Abstract Number: Esoc2026a77 Prevalence and Risk Factors of Retinal Ischemic Complications Following Carotid Artery Stenting

Abstract Background and aims To determine the prevalence of retinal ischemic complications after carotid artery stenting (CAS), identify associated procedural and systemic vascular risk factors, and explore their relationship with neurological and visual outcomes. Methods Participants underwent optical coherence tomography (OCT)/OCT angiography with simultaneous confocal scanning superluminescent ophthalmoscope imaging centered on the optic nerve head and macular fovea 1–3 days before and 4 days after CAS. Vascular risk factors, stenting location, and perioperative complications were recorded. Main Outcome Measures include: Incidence of retinal ischemic complications, neurological deficits, and retinal/choroidal vascular metrics. Results New-onset retinal complications after CAS included cotton-wool spots (CWS), paracentral acute middle maculopathy (PAMM), retinal artery/vein occlusion (RAO/RVO), and non-arteritic anterior ischemic optic neuropathy, often co-occurring. Post-CAS rates were significantly higher for CWS (8.45% vs. 2.59%), RAO (2.47% vs. 0.78%), and PAMM (2.99% vs. 1.29%). Stent coverage of the ophthalmic artery origin increased complication risk (CWS 28.57% vs. 6.63%; RAO 21.43% vs. 1.81%; RVO 7.14% vs. 0%; PAMM 14.29% vs. 2.11%; p 0.001). Retinal complications were associated with subjective vision impairment (p 0.05), and retinal complications overall correlated with neurological deficits (p = 0.006). Conclusions Stent placement across the ophthalmic artery origin and systemic vascular risks contribute to retinal ischemia after CAS. Routine perioperative retinal screening in high-risk patients may aid early detection and enhance cerebral safety monitoring. Conflict of interest Tianxiang Lan. nothing to disclose.