Objectives

Central retinal artery occlusion (CRAO) is a stroke of the retina potentially amenable to intravenous thrombolysis (IVT). We aimed to determine feasibility of an emergency treatment protocol and risk profile of IVT for CRAO in a comprehensive stroke center (CSC).

Methods

We performed a retrospective, observational cohort study including patients with acute CRAO admitted to a CSC over 4 years. Patients are offered IVT if they present with acute vision loss of ≤ 20/200 in the affected eye, have no other cause of vision loss (incorporating a dilated ophthalmologic exam), and meet criteria akin to acute ischemic stroke. We collected socio-demographic data, triage data, time from onset to presentation, IVT candidacy, and rates of symptomatic intracranial hemorrhage (sICH)- or extracranial hemorrhage.

Results

36 patients presented within the study period, mean (standard deviation (SD)) age of 70.7 (10), 52 % female, and median time (Q1, Q3) to ED presentation of 13.5 (4.3, 18.8) h. Patients within 4.5 h from onset presented more commonly directly to our ED (66.6 % vs 37.1 %, p = 0.1). Nine patients (25 %) presented within the 4.5 h window. Of those eligible, 7 (77 %) received IVT. There were no events of intracranial or extracranial hemorrhage.

Conclusions

Our study confirmed that IVT for acute CRAO is feasible. We found a high rate of treatment with IVT of those eligible. However, because 75 % of patients presented outside the treatment window, continued educational efforts are needed to improve rapid triage to emergency departments to facilitate evaluation for possible candidacy with IVT.

中文翻译：

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视网膜中央动脉闭塞的静脉溶栓治疗——综合性卒中中心的真实经验

目标

视网膜中央动脉阻塞（CRAO）是一种可能适合静脉溶栓（IVT）的视网膜中风。我们的目的是确定综合卒中中心 (CSC) 中 CRAO 紧急治疗方案和 IVT 风险状况的可行性。

方法

我们进行了一项回顾性观察性队列研究，纳入了入住 CSC 超过 4 年的急性 CRAO 患者。如果患者患眼出现≤20/200的急性视力丧失，没有其他原因导致视力丧失（包括散瞳眼科检查），并且符合类似于急性缺血性中风的标准，则为患者提供IVT 。我们收集了社会人口统计数据、分诊数据、从发病到就诊的时间、IVT 候选资格以及症状性颅内出血 (sICH) 或颅外出血的发生率。

结果

研究期间有 36 名患者就诊，平均（标准差 (SD)）年龄为 70.7 (10)，52% 为女性，到 ED 就诊的中位时间 (Q1, Q3) 为 13.5 (4.3, 18.8) 小时。发病后 4.5 小时内的患者更常见地直接到我们的急诊室就诊（66.6% vs 37.1%，p = 0.1）。 9 名患者 (25%) 在 4.5 小时内就诊。在符合条件的人中，7 人（77%）接受了 IVT。没有发生颅内或颅外出血事件。

结论

我们的研究证实 IVT 治疗急性 CRAO 是可行的。我们发现符合条件的人接受 IVT 治疗的比例很高。然而，由于 75% 的患者在治疗窗口外就诊，因此需要继续开展教育工作，以改进对急诊科的快速分诊，以方便评估可能接受 IVT 的候选资格。