Thrombolytic Therapy for Non-arteritic Central Retinal Artery Occlusion in an Academic Multi-site Stroke Center (S45.010)

Abstract

<h3>Objective:</h3> To review our academic multi-site stroke center experience with intravenous (IVT) and intra-arterial thrombolysis (IAT) for central retinal artery occlusion (CRAO). <h3>Background:</h3> CRAO is a subtype of acute ischemic stroke leading to severe visual loss. Conventional management is not effective and potentially harmful. 2021 American Heart Association scientific statement proposes similar time-windows for thrombolysis in CRAO and cerebral strokes (4.5hours for IVT, 6hours for IAT). <h3>Design/Methods:</h3> We retrospectively identified consecutive CRAO patients that received IVT or IAT in our academic enterprise stroke centers (1997–2022). Demographic, clinical characteristics, thrombolysis timeline, concurrent CRAO therapies, hospital complications, and follow-up visual outcomes were collected and analyzed using descriptive statistics. <h3>Results:</h3> Of 563 CRAO admissions, 20 (3.55%) received thrombolytic therapy: 13 IVT (mean age 68, range 55–82, 61.5% male, 12 alteplase and 1 tenecteplase, all embolic etiology) and 7 IAT (mean age 55, range 17–83, 85.7% male, 4 post-operative and 3 embolic). 11/20 (55%) received additional therapies (ocular massage, intraocular pressure lowering drops, diuretics, intra-arterial verapamil). 1 CRAO mimic received IVT. Median visual loss to IVT was 158 minutes (range 67–260 min). Baseline mean logMAR visual acuity (VA) was −3.11 (±1.16). 8/13 IVT had 3-month follow-up VA recorded (mean VA −2.53). 50% improved at least one Snellen line, 12.5% had VA &gt; 20/100. 1/13 (7.6%) had intracranial hemorrhage after IVT. Median visual loss to IAT was 335 minutes (131 minutes to 20 hours). Dose range was 5–30 mg. Baseline IAT mean logMAR VA was −3.5 (±1.19). 5/7 showed VA improvement. 1/7 had profuse epistaxis after IAT. <h3>Conclusions:</h3> The management of acute CRAO in a multi-site academic stroke center remains heterogeneous, consultant specific. Most received a combination of thrombolytic and other conventional therapies, hence thrombolysis-specific outcomes could not be described. Prospective studies comparing thrombolysis and placebo are warranted to guide hyperacute CRAO practice. <b>Disclosure:</b> Dr. Alhayek has nothing to disclose. Mr. Sobczak has nothing to disclose. Miss Weinberg has nothing to disclose. Dr. Demaerschalk has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The Neurologist . Dr. Dumitrascu has nothing to disclose.