IMAGES IN CARDIOLOGY
Visual Disturbance Following Cardiac Catheterization
Michael J. Daly, MBBCH, Andrew J. Boyle, MBBCH, Louise Morrison, MBBCH,
Ernest K. Hunter, MD
Coleraine, Northern Ireland, United Kingdom
From the Causeway
June 15, 2012;
accepted July 5, 2012.
nous fibrinolysis. Ninety minutes post-therapy, the patient underwent rescue coronary angio-
plasty, performed via the right radial artery, with a single drug-eluting stent placed in the
proximal right coronary artery. Four hours post-angioplasty, the patient noticed blurred vision
in his left eye, and examination revealed a superior medial quadrantanopia and reduced visual
acuity (20/100). Fundoscopy demonstrated a white embolus (Hollenhorst plaque) in the infe-
rior branch of the central retinal artery (A, arrow) with associated retinal edema.
Retinal cholesterol emboli can be an initial sign of vascular disease (1) and are due to ulcer-
ation or disruption of an atheromatous plaque, frequently localized to the aortic arch (2). Such
embolic events are a rare but serious complication of cardiac catheterization and can appear up
to 24-h post-procedure (2).
69-year-old male with a background of hypertension and hyperlipidemia presented
with acute ischemic-type chest pain at rest. Initial electrocardiography showed infero-
lateral territory ST-segment elevation, and he was treated as standard with intrave-
1. Meyer CH, Holz FG. Images in clinical medicine.
Blurred vision after cardiac catheterization. N Engl
J Med 2009;361:2366.
2. Kymionis GD, Tsilimbaris MK, Christodoulakis EB,
Pallikaris IG. Late onset branch retinal artery occlusion
following coronary angiography. Acta Ophthalmol
Journal of the American College of Cardiology
© 2013 by the American College of Cardiology Foundation
Published by Elsevier Inc.
Vol. 61, No. 3, 2013
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