Safety and effectiveness of IV Thrombolysis in retinal artery occlusion: A multicenter retrospective cohort study

Author:

Baumgartner Philipp1ORCID,Kook Lucas23,Altersberger Valerian L4,Gensicke Henrik45,Ardila-Jurado Elena6,Kägi Georg67,Salerno Alexander8ORCID,Michel Patrik8,Gopisingh Kiran M9,Nederkoorn Paul J9,Scheitz Jan F10ORCID,Nolte Christian H10ORCID,Heldner Mirjam R7,Arnold Marcel7,Cordonnier Charlotte11,Della Schiava Lucie11,Hametner Christian12,Ringleb Peter A.12,Leker Ronen R13ORCID,Jubran Hamza13,Luft Andreas R114,Engelter Stefan T45,Wegener Susanne1ORCID,

Affiliation:

1. Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland

2. Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland

3. Institute for Data Analysis and Process Design, Zurich University of Applied Sciences, Winterthur, Switzerland

4. Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland

5. Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland

6. Department of Neurology, Kantonsspital St. Gallen, Switzerland

7. Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

8. Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland

9. Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands

10. Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany

11. Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France

12. Department of Neurology, University Hospital Heidelberg, Germany

13. Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

14. Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland

Abstract

Background: Retinal artery occlusion (RAO) may lead to irreversible blindness. For acute RAO, intravenous thrombolysis (IVT) can be considered as treatment. However, due to the rarity of RAO, data about IVT safety and effectiveness is limited. Methods: From the multicenter database ThRombolysis for Ischemic Stroke Patients (TRISP), we retrospectively analyzed visual acuity (VA) at baseline and within 3 months in IVT and non-IVT treated RAO patients. Primary outcome was difference of VA between baseline and follow up (∆VA). Secondary outcomes were rates of visual recovery (defined as improvement of VA ⩾ 0.3 logMAR), and safety (symptomatic intracranial hemorrhage (sICH) according to ECASS II criteria, asymptomatic intracranial hemorrhage (ICH) and major extracranial bleeding). Statistical analysis was performed using parametric tests and a linear regression model adjusted for age, sex and baseline VA. Results: We screened 200 patients with acute RAO and included 47 IVT and 34 non-IVT patients with complete information about recovery of vision. Visual Acuity at follow up significantly improved compared to baseline in IVT patients (∆VA 0.5 ± 0.8, p < 0.001) and non-IVT patients (∆VA 0.40 ± 1.1, p < 0.05). No significant differences in ∆VA and visual recovery rate were found between groups at follow up. Two asymptomatic ICH (4%) and one (2%) major extracranial bleeding (intraocular bleeding) occurred in the IVT group, while no bleeding events were reported in the non-IVT group. Conclusion: Our study provides real-life data from the largest cohort of IVT treated RAO patients published so far. While there is no evidence for superiority of IVT compared to conservative treatment, bleeding rates were low. A randomized controlled trial and standardized outcome assessments in RAO patients are justified to assess the net benefit of IVT in RAO.

Funder

Swiss National Science Foundation

Olga Mayenfish foundation

UZH Clinical Research Priority Program (CRPP) Stroke

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Neurology (clinical)

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