title: Selective thrombolysis performed through meningo-ophthalmic artery in central retinal artery occlusion.
abstract: The poor natural history of central retinal artery occlusion (CRAO) is usually not modified with conventional, conservative management techniques. Guidelines for selective intraarterial ophthalmic thrombolysis are still lacking. While many centers continue to perform this procedure with promising results, others are reluctant due to conflicting findings in recent studies. We present our experience in a 36-year-old male with CRAO. Based on the patient's clinical presentation, we planned to perform selective intraarterial ophthalmic thrombolysis via the ophthalmic artery. When angiography demonstrated that the retina was not supplied by the ophthalmic artery, but by a meningo-ophthalmic artery branching from the internal maxillary artery, we instead administered thrombolytic agents via the meningo-ophthalmic artery. The patient's vision recovered completely, with visual acuity and visual field examination at 30 day follow up comparable to his pre-treatment status. This case emphasizes the need for external carotid artery examination in cases of nonvisualization of the ophthalmic artery. In addition, it illustrates the successful use of the meningo-ophthalmic artery to perform selective intraarterial thrombolysis for CRAO.
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O.Box 12000, Jerusalem 91120, Israel. jcohenns@yahoo.com
authors.forename: José E
authors.initials: JE
authors.lastname: Cohen
authors.forename: Samuel
authors.initials: S
authors.lastname: Moscovici
authors.forename: Michael
authors.initials: M
authors.lastname: Halpert
authors.forename: Eyal
authors.initials: E
authors.lastname: Itshayek
mesh_terms: D000328:Adult; D000792:Angiography; D000925:Anticoagulants / Q000627:therapeutic use; D001766:Blindness / Q000209:etiology; D002343:Carotid Artery, Internal / Q000473:pathology; D004487:Edema / Q000209:etiology; D057510:Endovascular Procedures; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D009880:Ophthalmic Artery; D011680:Pupil; D012018:Reflex / Q000502:physiology; D015356:Retinal Artery Occlusion / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator