BACKGROUND: Amaurosis fugax is a classic clinical presentation of carotid arterial embolism. Amaurosis results from ischemia to the retinal tissue, is vision threatening, and an ophthalmological emergency. Stenoses isolated within the distal arteries supplying the retina (including the ophthalmic artery) are likely underdiagnosed during the workup of amaurosis, as evaluation is typically focused on carotid artery disease resulting in embolic events. Isolated stenosis of the ophthalmic artery may also be underrecognized by clinicians, as its discussion appears limited to case reports within the literature. CASE PRESENTATION: Our case report describes a young and otherwise healthy 39-year-old female patient without typical risk factors who presented with features suggestive of amaurosis fugax. She underwent full neuro-ophthalmologic workup and was found to have an isolated 3mm severe stenosis of her ipsilateral ophthalmic artery diagnosed with magnetic resonance angiography (MRA). The remainder of the workup was unremarkable, and the patient was started on empiric daily aspirin. The patient has been followed clinically for over 3 years without recurrence of symptoms. CONCLUSION: This report is important, as it highlights the importance of non-invasive angiographic imaging in the workup of patients with amaurosis fugax. This case may encourage physicians to specifically request analysis of the ophthalmic artery, particularly when other etiologies of amaurosis are not found. Identification of localized ophthalmic artery disease may lead to appropriate therapy and may also prevent further episodes of visual loss, even in atypical patient populations, as it has in our case.

Pulmonary sequestration is a rare congenital malformation of the lower respiratory tract, characterized by nonfunctioning lung tissue without tracheobronchial communication and receiving its blood supply from the systemic circulation. It can present as either intralobar or extralobar sequestration, with intralobar being more common. Surgical resection remains the treatment of choice, although preoperative strategies such as endovascular occlusion can reduce the risk of intraoperative complications. We report the case of a 52-year-old woman with a history of recurrent pulmonary infections who was referred for evaluation of an incidentally discovered cystic lesion in the left lower lobe following a transient episode of amaurosis fugax. Chest CT revealed a 5.3 cm pulmonary sequestration supplied by a large aberrant artery (AA) originating from the descending aorta. A two-stage hybrid procedure was performed, starting with thoracic endovascular aortic repair (TEVAR) to exclude the AA, followed by video-assisted thoracoscopic surgery (VATS) left lower lobectomy. The patient had an uneventful recovery and was discharged postoperatively. TEVAR was employed as a preoperative strategy to minimize the bleeding risks associated with the large AA during minimally invasive lobectomy. A hybrid two-stage approach using TEVAR followed by VATS is a safe and effective method for managing intralobar pulmonary sequestration with large aberrant vessels. Careful preoperative planning and a multidisciplinary approach are essential for optimal outcomes.