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IV Thrombolysis for central retinal artery occlusion - Real-world experience from a comprehensive stroke center

Christoph Stretz1, John E Paddock2, Tina M Burton1

  • 1Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, United States.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|February 1, 2024
PubMed

Insights

Intravenous thrombolysis (IVT) is a feasible treatment for central retinal artery occlusion (CRAO). However, most patients miss the treatment window, highlighting the need for improved emergency care and rapid triage for stroke patients.

Area of Science:

  • Ophthalmology
  • Neurology
  • Emergency Medicine

Background:

  • Central retinal artery occlusion (CRAO) is a critical condition representing a stroke of the retina.
  • Intravenous thrombolysis (IVT) is a potential treatment for acute ischemic stroke and may be applicable to CRAO.
  • Establishing feasibility and safety protocols for IVT in CRAO is essential for improving patient outcomes.

Purpose of the Study:

  • To assess the feasibility of an emergency treatment protocol for CRAO using IVT.
  • To determine the risk profile associated with IVT administration in CRAO patients.
  • To evaluate the implementation of IVT for CRAO within a comprehensive stroke center.

Main Methods:

  • A retrospective, observational cohort study was conducted over four years.
  • Patients with acute CRAO were evaluated for IVT eligibility based on criteria similar to acute ischemic stroke.
  • Data collected included demographics, triage information, time to presentation, IVT candidacy, and hemorrhage events.

Main Results:

  • Nine out of 36 CRAO patients (25%) presented within the 4.5-hour treatment window.
  • Of those eligible for IVT, 77% received the treatment.
  • No symptomatic intracranial or extracranial hemorrhages were reported in patients receiving IVT.

Conclusions:

  • IVT is a feasible treatment option for acute CRAO.
  • A high percentage of eligible patients received IVT, indicating successful protocol implementation.
  • The majority of patients presented outside the optimal treatment window, emphasizing the need for public and professional education to expedite emergency department triage for potential IVT candidacy.
Abstract

Keywords:
Central retinal artery occlusionIschemic strokeTreatmentthrombolysis

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