Central retinal artery occlusion (CRAO) is a condition that can cause sudden loss of vision. There is currently no effective treatment for CRAO. Previous research has suggested that Intra-arterial thrombolysis (IAT), a procedure by which clot busting medication is delivered through the arterial system inside the clot, may be a promising option, however; estimates on its use and associated outcomes have not been available. A new study from the Zeenat Qureshi Stroke Research Center, published in the Journal of Neuroimaging, investigates the use of thrombolysis as a treatment for CRAO in the United States.
Analyzing data from the Nationwide Inpatient Sample, which contains information representing 20 percent of hospital stays in the U.S., the study finds that none of the patients who received IAT required rehabilitation or long term facility placement compared to 12 percent of the patients who did not receive such treatment.
Thrombolysis should be performed as soon as possible, but the study finds varying time windows for effective treatment. Although more data is required, it appears that for maximum benefit, IAT should be performed within 12 hours of symptom onset, although it may continue to be effective for up to one day after CRAO occurs in some patients.
Due to the lack of standardized care for CRAO patients, different centers approach the condition in different ways. Roughly 2 percent of patients admitted to hospitals with the condition receive IAT, but this treatment is limited exclusively to patients in urban teaching hospitals. The study finds that the highest proportion of CRAO patients are admitted to non-teaching centers, where thrombolysis is not used, and therefore may not receive potentially vision-saving treatment.
The use of thrombolysis as a treatment for CRAO is still debated, but as there are no other options, it seems a beneficial avenue of investigation. “If such treatment is proven with clinical trial then transfer and acute management of such patients to more specialized centers can potentially salvage their vision,” says lead author M. Fareed K. Suri, M.D., who stresses the need for a large-scale clinical trial to provide more information on the efficacy of thrombolysis as a treatment for CRAO.
M. Fareed K. Suri, M.D., is a vascular and interventional neurologist and a researcher at the Zeenat Qureshi Stroke Research Center, University of Minnesota. Dr. Suri can be reached for questions at suri0027umn.edu.
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