Central retinal artery occlusion following transcatheter aortic valve implantation (TAVI) for aortic stenosis: a case report

Central retinal artery occlusion following transcatheter aortic valve implantation (TAVI) for aortic stenosis: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Central retinal artery occlusion following transcatheter aortic valve implantation (TAVI) for aortic stenosis: a case report Pablo Ballester Dolz, Kemal Mutibayraktaroglu, Yuri Belitsky, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8828753/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Apr, 2026 Read the published version in BMC Ophthalmology → Version 1 posted 12 You are reading this latest preprint version Abstract Background : Transcatheter aortic valve implantation is the standard treatment for high risk elderly patients suffering from symptomatic severe aortic stenosis. While this procedure is significantly less invasive compared to traditional methods, there are concerns regarding the potential risk of cerebrovascular accidents and ocular complications. We report a case of monocular central retinal artery occlusion that occurred following transcatheter aortic valve implantation due to aortic stenosis. The occurrence of central retinal artery occlusion post-transcatheter aortic valve implantation has not previously been reported. Case presentation: A 78-year-old male presented with a sudden, painless loss of vision in the left eye immediately after undergoing transcatheter aortic valve implantation. Fundus examination revealed moderate optic disc edema, mild venous tortuosity and a diffusely pale retina in the macular area with a cherry spot in the foveal area. Optical coherence tomography indicated signs of retinal ischemia. The patient was referred to the emergency department for further assessment. Conclusions: Although there is evidence of embolization occurring after TAVI, this is the first case of central retinal artery occlusion that has been reported. Patients who have undergone this procedure and report visual impairment should be subjected to a thorough ophthalmological examination. Transcatheter aortic valve implantation Central retinal artery occlusion Figures Figure 1 Figure 2 Figure 3 Background Aortic stenosis (AS) is the most common valvular disease in developed countries, affecting around nine million people globally.[ 1 ] Transcatheter aortic valve implantation (TAVI) is an established therapeutic approach for patients with severe symptomatic aortic stenosis, applicable to both high-risk and intermediate-risk groups.[ 2 , 3 ] Previous research indicates that the risk of retinal embolization during or following interventional procedures, such as coronary bypass grafting, cardiac catheterisation (including TAVI), or carotid artery stenting, ranges from 55% to 100% after coronary bypass surgery, approximately 1.25% to 13.2% after carotid artery stenting, and around 6.3% after cardiac catheterisation.[ 4 ] Although TAVI is considerably less invasive than conventional surgical valve replacement, recent studies propose that it has a relatively high rate of cerebrovascular accidents, reaching up to 5%.[ 2 , 5 ] Therefore, it has been suggested that a risk for retinal arterial occlusive events exists. Indeed, there are studies showing that retinal embolic events and the appearance of new retinal abnormalities following TAVI occur in 15% and 20% respectively[ 4 ], and that there is a noted impairment of choroidal microperfusion in patients undergoing TAVI.[ 6 ] We here present a case of central retinal artery occlusion (CRAO) following TAVI in a patient with aortic stenosis. Case presentation A 78-year-old man with a medical history of chronic ischemic heart disease (artherosclerosis, angina pectoris and PCI [percutaneous coronary intervention] in 2013) and aortic stenosis arrived at the ophthalmological emergency department at Sahlgrenska University Hospital. The visit was prompted by a referral from the cardiology department due to a sudden and significant reduction in vision that occurred immediately following TAVI, six days prior to presentation. A Naviator Transcatheter Aortic Valve 27 mm was implantated after ballon aortic valvuloplasty (BAV) was performed. The procedure was noted to be uncomplicated and successful. A single dose of Heparin 8000IU was administered, and acetylsalicylic acid was prescribed. A provisional pacemaker was used for telemetry throughout the post-operative period. Immediately after TAVI procedure, the patient experienced a sudden decrease in vision in the left eye, followed by formed visual hallucinations . No other neurological symptoms were present. A brain CT scan was performed one day after TAVI and did not demonstrate an acute ischemic stroke but revealed older lacunar infarcts, including one adjacent to the head of the caudate nucleus, an older right frontal subcortical ischemic lesion, and moderate white matter changes. The patient was hospitalized for three days with telemetry monitoring and was subsequently discharged at home with an outpatient follow-up scheduled with an ophthalmologist. He was known to the ophthalmology clinic due to blindness in the right eye secondary to a chronic retinal detachment that was initially diagnosed 11 years previously resulting in secondary glaucoma. No retinal surgery was performed at the time of the diagnosis. In addition, the subject underwent cataract surgery in both eyes, approximately 16 years before presentation and he also had Nd:YAG capsulotomy in the left eye three years after cataract surgery. At presentation, visual acuity was no light perception (NLP) in the right eye and hand movement (HM) in the left eye (BCVA). Intraocular pressure measured with iCare tonometry was 41 mmHg in the right eye and 8 mmHg in the left eye. The patient denied ocular pain, and extraocular movements were normal. The direct pupillary light reflex in the left eye was present; however, the indirect response and assessment of a relative afferent pupillary defect (RAPD) could not be performed. Slit-lamp examination of the anterior segment revealed an opaque cornea preventing further view of the right eye and no signs of inflammation in the left eye. Dilated examination showed a well-positioned intraocular lens with no evidence of vitritis or hemorrhage in the vitreous cavity. Fundus examination demonstrated moderate optic disc edema with mild venous tortuosity and a diffusely pale retina in the macular area and a cherry spot in the foveal area. Fundus photographs were obtained using a Zeiss Clarus fundus camera (CLARUS 500™, Carl Zeiss Meditec AG, Jena, Germany), see Figure 1. Optical coherence tomography (OCT) of the macula revealed inner retinal hyperreflectivity with increased inner retinal thickness (Figure 2 and 3). Based on the clinical findings, a diagnosis of central retinal artery occlusion was made, and the patient was referred to the emergency department for further evaluation. The patient underwent blood tests in the emergency department, which revealed elevated levels of erythrocyte sedimentation rate (ESR) at 53 mm/h and C-reactive protein (CRP) at 44 mg/L. However, normal values of CRP were recorded prior to TAVI, with a measurement of 3 mg/L. Hemoglobin was slightly decreased at 128 g/L, and thrombocytes were 117 10*9/L. Electrolytes remained within normal limits, but renal function showed a decline, consistent with previous assessments, with a GFR of 44 ml/min/1.7 and creatinine levels at 119 µmol/ml. Troponin levels were elevated at 200 ng/L, while coagulation parameters were normal, with a prothrombin time (INR) of 0.9 and APTT of 27 seconds. Vital signs indicated a blood pressure of 180/79 mmHg, a body temperature of 36.9 °C, and a heart rate of 90 bpm with a regular rhythm. Neurological examination was normal. The patient was admitted for telemetry monitoring, and a carotid artery duplex ultrasound conducted the day following admission revealed stenosis ranging from 20-49% (NASCET) in both the right and left internal carotid arteries, along with atherosclerotic plaque in the right external carotid artery. However, there was no stenosis observed in the common carotid artery, nor in the external carotid or common carotid artery on the left side. Discussion This report details a case of central retinal artery occlusion in a 78-year-old patient with aortic stenosis following transcatheter aortic valve implantation (TAVI). While earlier studies have indicated that TAVI elevates the risk of embolic events[ 4 ], there are no prior reports of central retinal artery occlusion occurring in a patient post-TAVI. Although the risk of major embolic events especially ischemic stroke during or after TAVI has been extensively studied[ 7 ], the effects of TAVI-related hemodynamic changes on retinal circulation and the associated risk of retinal embolic events remain poorly understood. Cerebrovascular complications are significant contributors to both mortality and morbidity among patients receiving TAVI. Typically, these complications arise from atherosclerotic or gas microembolism, which result from the repeated manipulation of devices and catheters inside the blood vessels.[ 8 , 9 ] Moreover, neurological impairment may be linked to ballong aortic valvuloplasty (BAV) and rapid ventricular pacing (RVP), which are necessary during the deployment of balloon-expandable valve types where oxygen saturation in body tissues can fluctuate. This brief and restricted duration of hypoperfusion has been suggested as a potential cause of localized ganglion cell complex (GCC) quadrant defects occurring in patients one day following TAVI. The defects observed in the GCC were demonstrated to be transient, as they vanished in all patients one month following TAVI.[ 9 ] In a study involving a cohort of 20 patients, researchers identified retinal abnormalities that may have arisen from unilateral retinal embolic events occurring during the early postoperative phase in 4 out of the 20 patients (20%) who underwent elective TAVI procedures. Nevertheless, no participant experienced any visual consequences after the procedure, although 1 out of 20 did suffer a clinical stroke on the sixth day following the procedure.[ 4 ] In another study with a total of 20 individuals, fundus photography revealed signs of embolization in three participants, retinal vessel emboli were observed in three participants, and a single cotton wool spot was observe in one patient; however, no adjacent areas of ischemia or hemorrhages were noted following TAVI. Wide-field OCTA revealed new-onset areas of focal retinal ischemia that were not visible on color fundus photography in four participants. Those findings are consistent with the impairment of the choroidal microperfusion in patients undergoing TAVI and support the hypothesis of silent embolization to the retinal vasculature during TAVI. Nevertheless, the study did not reveal any direct complications that affected the vision following TAVI in that cohort.[ 6 ] Conclusion To our knowledge this is the first case report on CRAO following TAVI, although there are other reports in the literature already showing asymptomatic embolization to the retina. This diagnosis shoud be kept in mind in any patient experiencing visual impairment after TAVI and a full opthalmological examination should be undertaken. Abbreviations APTT Activated partial thromboplastin time AS Aortic stenosis BAV Balloon aortic valvuloplasty BCVA Best-corrected visual acuity CRAO Central retinal artery occlusion CT Computed tomography ESR Erythrocyte sedimentation rate GCC Ganglion cell complex GFR Glomerular filtration rate HM Hand movement INR International normalised ratio IU International units Nd:YAG Neodymium-doped yttrium–aluminum–garnet laser NASCET North American Symptomatic Carotid Endarterectomy Trial NLP No light perception OCT Optical coherence tomography OCTA Optical coherence tomography angiography PCI Percutaneous coronary intervention RAPD Relative afferent pupillary defect RNFL Retinal nerve fibre layer RVP Rapid ventricular pacing TAVI Transcatheter aortic valve implantation Declarations Acknowledgements Not applicable. Funding None to declare. Availability of data and materials Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. Author information Pablo Ballester Dolz [email protected] Kemal Mutibayraktaroglu [email protected] Yuri Belitsky [email protected] Philipp Schwember [email protected] Madeleine Zetterberg [email protected] Affilations Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden: Pablo Ballester Dolz, Kemal Mutibayraktaroglu, Yuri Belitsky, Philipp Schwember and Madeleine Zetterberg. Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden: Yuri Belitsky and Madeleine Zetterberg. Ethics approval and consent to participate The patients informed consent to participate was obtained in this case report. Consent for publication The patient provided written informed consent for the publication of the clinical data and images contained in this case report. Competing interests The authors declare that they have no competing interests. Authors' contributions PBD participated in the conceptualization, data collection, and the composition of the initial draft. KM contributed to the writing of the original draft. YB, PS and MZ took part in the review, editing, and supervision of the original draft. All authors read and approved the final manuscript. References Fallahtafti P, Soleimani H, Ebrahimi P, Ghaseminejad-Raeini A, Karimi E, Shirinezhad A, Sabri M, Mehrani M, Taheri H, Siegel R et al : Comparative Analysis of PCI Strategies in Aortic Stenosis Patients Undergoing TAVI: A Systematic Review and Network Meta-Analysis . Clin Cardiol 2024, 47 (8):e24324. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR et al : Transcatheter versus surgical aortic-valve replacement in high-risk patients . N Engl J Med 2011, 364 (23):2187-2198. Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Sondergaard L, Mumtaz M, Adams DH, Deeb GM, Maini B, Gada H et al : Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients . N Engl J Med 2017, 376 (14):1321-1331. Fusi-Rubiano WJ, Yang YC, Smallwood AF, Chavan RC, Khogali S, Narendran N, Cotton JM: Retinal embolic events: frequency and impact following transcatheter aortic valve implantation (TAVI) for aortic stenosis . BMJ Open Ophthalmol 2017, 1 (1):e000033. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR et al : Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery . N Engl J Med 2010, 363 (17):1597-1607. Wolpers AC, Welchowski T, Sedaghat A, Wintergerst MWM, Al-Kassou B, Finger RP, Terheyden JH: Modifications in ocular microperfusion after transcatheter aortic valve implantation . Sci Rep 2023, 13 (1):14181. Reddy P, Merdler I, Ben-Dor I, Satler LF, Rogers T, Waksman R: Cerebrovascular events after transcatheter aortic valve implantation . EuroIntervention 2024, 20 (13):e793-e805. Nuis RJ, Van Mieghem NM, Schultz CJ, Moelker A, van der Boon RM, van Geuns RJ, van der Lugt A, Serruys PW, Rodes-Cabau J, van Domburg RT et al : Frequency and causes of stroke during or after transcatheter aortic valve implantation . Am J Cardiol 2012, 109 (11):1637-1643. Erdol MA, Ozbebek YE, Erbahceci Timur IE, Ugurlu N, Bozkurt E: Effect of Transcatheter Aortic Valve Replacement on Retinal Layer Thickness Measured by Optical Coherence Tomography . Angiology 2020, 71 (9):817-824. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 Apr, 2026 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 12 Mar, 2026 Reviews received at journal 10 Mar, 2026 Reviewers agreed at journal 10 Mar, 2026 Reviews received at journal 09 Mar, 2026 Reviewers agreed at journal 09 Mar, 2026 Reviewers agreed at journal 09 Mar, 2026 Reviewers agreed at journal 09 Mar, 2026 Reviewers invited by journal 02 Mar, 2026 Editor invited by journal 17 Feb, 2026 Editor assigned by journal 17 Feb, 2026 Submission checks completed at journal 17 Feb, 2026 First submitted to journal 09 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8828753","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":600767346,"identity":"c78f8fbd-71cc-452c-b985-429638008d2d","order_by":0,"name":"Pablo Ballester 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Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Madeleine","middleName":"","lastName":"Zetterberg","suffix":""}],"badges":[],"createdAt":"2026-02-09 09:54:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8828753/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8828753/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-026-04805-w","type":"published","date":"2026-04-29T15:57:20+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":104404558,"identity":"db33b3b0-ace1-419d-80cc-483b880fc62d","added_by":"auto","created_at":"2026-03-11 12:20:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":517596,"visible":true,"origin":"","legend":"\u003cp\u003eColor and green filter fundus pictures illustrate moderate optic disc edema with mild venous tortuosity and a diffusely pale retina in the macular area and a cherry spot in the foveal area.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8828753/v1/29589b00159864686b484f96.png"},{"id":104181646,"identity":"9d0b6e19-be4d-494b-b6a0-ffb5581e3237","added_by":"auto","created_at":"2026-03-08 17:29:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":659660,"visible":true,"origin":"","legend":"\u003cp\u003eOptical coherence tomography images reveal generalized retinal thickening of the macular region, where cross-section images show hyperreflectivity in the inner retina.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8828753/v1/6bf6c9255673bed921d8f59d.png"},{"id":104181644,"identity":"01d1f903-a144-4546-ad5e-28970424e5b0","added_by":"auto","created_at":"2026-03-08 17:29:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":546466,"visible":true,"origin":"","legend":"\u003cp\u003eOptical coherence tomography illustrates six different cross-sectional pictures of the macula showing signs of central retinal artery occlusion.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8828753/v1/a95fcb199c3de23e5882ff90.png"},{"id":108437607,"identity":"e89dc6bd-2559-47be-90cf-6420fc5b153d","added_by":"auto","created_at":"2026-05-04 16:00:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2252258,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8828753/v1/7e4d2319-4ca5-44ba-b4dc-9134d34c1164.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Central retinal artery occlusion following transcatheter aortic valve implantation (TAVI) for aortic stenosis: a case report","fulltext":[{"header":"Background","content":"\u003cp\u003eAortic stenosis (AS) is the most common valvular disease in developed countries, affecting around nine million people globally.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Transcatheter aortic valve implantation (TAVI) is an established therapeutic approach for patients with severe symptomatic aortic stenosis, applicable to both high-risk and intermediate-risk groups.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003ePrevious research indicates that the risk of retinal embolization during or following interventional procedures, such as coronary bypass grafting, cardiac catheterisation (including TAVI), or carotid artery stenting, ranges from 55% to 100% after coronary bypass surgery, approximately 1.25% to 13.2% after carotid artery stenting, and around 6.3% after cardiac catheterisation.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAlthough TAVI is considerably less invasive than conventional surgical valve replacement, recent studies propose that it has a relatively high rate of cerebrovascular accidents, reaching up to 5%.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTherefore, it has been suggested that a risk for retinal arterial occlusive events exists. Indeed, there are studies showing that retinal embolic events and the appearance of new retinal abnormalities following TAVI occur in 15% and 20% respectively[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and that there is a noted impairment of choroidal microperfusion in patients undergoing TAVI.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] We here present a case of central retinal artery occlusion (CRAO) following TAVI in a patient with aortic stenosis.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 78-year-old man with a medical history of chronic ischemic heart disease (artherosclerosis, angina pectoris and PCI [percutaneous coronary intervention] \u0026nbsp;in 2013) and aortic stenosis arrived at the ophthalmological emergency department at Sahlgrenska University Hospital. The visit was prompted by a referral from the cardiology department due to a sudden and significant reduction in vision that occurred immediately following TAVI, six days prior to presentation. A Naviator Transcatheter Aortic Valve 27 mm was implantated after ballon aortic valvuloplasty (BAV) was performed. The procedure was noted to be uncomplicated and successful. A single dose of Heparin 8000IU was administered, and acetylsalicylic acid was prescribed. A provisional pacemaker was used for telemetry throughout the post-operative period. Immediately after TAVI procedure, the patient experienced a sudden decrease in vision in the left eye, followed by formed visual hallucinations . No other neurological symptoms were present. A brain CT scan was performed one day after TAVI and did not demonstrate an acute ischemic stroke but revealed older lacunar infarcts, including one adjacent to the head of the caudate nucleus, an older right frontal subcortical ischemic lesion, and moderate white matter changes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe patient was hospitalized for three days with telemetry monitoring and was subsequently discharged at home with an outpatient follow-up scheduled with an ophthalmologist.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHe was known to the ophthalmology clinic due to blindness in the right eye secondary to a chronic retinal detachment that was initially diagnosed 11 years previously resulting in secondary glaucoma. No retinal surgery was performed at the time of the diagnosis. In addition, the subject underwent cataract surgery in both eyes, approximately 16 years before presentation and he also had Nd:YAG capsulotomy in the left eye three years after cataract surgery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt presentation, visual acuity was no light perception (NLP) in the right eye and hand movement (HM) \u0026nbsp;in the left eye (BCVA). Intraocular pressure measured with iCare tonometry was 41 mmHg in the right eye and 8 mmHg in the left eye. The patient denied ocular pain, and extraocular movements were normal.\u003c/p\u003e\n\u003cp\u003eThe direct pupillary light reflex in the left eye was present; however, the indirect response and assessment of a relative afferent pupillary defect (RAPD) could not be performed. Slit-lamp examination of the anterior segment revealed an opaque cornea preventing further view of the right eye and no signs of inflammation in the left eye.\u003c/p\u003e\n\u003cp\u003eDilated examination showed a well-positioned intraocular lens with no evidence of vitritis or hemorrhage in the vitreous cavity. Fundus examination demonstrated moderate optic disc edema with mild venous tortuosity and a diffusely pale retina in the macular area and a cherry spot in the foveal area. Fundus photographs were obtained using a Zeiss Clarus fundus camera (CLARUS 500\u0026trade;, Carl Zeiss Meditec AG, Jena, Germany), see Figure 1.\u003c/p\u003e\n\u003cp\u003eOptical coherence tomography (OCT) of the macula revealed inner retinal hyperreflectivity with increased inner retinal thickness (Figure 2 and 3). Based on the clinical findings, a diagnosis of central retinal artery occlusion was made, and the patient was referred to the emergency department for further evaluation.\u003c/p\u003e\n\u003cp\u003eThe patient underwent blood tests in the emergency department, which revealed elevated levels of erythrocyte sedimentation rate (ESR) at 53 mm/h and C-reactive protein (CRP) at 44 mg/L. However, normal values of CRP were recorded prior to TAVI, with a measurement of 3 mg/L. Hemoglobin was slightly decreased at 128 g/L, and thrombocytes were 117 10*9/L. Electrolytes remained within normal limits, but renal function showed a decline, consistent with previous assessments, with a GFR of 44 ml/min/1.7 and creatinine levels at 119 \u0026micro;mol/ml. Troponin levels were elevated at 200 ng/L, while coagulation parameters were normal, with a prothrombin time (INR) of 0.9 and APTT of 27 seconds. Vital signs indicated a blood pressure of 180/79 mmHg, a body temperature of 36.9 \u0026deg;C, and a heart rate of 90 bpm with a regular rhythm. Neurological examination was normal. The patient was admitted for telemetry monitoring, and a carotid artery duplex ultrasound conducted the day following admission revealed stenosis ranging from 20-49% (NASCET) in both the right and left internal carotid arteries, along with atherosclerotic plaque in the right external carotid artery. However, there was no stenosis observed in the common carotid artery, nor in the external carotid or common carotid artery on the left side.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis report details a case of central retinal artery occlusion in a 78-year-old patient with aortic stenosis following transcatheter aortic valve implantation (TAVI). While earlier studies have indicated that TAVI elevates the risk of embolic events[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], there are no prior reports of central retinal artery occlusion occurring in a patient post-TAVI.\u003c/p\u003e \u003cp\u003eAlthough the risk of major embolic events especially ischemic stroke during or after TAVI has been extensively studied[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], the effects of TAVI-related hemodynamic changes on retinal circulation and the associated risk of retinal embolic events remain poorly understood.\u003c/p\u003e \u003cp\u003eCerebrovascular complications are significant contributors to both mortality and morbidity among patients receiving TAVI. Typically, these complications arise from atherosclerotic or gas microembolism, which result from the repeated manipulation of devices and catheters inside the blood vessels.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Moreover, neurological impairment may be linked to ballong aortic valvuloplasty (BAV) and rapid ventricular pacing (RVP), which are necessary during the deployment of balloon-expandable valve types where oxygen saturation in body tissues can fluctuate. This brief and restricted duration of hypoperfusion has been suggested as a potential cause of localized ganglion cell complex (GCC) quadrant defects occurring in patients one day following TAVI. The defects observed in the GCC were demonstrated to be transient, as they vanished in all patients one month following TAVI.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn a study involving a cohort of 20 patients, researchers identified retinal abnormalities that may have arisen from unilateral retinal embolic events occurring during the early postoperative phase in 4 out of the 20 patients (20%) who underwent elective TAVI procedures. Nevertheless, no participant experienced any visual consequences after the procedure, although 1 out of 20 did suffer a clinical stroke on the sixth day following the procedure.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn another study with a total of 20 individuals, fundus photography revealed signs of embolization in three participants, retinal vessel emboli were observed in three participants, and a single cotton wool spot was observe in one patient; however, no adjacent areas of ischemia or hemorrhages were noted following TAVI. Wide-field OCTA revealed new-onset areas of focal retinal ischemia that were not visible on color fundus photography in four participants. Those findings are consistent with the impairment of the choroidal microperfusion in patients undergoing TAVI and support the hypothesis of silent embolization to the retinal vasculature during TAVI. Nevertheless, the study did not reveal any direct complications that affected the vision following TAVI in that cohort.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTo our knowledge this is the first case report on CRAO following TAVI, although there are other reports in the literature already showing asymptomatic embolization to the retina. This diagnosis shoud be kept in mind in any patient experiencing visual impairment after TAVI and a full opthalmological examination should be undertaken.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAPTT Activated partial thromboplastin time\u003c/p\u003e\n\u003cp\u003eAS Aortic stenosis\u003c/p\u003e\n\u003cp\u003eBAV Balloon aortic valvuloplasty\u003c/p\u003e\n\u003cp\u003eBCVA Best-corrected visual acuity\u003c/p\u003e\n\u003cp\u003eCRAO Central retinal artery occlusion\u003c/p\u003e\n\u003cp\u003eCT Computed tomography\u003c/p\u003e\n\u003cp\u003eESR Erythrocyte sedimentation rate\u003c/p\u003e\n\u003cp\u003eGCC Ganglion cell complex\u003c/p\u003e\n\u003cp\u003eGFR Glomerular filtration rate\u003c/p\u003e\n\u003cp\u003eHM Hand movement\u003c/p\u003e\n\u003cp\u003eINR International normalised ratio\u003c/p\u003e\n\u003cp\u003eIU International units\u003c/p\u003e\n\u003cp\u003eNd:YAG Neodymium-doped yttrium\u0026ndash;aluminum\u0026ndash;garnet laser\u003c/p\u003e\n\u003cp\u003eNASCET North American Symptomatic Carotid Endarterectomy Trial\u003c/p\u003e\n\u003cp\u003eNLP No light perception\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOCT Optical coherence tomography\u003c/p\u003e\n\u003cp\u003eOCTA Optical coherence tomography angiography\u003c/p\u003e\n\u003cp\u003ePCI Percutaneous coronary intervention\u003c/p\u003e\n\u003cp\u003eRAPD Relative afferent pupillary defect\u003c/p\u003e\n\u003cp\u003eRNFL Retinal nerve fibre layer\u003c/p\u003e\n\u003cp\u003eRVP Rapid ventricular pacing\u003c/p\u003e\n\u003cp\u003eTAVI Transcatheter aortic valve implantation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData sharing is not applicable to this article as no datasets were generated or analyzed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePablo Ballester Dolz [email protected] \u003c/p\u003e\n\u003cp\u003eKemal Mutibayraktaroglu [email protected] \u003c/p\u003e\n\u003cp\u003eYuri Belitsky [email protected] \u003c/p\u003e\n\u003cp\u003ePhilipp Schwember [email protected] \u003c/p\u003e\n\u003cp\u003eMadeleine Zetterberg \u003cem\[email protected]\u003c/em\u003e \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAffilations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegion Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden: Pablo Ballester Dolz, Kemal Mutibayraktaroglu, Yuri Belitsky, Philipp Schwember and Madeleine Zetterberg.\u003c/p\u003e\n\u003cp\u003eDepartment of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden: Yuri Belitsky and Madeleine Zetterberg.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patients informed consent to participate was obtained in this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient provided written informed consent for the publication of the clinical data and images contained in this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePBD participated in the conceptualization, data collection, and the composition of the initial draft. KM contributed to the writing of the original draft. YB, PS and MZ took part in the review, editing, and supervision of the original draft. All authors read and approved the final manuscript. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eFallahtafti P, Soleimani H, Ebrahimi P, Ghaseminejad-Raeini A, Karimi E, Shirinezhad A, Sabri M, Mehrani M, Taheri H, Siegel R\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eComparative Analysis of PCI Strategies in Aortic Stenosis Patients Undergoing TAVI: A Systematic Review and Network Meta-Analysis\u003c/strong\u003e. \u003cem\u003eClin Cardiol\u0026nbsp;\u003c/em\u003e2024, \u003cstrong\u003e47\u003c/strong\u003e(8):e24324.\u003c/li\u003e\n \u003cli\u003eSmith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eTranscatheter versus surgical aortic-valve replacement in high-risk patients\u003c/strong\u003e. \u003cem\u003eN Engl J Med\u0026nbsp;\u003c/em\u003e2011, \u003cstrong\u003e364\u003c/strong\u003e(23):2187-2198.\u003c/li\u003e\n \u003cli\u003eReardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Sondergaard L, Mumtaz M, Adams DH, Deeb GM, Maini B, Gada H\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eSurgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients\u003c/strong\u003e. \u003cem\u003eN Engl J Med\u0026nbsp;\u003c/em\u003e2017, \u003cstrong\u003e376\u003c/strong\u003e(14):1321-1331.\u003c/li\u003e\n \u003cli\u003eFusi-Rubiano WJ, Yang YC, Smallwood AF, Chavan RC, Khogali S, Narendran N, Cotton JM: \u003cstrong\u003eRetinal embolic events: frequency and impact following transcatheter aortic valve implantation (TAVI) for aortic stenosis\u003c/strong\u003e. \u003cem\u003eBMJ Open Ophthalmol\u0026nbsp;\u003c/em\u003e2017, \u003cstrong\u003e1\u003c/strong\u003e(1):e000033.\u003c/li\u003e\n \u003cli\u003eLeon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eTranscatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery\u003c/strong\u003e. \u003cem\u003eN Engl J Med\u0026nbsp;\u003c/em\u003e2010, \u003cstrong\u003e363\u003c/strong\u003e(17):1597-1607.\u003c/li\u003e\n \u003cli\u003eWolpers AC, Welchowski T, Sedaghat A, Wintergerst MWM, Al-Kassou B, Finger RP, Terheyden JH: \u003cstrong\u003eModifications in ocular microperfusion after transcatheter aortic valve implantation\u003c/strong\u003e. \u003cem\u003eSci Rep\u0026nbsp;\u003c/em\u003e2023, \u003cstrong\u003e13\u003c/strong\u003e(1):14181.\u003c/li\u003e\n \u003cli\u003eReddy P, Merdler I, Ben-Dor I, Satler LF, Rogers T, Waksman R: \u003cstrong\u003eCerebrovascular events after transcatheter aortic valve implantation\u003c/strong\u003e. \u003cem\u003eEuroIntervention\u0026nbsp;\u003c/em\u003e2024, \u003cstrong\u003e20\u003c/strong\u003e(13):e793-e805.\u003c/li\u003e\n \u003cli\u003eNuis RJ, Van Mieghem NM, Schultz CJ, Moelker A, van der Boon RM, van Geuns RJ, van der Lugt A, Serruys PW, Rodes-Cabau J, van Domburg RT\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eFrequency and causes of stroke during or after transcatheter aortic valve implantation\u003c/strong\u003e. \u003cem\u003eAm J Cardiol\u0026nbsp;\u003c/em\u003e2012, \u003cstrong\u003e109\u003c/strong\u003e(11):1637-1643.\u003c/li\u003e\n \u003cli\u003eErdol MA, Ozbebek YE, Erbahceci Timur IE, Ugurlu N, Bozkurt E: \u003cstrong\u003eEffect of Transcatheter Aortic Valve Replacement on Retinal Layer Thickness Measured by Optical Coherence Tomography\u003c/strong\u003e. \u003cem\u003eAngiology\u0026nbsp;\u003c/em\u003e2020, \u003cstrong\u003e71\u003c/strong\u003e(9):817-824.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Transcatheter aortic valve implantation, Central retinal artery occlusion","lastPublishedDoi":"10.21203/rs.3.rs-8828753/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8828753/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Transcatheter aortic valve implantation is the standard treatment for high risk elderly patients suffering from symptomatic severe aortic stenosis. While this procedure is significantly less invasive compared to traditional methods, there are concerns regarding the potential risk of cerebrovascular accidents and ocular complications. We report a case of monocular central retinal artery occlusion that occurred following transcatheter aortic valve implantation due to aortic stenosis. The occurrence of central retinal artery occlusion post-transcatheter aortic valve implantation has not previously been reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation: \u003c/strong\u003eA 78-year-old male presented with a sudden, painless loss of vision in the left eye immediately after undergoing transcatheter aortic valve implantation. Fundus examination revealed moderate optic disc edema, mild venous tortuosity and a diffusely pale retina in the macular area with a cherry spot in the foveal area. Optical coherence tomography indicated signs of retinal ischemia. The patient was referred to the emergency department for further assessment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Although there is evidence of embolization occurring after TAVI, this is the first case of central retinal artery occlusion that has been reported. Patients who have undergone this procedure and report visual impairment should be subjected to a thorough ophthalmological examination.\u003c/p\u003e","manuscriptTitle":"Central retinal artery occlusion following transcatheter aortic valve implantation (TAVI) for aortic stenosis: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 17:28:56","doi":"10.21203/rs.3.rs-8828753/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-12T05:00:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-10T21:22:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"319733398238393989755536933148876652858","date":"2026-03-10T19:53:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-09T15:32:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"61523285587729046855634138655885562813","date":"2026-03-09T14:19:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5438674725033227638757210882759185531","date":"2026-03-09T12:50:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217972629760424914676662152407937535274","date":"2026-03-09T10:58:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-02T12:25:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-17T12:14:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-17T05:06:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-17T05:06:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2026-02-09T09:28:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cab27e0d-5051-44b6-8b8f-8ec57d30d322","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T15:59:38+00:00","versionOfRecord":{"articleIdentity":"rs-8828753","link":"https://doi.org/10.1186/s12886-026-04805-w","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2026-04-29 15:57:20","publishedOnDateReadable":"April 29th, 2026"},"versionCreatedAt":"2026-03-08 17:28:56","video":"","vorDoi":"10.1186/s12886-026-04805-w","vorDoiUrl":"https://doi.org/10.1186/s12886-026-04805-w","workflowStages":[]},"version":"v1","identity":"rs-8828753","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8828753","identity":"rs-8828753","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}