Abstract TMP58: Telestroke Evaluation And Treatment Of CRAO: Current Practice And Opportunities For Improvement

Abstract

Background: The VA National Telestroke Program (NTSP) provides acute care to more than 60 facilities nationwide. Central retinal artery occlusion (CRAO), is not an acute stroke per se but may trigger a telestroke consult; management of these patients is not standardized. The purpose of this project was to examine clinical characteristics, telestroke evaluation, and visual outcomes for patients with monocular vision loss seen in the NTSP. Methods: This was a retrospective chart review of NTSP consults from 3/2018 -6/2021. We identified cases by review of all patients with non-stroke/TIA diagnosis and reviewed all those with monocular visual symptoms. Data were obtained from the NTSP dataset and subsequent chart review including: time of symptom onset to NTSP consult, initial and follow-up (f/u) diagnosis and visual acuity (VA), carotid imaging results, receipt of tPA, and type of f/u. Descriptive data were summarized for all patients, those with f/u, and those with final diagnosis of retinal ischemia. Results: Of the 40 patients identified, mean time to presentation was > 8 hours, 3 were treated with tPA, and 31 (78%) had f/u with ophthalmology/optometry (Table). Among 31 patients with f/u, 42% (N = 13) had final diagnosis of retinal ischemia (CRAO/BRAO, venous occlusion or retinal TIA); 11 (36%) had another ocular diagnosis, 3 (10%) had other retinal pathology and 4 (13%) had a non-ocular diagnosis. Only 3 of 13 (23%) had improved VA at f/u, one of these three had received tPA. Conclusion and potential impact: Fewer than 50% of acute telestroke patients who present with monocular vision loss have a final diagnosis of CRAO, most present far outside the thrombolysis window, and visual outcomes among those with retinal ischemia are poor. Efforts focused on improving acute diagnosis of CRAO via tele-retina imaging and reducing patient time to presentation are needed prior to testing standardized thrombolysis treatment protocols for patients with CRAO.