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[Intra-arterial fibrinolysis in central artery occlusion]
M Schumacher1, D Schmidt, A K Wakhloo
1Abteilung Röntgendiagnostik der Universität Freiburg i. Br.
Insights
Central retinal artery occlusion (CRAO) treatment using intraarterial fibrinolysis showed improved retinal perfusion and visual function in patients. Two patients experienced complete visual recovery, suggesting a promising therapeutic approach for CRAO.
Area of Science:
- Ophthalmology
- Vascular Neurology
- Interventional Radiology
Context:
- Central retinal artery occlusion (CRAO) typically has a poor prognosis.
- Conventional treatments for CRAO yield unfavorable outcomes.
Purpose:
- To investigate the efficacy of superselective intraarterial fibrinolytic therapy for central retinal artery occlusion.
Summary:
- Intraarterial fibrinolysis with urokinase was administered via microcatheter to the ophthalmic artery in 6 CRAO patients.
- Fluorescein angiography demonstrated improved retinal and choroidal perfusion post-therapy in 5 patients.
- All patients exhibited enhanced visual function, with two achieving complete visual acuity recovery.
Impact:
- Intraarterial fibrinolysis represents a potentially effective treatment for central retinal artery occlusion.
- This approach offers hope for improved visual outcomes in patients with CRAO.
Abstract:
Central retinal artery occlusion is known to have a poor natural outcome, and also conventional therapeutic procedures e.g. paracentesis, hemodilution or local massage show unfavorable results. As in intraarterial fibrinolytic therapy in cerebral vessels, we also applied this method to the territory of the ophthalmic artery in 6 patients with occlusion of the central retinal artery. The fibrinolysis was done with a microcatheter superselectively, placed in the proximal part of the ophthalmic artery. The amount of urokinase varied from 200,000 to 900,000 IU, diluted in saline solution. In 5 patients, fluorescein angiography was carried out before and after fibrinolytic therapy, confirming the significant improvement of retinal and choroidal perfusion seen on the arterial ophthalmic angiogram. All patients showed an improvement of visual function after therapy, two patients even had a complete recovery of visual acuity.