title: Interest of local intra-arterial fibrinolysis in acute central retinal artery occlusion: Clinical experience in 16 patients.
abstract: OBJECTIVE
  Central retinal artery occlusion (CRAO) is a rare disease with poor visual prognosis. We evaluated clinical effectiveness of in situ fibrinolysis with original angiographic scores describing the aspect of carotid siphon, proximal ophthalmic artery, and choroid blush.
  
  
  METHODS
  Retrospective study of 16 consecutive cases of CRAO between 2007 and 2013. Fourteen underwent in situ fibrinolysis, two were excluded due to pre-occlusive internal carotid stenosis on pre-procedural diagnostic angio-CT. Fibrinolysis was performed with rt-PA (average injected dose: 35 mg), with an average onset delay of 8hours (4-17h). We reported angiographic scores pre- and post-fibrinolysis, visual acuity (VA) before and after treatment, and VA improvement evaluated by ophthalmologist 6 to 12 months after thrombolysis.
  
  
  RESULTS
  Six patients (43%) recovered post-fibrinolysis VA significally improved, superior or equal to 1/10 (1/10 to 8/10). An irregular carotid siphon (2 cases) appeared as a predictive factor of failure. Fibrinolysis procedure led to a significant improvement of angiographic permeability of proximal ophthalmic artery (P=0.0498), but this result was not accompanied by any VA improvement. The aspect of choroid blush showed no correlation with the management of thrombolysis.
  
  
  CONCLUSIONS
  In situ fibrinolysis was more effective than medical treatments or natural evolution of CRAO (VA improvement was respectively 40% and 20%). However, the benefit/risk ratio must be discussed, and an angio-CT of supra-aortic trunks could be systematically performed before thrombolysis, to assess the potential VA recovery compared with complications such as ischemic stroke.
authors.affiliation: Department of Neuroradiology, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Mercier
authors.affiliation: Department of Neuroradiology, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Adrian
authors.initials: A
authors.lastname: Kastler
authors.affiliation: Department of Neuroradiology, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France. Electronic address: bjean@chu-clermontferrand.fr.
authors.forename: Betty
authors.initials: B
authors.lastname: Jean
authors.affiliation: Department of Ophthalmology, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Souteyrand
authors.affiliation: Department of Neuroradiology, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chabert
authors.affiliation: Department of Neuroradiology, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Claise
authors.affiliation: Department of Clinical Research and Innovation, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Department of Neuroradiology, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Gabrillargues
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007269:Injections, Intra-Arterial; D056965:Injections, Intraocular; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D015356:Retinal Artery Occlusion / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000295:instrumentation / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Angiography; Central retinal artery occlusion; Fibrinolysis; Visual acuity