INTRAVENOUS THROMBOLYTIC THERAPY FOR ACUTE NONARTERITIC CENTRAL RETINAL ARTERY OCCLUSION. A REVIEW

Česká verze

Authors: K. Janská ¹; R. Bodnár ¹; P. Janský ²; M. Vosko ³
Authors place of work: Oční oddělení ON Příbram ¹; Neurologická klinika 2. LF UK a FN Motol, Praha ²; Department of Neurology 2, Kepler Universitätsklinikum, Med Campus III, Linz, Austria ³
Published in the journal: Čes. a slov. Oftal., 78, 2022, No. 3, p. 101-109
Category: Přehledový článek
doi: https://doi.org/10.31348/2021/32

Summary

Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke. It is a critical condition that often leads to severe visual loss or blindness and can be a harbinger of further cerebrovascular events. Due to the lack of scientific data, there are no effective evidence-based forms of therapy for this condition. None of the conservative therapies have proven effective. The results of some previously published studies suggest a benefit of intravenous thrombolytic therapy in the same regimen as in the treatment of ischemic stroke.

This work aims to present an overview of published clinical studies focused on the use of intravenous thrombolysis for CRAO, evaluate its efficacy and safety, and propose an optimal diagnostic and therapeutic algorithm for acute management of CRAO.

Summary statistics of patient data from relevant studies indicate that a significant visual acuity improvement was achieved by a total of 45 % of patients receiving alteplase within 4.5 hours of symptoms onset. The occurrence of adverse events in this time window was not significant. Intravenous thrombolytic therapy in CRAO thus appears to be effective and safe. However, we still lack data from adequate prospective randomized controlled trials to confirm this conclusion. To date, two randomized trials are being conducted. The intravenous thrombolysis administration, patient monitoring, etiologic workup, and setting of effective secondary prevention should be ensured at the centre of highly specialized cerebrovascular care. Urgent transport of the CRAO patient to the nearest centre is essential.

Keywords:

Visual acuity – thrombolysis – central retinal artery occlusion – alteplase

Zdroje

1. Hayreh SS, Zimmerman MB. Central retinal artery occlusion: Visual outcome. Am J Ophthalmol. 2005;140:376-391.

2. Feltgen N, Neubauer A, Jurklies B, et al. EAGLE-Study Group. Multicenter study of the European Assessment Group for Lysis in the Eye (EAGLE) for the treatment of central retinal artery occlusion: design issues and implications. EAGLE Study report no. 1: EAGLE Study report no. 1. Graefes Arch Clin Exp Ophthalmol. 2006 Aug;244(8):950-956.

3. Rumelt S, Dorenboim Y, Rehany U. Aggressive systematic treatment for central retinal artery occlusion. Am J Ophthalmol 2000 Dec;130:908.

4. Park SJ, Choi NK, Seo KH, Park KH, Woo SJ. Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011. Ophthalmology. 2014;121:1933-1938.

5. Leavitt JA, Larson TA, Hodge DO, Gullerud RE. The incidence of central retinal artery occlusion in Olmsted county, Minnesota. Am J Ophthalmol. 2011;152:820-823.

6. Dumitrascu OM, Newman NJ, Biousse V. Thrombolysis for Central Retinal Artery Occlusion in 2020: Time Is Vision! J Neuroophthalmol. 2020 Sep;40(3):333-345.

7. Schrag M, Youn T, Schindler J, Kirshner H, Greer D. Intravenous fibrinolytic therapy in central retinal artery occlusion: a patient-level meta-analysis. JAMA Neurol. 2015;72:1148-1154.

8. Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Jul;44(7):2064-2089.

9. Fraser SG, Adams W. Interventions for acute non-arteritic central retinal artery occlusion. Cochrane Database Syst Rev. 2009.

10. Flaxel CJ, Adelman RA, Bailey ST, Hyman L, Flaxel CJ, Adelman RA. Retinal and ophthalmic artery occlusions preferred practice pattern(R). Ophthalmol. 2020;127:259-287.

11. Schumacher M, Schmidt D, Jurklies B, et al. EAGLE-Study Group. Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial. Ophthalmology. 2010 Jul;117(7):1367-1375

12. Youn TS, Lavin P, Patrylo M, et al. Current treatment of central retinal artery occlusion: a national survey. J Neurol. 2018;265:330-335.

13. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50:344-418.

14. Biousse V, Calvetti O, Bruce BB, Newman NJ. Thrombolysis for central retinal artery occlusion. J Neuroophthalmol. 2007;27:215-230.

15. Kattah JC, Wang DZ, Reddy C. Intravenous recombinant tissuetype plasminogen activator thrombolysis in treatment of central retinal artery occlusion. Arch Ophthalmol. 2002;120:1234-1236.

16. Hattenbach LO, Kuhli-Hattenbach C, Scharrer I, Baatz H. Intravenous thrombolysis with low-dose recombinant tissue plasminogen activator in central retinal artery occlusion. Am J Ophthalmol. 2008;146:700-706.

17. Chen CS, Lee AW, Campbell B, et al. Efficacy of intravenous tissue- -type plasminogen activator in central retinal artery occlusion: report from a randomized, controlled trial. Stroke. 2011;42:2229- 2234.

18. Nedelmann M, Graef M, Weinand F, et al. Retrobulbar spot sign predicts thrombolytic treatment effects and etiology in central retinal artery occlusion. Stroke. 2015;46:2322-2324.

19. Préterre C, Godeneche G, Vandamme X, et al. Management of acute central retinal artery occlusion: intravenous thrombolysis is feasible and safe. Int J Stroke. 2017;12:720-723.

20. Schultheiss M, Hartig F, Spitzer MS, et al. Intravenous thrombolysis in acute central retinal artery occlusion - a prospective interventional case series. PLoS One. 2018;13.

21. Hou K, Wu W, Liu Y, Qu L, Xu B, Yu J. Role of the ophthalmic artery in the endovascular treatment for intracranial vascular diseases. Acta Neurol Belg. 2021 Jan 5.

22. Dorner GT, Polska E, Garhöfer G, Zawinka C, Frank B, Schmetterer L. Calculation of the diameter of the central retinal artery from noninvasive measurements in humans. Curr Eye Res. 2002;25:341-345.

23. Singh S, Dass R. The central artery of the retina. I. origin and course. Br J Ophthalmol. 1960;44:193-212.

24. Mac Grory B, Lavin P, Kirshner H, Schrag M. Thrombolytic therapy for acute central retinal artery occlusion. Stroke. 2020;51:687-695.

25. Brown GC, Shields JA. Cilioretinal arteries and retinal arterial occlusion. Arch Ophthalmol. 1979;97:84-92.

26. Hayreh SS. The cilio-retinal arteries. Br J Ophthalmol. 1963;47:71-89.

27. Hayreh SS, Jonas JB. Optic disk and retinal nerve fiber layer damage after transient central retinal artery occlusion: an experimental study in rhesus monkeys. Am J Ophthalmol. 2000;129:786-795.

28. Ma H, Campbell BCV, Parsons MW, et al. Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. N Engl J Med. 2019;380:1795-1803.

29. Campbell BCV, Ma H, Ringleb PA, et al. EXTEND, ECASS-4, and EPITHET Investigators. Extending thrombolysis to 4.5-9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data. Lancet. 2019;394:139-147.

30. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11-21.

31. Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378:708-718.

32. Thomalla G, Simonsen CZ, Boutitie F, et al. MRI-guided thrombolysis for stroke with unknown time of onset. N Engl J Med. 2018;379:611-622.

33. Zhao J, Zhao H, Li R, et al. Outcome of multimodal MRI-guided intravenous thrombolysis in patients with stroke with unknown time of onset. Stroke Vasc Neurol. 2019;4:3-7.

34. Callizo J, Feltgen N, Pantenburg S, et al. European Assessment Group for Lysis in the Eye. Cardiovascular risk factors in central retinal artery occlusion: results of a prospective and standardized medical examination. Ophthalmol. 2015;122:1881-1888.

35. Park SJ, Choi NK, Yang BR, et al. Risk and risk periods for stroke and acute myocardial infarction in patients with central retinal artery occlusion. Ophthalmology. 2015;122(11):2336-2343.

36. Lee J, Kim SW, Lee SC, Kwon OW, Kim YD, Byeon SH. Co-occurrence of acute retinal artery occlusion and acute ischemic stroke: diffusion- weighted magnetic resonance imaging study. Am J Ophthalmol. 2014;157(6):1231-1238.

37. Hayreh SS, Podhajsky PA, Zimmerman MB. Retinal artery occlusion: associated systemic and ophthalmic abnormalities. Ophthalmology. 2009 Oct;116(10):1928-1936.

38. Appen RE, Wray SH, Cogan DG. Central retinal artery occlusion. Am J Ophthalmol. 1975 Mar;79(3):374-381.

39. Greven CM, Slusher MM, Weaver RG. Retinal arterial occlusions in young adults. Am J Ophthalmol. 1995 Dec;120(6):776-783.

40. Brown GC, Magargal LE, Shields JA, Goldberg RE, Walsh PN. Retinal arterial obstruction in children and young adults. Ophthalmology. 1981 Jan;88(1):18-25.

41. Adams HP, Bendixen BH, Kappelle LJ et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 1993;24(1): 35-41.

42. Dattilo M, Newman NJ, Biousse V. Acute retinal arterial ischemia. Ann Eye Sci. 2018;3:28.

43. Watson T, Shantsila E, Lip GY. Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited. Lancet. 2009 Jan 10;373(9658):155-166.

44. Ertl M, Altmann M, Torka E, et al. The retrobulbar “spot sign” as a discriminator between vasculitic and thrombo-embolic affections of the retinal blood supply. Ultraschall Med. 2012 Dec;33(7):263-267.

45. Ochakovski GA, Wenzel DA, Spitzer MS, et al. Retinal oedema in central retinal artery occlusion develops as a function of time. Acta Ophthalmol. 2020.

46. Arruga J, Sanders MD. Ophthalmologic findings in 70 patients with evidence of retinal embolism. Ophthalmology. 1982;89:1336- 1347.

47. Bruno A, Russell PW, Jones WL, Austin JK, Weinstein ES, Steel SR. Concomitants of asymptomatic retinal cholesterol emboli. Stroke. 1992;23:900-902.

48. Sharma S, Brown GC, Pater JL, Cruess AF. Does a visible retinal embolus increase the likelihood of hemodynamically significant carotid artery stenosis in patients with acute retinal arterial occlusion? Arch Ophthalmol. 1998 Dec;116(12):1602-6.

49. Hayreh SS. Neovascular glaucoma. Prog Retin Eye Res. 2007 Sep;26(5):470-485.

50. Rudkin AK, Lee AW, Chen CS. Ocular neovascularization following central retinal artery occlusion: prevalence and timing of onset. Eu J Ophthalmol. 2010;20:1042-1046.

51. Rossmann H. The thrombolytic therapy of vascular occlusions of the retina [in German]. Klin Monbl Augenheilkd. 1966;149(6):874- 880.

52. Wang X, Liu Y, Suo Y, et al. Intravenous Recombinant Tissue-Type Plasminogen Activator Thrombolysis for Acute Central Retinal Artery Occlusion. J Craniofac Surg. 2021 Jan-Feb 01;32(1):313-316.

53. Wu XJ, Gao F, Liu X, Zhao Q. Observation on therapeutic efficacy of rt-PA intravenous thrombolysis combined with compound anisodine injection on central retinal artery occlusion. Exp Ther Med. 2016;12(4):2617-2621.

54. Hacke W, Kaste M, Bluhmki E, et al. ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 Sep 25;359(13):1317-1329.

55. Abel AS, Suresh S, Hussein HM, Carpenter AF, Montezuma SR, Lee MS. Practice patterns after acute embolic retinal artery occlusion. Asia Pac J Ophthalmol (Phila). 2017;6:37-39.