Incidence of Retinal Artery Occlusion After Carotid Endarterectomy Versus Carotid Artery Stenting
In brief
Carotid stenting linked to 64% higher retinal artery occlusion risk than endarterectomy
In a matched study of 17,851 patients per group, retinal artery occlusion within a year affected 0.421% after carotid stenting and 0.257% after endarterectomy; most events occurred within 72 hours. Stroke and mortality were also more frequent after stenting, but the absolute eye-event risk was low and the observational findings cannot show that stenting caused the differences.
- Journal
- Retina (Philadelphia, Pa.) (Q1)
- Published
- 6 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Zuhair Zaidi, Ahmed Alshaikhsalama, Brandon Winward, Faiza Sarwar, Mustafa Alrawi, Khalil Chamseddin, et al.
- PMID
- 42854197
- DOI
- 10.1097/IAE.0000000000005029
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 10 October 2026): Retinal artery occlusion risk after carotid procedures
Abstract
PURPOSE: Retinal artery occlusion (RAO) is a rare but vision-threatening complication of carotid revascularization, yet its comparative incidence after carotid endarterectomy (CEA) versus carotid artery stenting (CAS) is poorly characterized. We compared the risk of RAO and associated neurologic outcomes after CEA and CAS. METHODS: Retrospective multicenter cohort study using the TriNetX Research Network (January 1, 2004-March 15, 2026). Adults undergoing CEA or CAS with ≥6 months of follow-up and no prior diagnosis of any studied outcome condition (retinal artery or vein occlusion, glaucoma, legal blindness, or stroke were included. Propensity score matching on demographics, comorbidities, ophthalmic conditions, medications, and laboratory biomarkers (nearest-neighbor greedy algorithm; caliper 0.25 SD) yielded 17,851 patients per cohort. The primary outcome was the incidence of RAO at 90 days and 1 year after the index procedure. Secondary outcomes included central RAO (CRAO), branch RAO (BRAO), retinal vein occlusion, glaucoma, legal blindness, stroke (stratified by National Institutes of Health Stroke Scale [NIHSS] score), and mortality at the same intervals. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS: At 1 year, CAS was associated with higher risks of RAO (0.421% vs 0.257%; OR 1.64; 95% CI, 1.12-2.41), CRAO (OR 2.30; 1.10-4.84), BRAO (OR 3.21; 1.58-6.52), and legal blindness (OR 1.59; 1.26-2.92). CAS also conferred higher odds of stroke (6.20% vs 4.43%; OR 1.42; 1.25-1.62) and mortality (6.41% vs 3.87%; OR 1.70; 1.54-1.88). Most events occurred within 72 hours post-procedure. CONCLUSION: In this retrospective propensity-matched analysis, CAS was associated with greater risk of retinal and neurologic ischemic complications than CEA, although absolute event rates were low. These observational findings support consideration of heightened postoperative ophthalmic vigilance and interdisciplinary collaboration between ophthalmology and vascular surgery after CAS and suggest that targeted post-procedural ophthalmic evaluation may be reasonable in selected high-risk patients, pending prospective confirmation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.