Incidence of Retinal Artery Occlusion After Carotid Endarterectomy Versus Carotid Artery Stenting.

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.