Safety of intravenous thrombolysis in central retinal artery occlusion patients with concomitant acute cerebral infarctions

Background and objectives: Central retinal artery occlusion (CRAO) results in severe visual impairment. Intravenous thrombolysis (IVT) is a potential treatment for CRAO, but ambiguous data regarding efficacy and the possibility that the presence of cerebral infarctions may increase the risk of symptomatic intracranial hemorrhage (sICH) raise concerns. The aim of the current study was to evaluate the safety of IVT in patients with CRAO. Methods: This multi-center, international registry study included 66 patients with CRAO that presented within 4.5 h from symptom onset. Patients that received IVT were compared with those who didn't. Baseline and follow-up visual acuity (VA) were assessed and MR or CT imaging was used to detect acute cerebral infarctions. The primary outcome was the incidence of sICH following IVT. Secondary outcomes included change in visual acuity and additional safety parameters including any intracranial hemorrhage, subdural hematoma, subarachnoid hemorrhage, and major extracranial bleeding. Results: Of the 66 patients included, 55 (83 %) received IVT. Concomitant acute cerebral ischemia was identified in 15 (23 %) patients (12/55 vs. 3/11: in the IVT and non-IVT groups respectively, p = 0.69). One patient in each group experienced an ICH and only one of these, in the non-IVT group, was defined as sICH. There were no other safety concerns. A non-significant trend towards greater improvements in VA was observed in patients treated with IVT. Conclusion: IVT is safe in CRAO patients despite a relatively high prevalence of new DWI lesions. Improvement in visual outcomes were numerically more common in patients that received IVT.