C119 Orbital infarction syndrome after anterior circulation mechanical thrombectomy – a case report

<h3>Introduction</h3> To understand and identify complication of Orbital Infarction Syndrome (OIS) after Anterior circulation Mechanical Thrombectomy (MT). <h3>Case Description</h3> A 31 year old man presented with acute onset left side weakness of three hours onset with NIHSS 6. His MR Angio brain showed acute Right MCA infarct with Right MCA M1 segment occlusion. He was thrombolysed with Inj Tenecteplase 13 mg after which his weakness worsened to NIHSS 10. His CT brain did not show any bleeding. His Cerebral DSA showed Right MCA M1 cutoff with Right MCA territory filling via pial collaterals from Right ACA. MT was done using 0.062’ Red aspiration catheter using ADAPT technique. After the second pass there was TICI3 recanalisation. Post thrombectomy angiogram showed excellent filling of Right MCA and Right ophthalmic artery (OA) with absent choroid blush (CB). Post procedure there was improvement in left side weakness upto grade 4/5 power. After six hours patient started complaining loss of vision in right eye with proptosis and dilatation of pupil with perception of light. <h3>Conclusions</h3> There were differential diagnoses of caroticocavernous fistula and OIS. However, his dilated fundoscopic evaluation showed features of central retinal artery occlusion with cherry red spot.OIS is a rare entity with an incidence of 1.7%. It is defined as acute ischemia of intraorbital structures. It is caused by the interruption of rich collateral supply to the orbit from both the OA and the branches of the ECA. Absent post-EVT CB is 100% sensitive for OIS. <h3>Conflict of Interest</h3> No