular thrombectomy (EVT). The goal of this study was to determine the true incidence of post‐EVT OIS and to identify associated imaging findings on computed tomography angiography and digital subtraction angiography (DSA). METHODS A retrospective cohort study was performed at our comprehensive stroke center, including all patients who underwent EVT for anterior circulation strokes in 2019 and 2020. Patient charts were reviewed up to 24 hours after EVT for the presence of acute painful vision loss, ophthalmoplegia, chemosis, and proptosis. Patients with any combination of these symptoms in the absence of a carotid‐cavernous fistula were defined as having OIS. Pre‐EVT computed tomography angiography, pre‐EVT DSA, and post‐EVT DSA images were reviewed to determine the sensitivity and specificity of absent OA opacification, nonopacified external carotid artery, and absent choroid blush (CB) for post‐EVT OIS. Patients were excluded from sensitivity and specificity analysis for each finding that was objectively impossible to assess on their images, either because it was outside the field of view or not tested during the procedure. Findings were deemed indeterminate if motion artifact or contrast timing led to uncertainty about their presence. Sensitivity and specificity calculations were performed on a worst‐case‐scenario basis, with all indeterminate findings assumed to be false positives or false negatives. RESULTS Of 217 patients with anterior circulation EVT (male:female, 107:110; median age, 73 [21–98] years), 4 cases of OIS were discovered (male:female, 1:3; median age, 71 [66–80] years; incidence, 1.7%). The number of patients excluded from sensitivity and specificity analysis for each imaging finding was as follows: 34 for pre‐EVT CB, 45 for post‐EVT CB, 7 for pre‐EVT OA, and 19 for post‐EVT OA. CB was deemed indeterminate in 47 patients on pre‐EVT DSA and 36 patients on post‐EVT DSA. All indeterminate cases occurred in non‐OIS patients and were counted as false negatives. Absent OA opacification was 50% sensitive and 91% specific for OIS on both pre‐EVT computed tomography angiography and pre‐EVT DSA, and 0% sensitive and 97% specific on post‐EVT DSA. Absent CB was 33% sensitive and 65% specific for OIS on pre‐EVT DSA, and 100% sensitive and 73% specific on post‐EVT DSA. CONCLUSION Post‐EVT OIS is rare, with an incidence of 1.7%. Absent OA opacification is 91% specific for OIS on pre‐EVT computed tomography angiography and 97% specific for OIS on post‐EVT DSA. Absent post‐EVT CB is 100% sensitive for OIS, with a worst‐case scenario specificity of 73%. These findings may help alert clinicians to potential OIS cases as well as determine the underlying cause of OIS.

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Orbital Infarction Syndrome as a Rare Complication After Mechanical Thrombectomy in Ischemic Stroke

Cited by 3 publications

References 5 publications

An Eye Opener for a Blinding Disease—Orbital Infarction Syndrome

An Eye Opener for a Blinding Disease—Orbital Infarction Syndrome

OL-FS13 Alleviates Cerebral Ischemia-reperfusion Injury by Inhibiting miR-21-3p Expression

Incidence of Orbital Infarction Syndrome Following Anterior Circulation Endovascular Thrombectomy

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