Emergent cervical surgical embolectomy to rescue total monocular blindness due to simultaneous cervical internal and external carotid artery occlusion by cardiogenic emboli

BACKGROUND: Central retinal artery occlusion (CRAO) is a stroke of the retina and is associated with extremely poor prognosis. Although the pathophysiology of CRAO is diverse, including autoimmune or hematological disorders, neurosurgeons can perform carotid endarterectomy for the causal internal carotid artery stenosis or perform acute recanalization of the extra- or intracranial artery occlusion due to cardiogenic embolism. CASE DESCRIPTION: A 78-year-old male with a history of atrial fibrillation (Af) visited our hospital with a chief complaint of right monocular blindness. Magnetic resonance imaging revealed occlusion of the right internal and external carotid arteries. We performed emergent cervical surgical embolectomy for restoration of vision. Recanalization was accomplished within 8 h after onset, and the patient regained practical vision within 4 months. CONCLUSION: In the diagnosis and treatment of CRAO, occlusion of the internal and/or external carotid artery due to large cardiac emboli should be taken in consideration, especially when the patient has a history of Af, since acute recanalization might restore vision.