{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:13:57Z","timestamp":1785428037251,"version":"3.56.0"},"reference-count":46,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016168","name":"King Hussein Cancer Center","doi-asserted-by":"crossref","award":["25KHCC001"],"award-info":[{"award-number":["25KHCC001"]}],"id":[{"id":"10.13039\/100016168","id-type":"DOI","asserted-by":"crossref"}]},{"award":["25KHCC001"],"award-info":[{"award-number":["25KHCC001"]}],"id":[{"id":"https:\/\/ror.org\/0564xsr50","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Cerebrovascular accidents (CVAs) are among the most serious complications of intra-arterial chemotherapy (IAC) for retinoblastoma (RB). This study evaluated the incidence and potential risk factors of this rare event. Methods: A retrospective cohort study included RB patients who received IAC at a tertiary cancer center. Diagnosis of CVAs was based on clinical and\/or neuroimaging findings. Data included demographics, tumor features, complications, and outcomes. Meta-analysis was not feasible due to heterogeneity. A systematic review following PRISMA guidelines was conducted across major databases up to December 2025, including studies reporting CVA after IAC. Results: The cohort included 33 children who underwent 104 IAC procedures (Melphalan). CVA occurred in three patients (3\/33 (9%) of patients, and 3\/104 (2.9%) of procedures). Two were confirmed by neuroimaging, while one was a transient ischemic attack. Two patients (67%) were girls, and 2 of 3 (67%) were younger than 1 year. All events occurred during the IAC procedure and were ipsilateral to the treated eye. Two patients had no residual neurological deficits, while one showed improvement with only a minor residual deficit. The systematic review included 14 studies with 932 patients and identified 11 CVA events (1.2%; Range 0\u20139.1% per patient and 0\u20132.2% per IAC procedure). All were ischemic with variable presentations. Younger age, repeated catheterization, vasospasm, and embolic events were common risk factors. Outcomes were generally favorable. Conclusions: CVA after IAC, though rare, may be underreported. Events are likely procedure-related and influenced by age, treatment intensity, and vascular toxicity. Careful technique, close monitoring, and standardized reporting are needed to recognize\/reduce the real risk.<\/jats:p>","DOI":"10.3390\/jcm15124829","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:03:23Z","timestamp":1782263003000},"page":"4829","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Ocular Toxicity: Cerebrovascular Events After Intra-Arterial Chemotherapy for Retinoblastoma"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7750-6454","authenticated-orcid":false,"given":"Yacoub A.","family":"Yousef","sequence":"first","affiliation":[{"name":"Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8483-483X","authenticated-orcid":false,"given":"Alaa","family":"Tarazi","sequence":"additional","affiliation":[{"name":"Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8318-1171","authenticated-orcid":false,"given":"Mona","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4803-1976","authenticated-orcid":false,"given":"Hadeel","family":"Halalsheh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0195-0457","authenticated-orcid":false,"given":"Qusai F.","family":"Abu Salim","sequence":"additional","affiliation":[{"name":"Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dima","family":"Abu Laban","sequence":"additional","affiliation":[{"name":"Department of Radiology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reem","family":"AlJabari","sequence":"additional","affiliation":[{"name":"Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Mehyar","sequence":"additional","affiliation":[{"name":"Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazem","family":"Haboob","sequence":"additional","affiliation":[{"name":"Department of Radiology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"AlNawaiseh","sequence":"additional","affiliation":[{"name":"Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.pcl.2014.09.014","article-title":"Retinoblastoma","volume":"62","author":"Orbach","year":"2015","journal-title":"Pediatr. 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