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Updated: Sep 6, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
INTRAVENOUS THROMBOLYTIC THERAPY FOR ACUTE NONARTERITIC CENTRAL RETINAL ARTERY OCCLUSION. A REVIEW
Insights
Intravenous thrombolysis shows promise for central retinal artery occlusion (CRAO), a type of ischemic stroke. Studies indicate a 45% visual acuity improvement with alteplase, with no significant adverse events, suggesting a safe and effective treatment option.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Medicine
Background:
- Central retinal artery occlusion (CRAO) is an acute ischemic stroke with severe visual consequences.
- Current conservative therapies for CRAO lack proven efficacy.
- CRAO can indicate a higher risk of future cerebrovascular events.
Purpose of the Study:
- To review clinical studies on intravenous thrombolysis for CRAO.
- To evaluate the efficacy and safety of this treatment.
- To propose an optimal diagnostic and therapeutic algorithm for acute CRAO management.
Main Methods:
- Systematic review and meta-analysis of published clinical studies on intravenous thrombolysis in CRAO.
- Analysis of patient data regarding visual acuity improvement and adverse events.
- Evaluation of treatment outcomes within a 4.5-hour time window from symptom onset.
Main Results:
- Significant visual acuity improvement observed in 45% of patients treated with alteplase within 4.5 hours.
- No significant increase in adverse events reported within this therapeutic window.
- Intravenous thrombolysis appears effective and safe for acute CRAO management.
Conclusions:
- Intravenous thrombolysis is a potentially effective and safe treatment for central retinal artery occlusion.
- Further data from prospective randomized controlled trials are needed to confirm these findings.
- Specialized centers and urgent patient transfer are crucial for optimal CRAO management and secondary prevention.
Abstract:
Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke. It is a critical condition that often leads to severe visual loss or blindness and can be a harbinger of further cerebrovascular events. Due to the lack of scientific data, there are no effective evidence-based forms of therapy for this condition. None of the conservative therapies have proven effective. The results of some previously published studies suggest a benefit of intravenous thrombolytic therapy in the same regimen as in the treatment of ischemic stroke. This work aims to present an overview of published clinical studies focused on the use of intravenous thrombolysis for CRAO, evaluate its efficacy and safety, and propose an optimal diagnostic and therapeutic algorithm for acute management of CRAO. Summary statistics of patient data from relevant studies indicate that a significant visual acuity improvement was achieved by a total of 45 % of patients receiving alteplase within 4.5 hours of symptoms onset. The occurrence of adverse events in this time window was not significant. Intravenous thrombolytic therapy in CRAO thus appears to be effective and safe. However, we still lack data from adequate prospective randomized controlled trials to confirm this conclusion. To date, two randomized trials are being conducted. The intravenous thrombolysis administration, patient monitoring, etiologic workup, and setting of effective secondary prevention should be ensured at the centre of highly specialized cerebrovascular care. Urgent transport of the CRAO patient to the nearest centre is essential.
