Intravenous Fibrinolysis for Central Retinal Artery Occlusion Article Swipe
Brian Mac Grory
,
Alex Nackenoff
,
Sven Poli
,
Martin S. Spitzer
,
Max Nedelmann
,
B. Guillon
,
Cécile Preterre
,
Celia S. Chen
,
Andrew W. Lee
,
Shadi Yaghi
,
Christoph Stretz
,
Idrees Azher
,
John Paddock
,
Tatiana Bakaeva
,
David M. Greer
,
Julie Shulman
,
Robert G. Kowalski
,
Patrick Lavin
,
Eva Mistry
,
Kiersten Espaillat
,
Karen L. Furie
,
Howard S. Kirshner
,
Matthew Schrag
·
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1161/strokeaha.119.028743
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1161/strokeaha.119.028743
Background and Purpose: Central retinal artery occlusion results in sudden, painless, usually permanent loss of vision in the affected eye. There is no proven, effective treatment to salvage visual acuity and a clear, unmet need for an effective therapy. In this work, we evaluated the efficacy of intravenous tissue-type plasminogen activator (IV alteplase) in a prospective cohort study and an updated systematic review and meta-analysis. Methods: We enrolled consecutive patients with acute central retinal artery occlusion within 48 hours of symptoms onset and with a visual acuity of <20/200 from January 2009 until May 2019. The primary outcomes were safety and functional visual acuity recovery. We compared rates of visual recovery between those treated with alteplase within 4.5 hours of symptom onset to those who did not receive alteplase (including an analysis restricted to untreated patients presenting within the window for treatment). We incorporated these results into an updated systematic review and patient-level meta-analysis. Results: We enrolled 112 patients, of whom 25 (22.3% of the cohort) were treated with IV alteplase. One patient had an asymptomatic intracerebral hemorrhage after IV alteplase treatment. Forty-four percent of alteplase-treated patients had recovery of visual acuity when treated within 4.5 hours versus 13.1% of those not treated with alteplase ( P =0.003) and 11.6% of those presenting within 4 hours who did not receive alteplase ( P =0.03). Our updated patient-level meta-analysis of 238 patients included 67 patients treated with alteplase within 4.5 hours since time last known well with a recovery rate of 37.3%. This favorably compares with a 17.7% recovery rate in those without treatment. In linear regression, earlier treatment correlated with a higher rate of visual recovery ( P =0.01). Conclusions: This study showed that the administration of intravenous alteplase within 4.5 hours of symptom onset is associated with a higher likelihood of a favorable visual outcome for acute central retinal artery occlusion. Our results strongly support proceeding to a randomized, placebo-controlled clinical trial.
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Concepts
Metadata
- Type
- review
- Language
- en
- Landing Page
- https://doi.org/10.1161/strokeaha.119.028743
- https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.119.028743
- OA Status
- bronze
- Cited By
- 109
- References
- 26
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W3036034576
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W3036034576Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1161/strokeaha.119.028743Digital Object Identifier
- Title
-
Intravenous Fibrinolysis for Central Retinal Artery OcclusionWork title
- Type
-
reviewOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2020Year of publication
- Publication date
-
2020-06-17Full publication date if available
- Authors
-
Brian Mac Grory, Alex Nackenoff, Sven Poli, Martin S. Spitzer, Max Nedelmann, B. Guillon, Cécile Preterre, Celia S. Chen, Andrew W. Lee, Shadi Yaghi, Christoph Stretz, Idrees Azher, John Paddock, Tatiana Bakaeva, David M. Greer, Julie Shulman, Robert G. Kowalski, Patrick Lavin, Eva Mistry, Kiersten Espaillat, Karen L. Furie, Howard S. Kirshner, Matthew SchragList of authors in order
- Landing page
-
https://doi.org/10.1161/strokeaha.119.028743Publisher landing page
- PDF URL
-
https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.119.028743Direct link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
bronzeOpen access status per OpenAlex
- OA URL
-
https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.119.028743Direct OA link when available
- Concepts
-
Medicine, Fibrinolysis, Central retinal artery occlusion, Occlusion, Central retinal artery, Stroke (engine), Cardiology, Retinal, Internal medicine, Ophthalmology, Mechanical engineering, EngineeringTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
109Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 20, 2024: 27, 2023: 22, 2022: 20, 2021: 19Per-year citation counts (last 5 years)
- References (count)
-
26Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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