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Intra-Arterial Tissue Plasminogen Activator for Central Retinal Artery Occlusion
Ethan K Sobol1,2, Yu Sakai3, Danielle Wheelwright3
1Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Insights
Early intra-arterial tissue plasminogen activator (IAT) treatment for central retinal artery occlusion (CRAO) significantly improved vision. This safe intervention showed notable visual acuity gains in patients treated within 12 hours.
Area of Science:
- Ophthalmology
- Vascular Neurology
- Interventional Radiology
Background:
- Central retinal artery occlusion (CRAO) is a critical condition leading to vision loss.
- Prompt intervention is crucial for potentially restoring sight in CRAO patients.
Purpose of the Study:
- To evaluate the efficacy and safety of early intra-arterial tissue plasminogen activator (IAT) for treating acute central retinal artery occlusion (CRAO).
Main Methods:
- A retrospective case series included 15 patients with acute CRAO treated with IAT within 12 hours.
- Tissue plasminogen activator (tPA) was infused into the ophthalmic artery.
- Visual acuity was assessed at three weeks as the primary outcome.
Main Results:
- Significant visual acuity improvement was observed post-IAT (mean change -0.76 logMAR, p=0.006).
- 53% of patients gained 3 or more lines of vision; 27% improved from 'counting fingers' or worse to 20/80 or better.
- Treatment was safe, with no major adverse events reported.
Conclusions:
- Early IAT is a safe and effective treatment for central retinal artery occlusion, leading to significant visual recovery.
- Larger studies are warranted to further optimize treatment protocols and outcomes.
Purpose:
To investigate the benefit of early intra-arterial tissue plasminogen activator (IAT) for treatment of central retinal artery occlusion (CRAO).
Patients And Methods:
Fifteen eyes of 15 patients presenting with acute CRAO were included in this retrospective consecutive interventional case series. Patients were excluded if treatment with IAT was not initiated within 12 hours. The diagnosis was confirmed by an ophthalmologist. IAT was performed via a transfemoral arterial approach. Tissue plasminogen activator (tPA) was infused into the ophthalmic artery in aliquots up to 3mg to a maximum of 22mg. Paracentesis was done at the ophthalmologist's discretion. The primary outcome measure was visual acuity after three weeks. Adverse events were recorded during treatment and follow-up visits.
Results:
After treatment with IAT, there was a statistically significant improvement in visual acuity, with a mean change of -0.76 (SD 0.91; range -2.4 to 0.85) logMAR (p=0.006). Vision improved by 3 or more lines in 53%, and of these, the mean Snellen visual acuity improvement was >6 lines. Notably, 4 patients (27%) improved from CF or worse to 20/80 or better. The mean dose of tPA used was 17mg and the mean time to treatment was 8.83 hours (range: 5.5 to 12 hours). There were no statistically significant differences based on time to treatment, dose of tPA, or use of a paracentesis. No major adverse events were recorded.
Conclusion:
IAT was safe and showed significant visual improvement in this small uncontrolled study. Larger studies and efforts to decrease time to treatment should be initiated to optimize outcomes.
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