Nationwide Incidence and Trends in Central Retinal Arterial Occlusion Management: A 5000-Patient Analysis

Area of Science:

• Ophthalmology
• Vascular Neurology
• Interventional Cardiology

Background:

• Central retinal artery occlusion (CRAO) is a rare vascular event causing severe vision loss.
• Similarities with acute ischemic stroke suggest potential benefits from intravenous alteplase (tPA) and mechanical thrombectomy (MT).
• However, limited data and risks make intervention utility in CRAO uncertain.

Purpose of the Study:

• To evaluate the utilization and outcomes of tPA and MT in CRAO patients.
• To compare CRAO patients receiving these interventions with acute ischemic stroke patients.

Main Methods:

• Utilized the National Inpatient Sample database (2010-2019).
• Identified patients with CRAO and acute ischemic stroke using ICD codes.
• Analyzed demographic data, intervention rates, complications, and functional outcomes.

Main Results:

• The CRAO cohort (5009 patients) was younger and had higher rates of obesity, hypertension, and anticoagulant/tobacco use than stroke patients.
• CRAO patients received tPA less frequently (3.41% vs 6.21%) and MT even less (0.38% vs 1.31%).
• CRAO patients experienced fewer complications, lower poor functional outcomes (31.74% vs 58.1%), and reduced in-hospital mortality (1.2% vs 5.64%), but higher rates of profound blindness (9.24% vs 0.58%).

Conclusions:

• CRAO patients demonstrate different risk factors and generally better in-hospital outcomes compared to stroke patients.
• Current data do not show a significant association between tPA/MT and reduced profound blindness in CRAO, possibly due to small intervention sample sizes.
• Further research with larger cohorts and novel therapies is needed to optimize visual restoration in CRAO.