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Central Retinal Artery Occlusion: Current Practice, Awareness and Prehospital Delays in Switzerland
Elena Ardila Jurado1, Veit Sturm2, Florian Brugger1
1Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Insights
Central retinal artery occlusion (CRAO) patients experience significant prehospital delays due to low public and physician awareness. Improving CRAO knowledge is crucial for timely treatment and preventing blindness.
Area of Science:
- Ophthalmology
- Neurology
- Emergency Medicine
Background:
- Central retinal artery occlusion (CRAO) can cause irreversible vision loss.
- Prompt recognition and reperfusion are critical for managing CRAO.
- Understanding prehospital pathways and public knowledge is vital for improving outcomes.
Purpose of the Study:
- To compare prehospital pathways and delays in CRAO versus ischemic stroke.
- To assess public, general practitioner (GP), and ophthalmologist knowledge of CRAO.
- To identify barriers to timely CRAO treatment.
Main Methods:
- Analysis of Swiss Stroke Registry data (2014-2019) for CRAO and stroke patients.
- Comparison of prehospital pathways, symptom-to-door times, and acute treatment rates.
- Online survey assessing CRAO knowledge and emergency response intentions among the public, GPs, and ophthalmologists.
Main Results:
- CRAO patients had significantly longer symptom-to-door times (852 min) than stroke patients (300 min).
- Thrombolysis/thrombectomy rates were lower for CRAO (13.2%) compared to stroke (30.9%).
- Only 28.6% of the public recognized CRAO symptoms, and awareness of treatment options among physicians was varied.
Conclusions:
- Low public and physician awareness contributes to prehospital delays in CRAO management.
- Non-standardized prehospital organization hinders effective CRAO treatment.
- Educational initiatives are necessary to enhance CRAO awareness and improve patient outcomes.
Background And Purpose:
Central retinal artery occlusion (CRAO) often leads to permanent monocular blindness. Hence, early recognition and rapid re-perfusion is of paramount importance. This study aims to describe prehospital pathways in CRAO compared to stroke and study the knowledge about CRAO.
Methods:
(1) Description of baseline characteristics, prehospital pathways/delays, and acute treatment (thrombolysis/thrombectomy vs. standard of care) of patients with CRAO and ischemic stroke registered in the Swiss Stroke Registry. (2) Online survey about CRAO knowledge amongst population, general practitioners (GPs) and ophthalmologists in Eastern Switzerland.
Results:
Three hundred and ninety seven CRAO and 32,816 ischemic stroke cases were registered from 2014 until 2019 in 20 Stroke Centers/Units in Switzerland. In CRAO, 25.6% arrived at the hospital within 4 h of symptom onset and had a lower rate of emergency referrals. Hence, the symptom-to-door time was significantly longer in CRAO compared to stroke (852 min. vs. 300 min). The thrombolysis/thrombectomy rate was 13.2% in CRAO and 30.9% in stroke. 28.6% of the surveyed population recognized CRAO-symptoms, 55.4% of which would present directly to the emergency department in contrast to 90.0% with stroke symptoms. Almost 100% of the ophthalmologist and general practitioners recognized CRAO as a medical emergency and 1/3 of them considered IV thrombolysis a potentially beneficial therapy.
Conclusions:
CRAO awareness of the general population and physician awareness about the treatment options as well as the non-standardized prehospital organization, seems to be the main reason for the prehospital delays and impedes treating CRAO patients. Educational efforts should be undertaken to improve awareness about CRAO.
