Abstract | BACKGROUND: EVIDENCE ACQUISITION: MEDLINE, Scopus, and Cochrane online databases were systematically searched from 1960 to present, for reports of acute IV or IA therapy with alteplase or tenecteplase in nonarteritic CRAO patients. English language case reports, case series, interventional studies, or randomized controlled trials were included. The study type, age and number of subjects, the regimen administered, the time since symptoms' onset, visual outcome, and safety reports were noted. RESULTS: Use of IV thrombolysis with alteplase was reported in 7 articles encompassing 111 patients, with 54% of them receiving IV tPA within 4.5 hours of symptom onset, and none developing symptomatic intracranial or ocular hemorrhage. Six studies described IA alteplase administration, with only 18 of a total of 134 patients (13.4%) treated within the first 6 hours after visual loss. The reported adverse events were minimal. Visual outcomes post-IV and IA thrombolysis were heterogeneously reported; however, most studies demonstrated benefit of the respective reperfusion therapies when administered very early. We found no reports of tenecteplase administration in CRAO. CONCLUSIONS: In 2020, nonarteritic CRAO patients should theoretically receive the same thrombolytic therapies, in the same time window, as patients with acute cerebral ischemia. Eye stroke and teleeye stroke code encounters must include an expert ophthalmologic evaluation to confirm the correct diagnosis and to evaluate for ocular signs that may help guide IV tPA administration or IA management. Future research should focus on developing feasible retinal penumbra imaging studies that, similar to cerebral tissue viability or perfusion imaging, can be incorporated into the thrombolysis decision-making algorithm.
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Authors | Oana M Dumitrascu, Nancy J Newman, Valérie Biousse |
Journal | Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
(J Neuroophthalmol)
Vol. 40
Issue 3
Pg. 333-345
(09 2020)
ISSN: 1536-5166 [Electronic] United States |
PMID | 32739995
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Systematic Review)
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Chemical References |
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Topics |
- Fibrinolytic Agents
(administration & dosage)
- Humans
- Infusions, Intravenous
- Retinal Artery Occlusion
(drug therapy)
- Thrombolytic Therapy
(methods)
- Treatment Outcome
- Visual Acuity
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