title: Endovascular Management of Central Retinal Arterial Occlusion.
abstract: BACKGROUND
  Central retinal artery occlusion (CRAO) is an ophthalmologic emergency due to the sudden cessation of circulation to the inner retinal layer. Without immediate treatment, permanent blindness may ensue. Several treatment options exist, ranging from noninvasive medical management to thrombolysis. Nonetheless, ongoing debate exists regarding the best therapeutic strategy.
  
  
  METHODS
  The authors present the case of a 78-year-old woman with a medical history of hypercholesterolemia and rheumatoid arthritis who experienced complete loss of vision in her left eye. Following ophthalmologic evaluation demonstrating left CRAO, anterior chamber paracentesis was performed. Endovascular intervention was performed via local intra-arterial fibrinolysis with alteplase. Her vision returned to 20/20 following the procedure. In general, conventional therapies have not significantly improved patient outcomes.
  
  
  CONCLUSIONS
  Several management options exist for CRAO. In general, conservative measures have not been reported to yield better patient outcomes as compared to the natural history of this medical emergency. Endovascular approaches are another option as observed with this case reported. In cases of CRAO, therapeutic strategies such as intra-arterial fibrinolysis utilize a local infusion of reactive tissue plasminogen activator directly at the site of occlusion via catheterization of the ophthalmic artery. Although several case series do show promising results after treating CRAO with intra-arterial fibrinolysis, further studies are required given the reports of complications.
authors.affiliation: 1 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.|2 Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: 1 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Nihar B
authors.initials: NB
authors.lastname: Gala
authors.affiliation: 3 Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Baumrind
authors.affiliation: 4 Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Hansberry
authors.affiliation: 1 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Thabet
authors.affiliation: 1 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Chirag D
authors.initials: CD
authors.lastname: Gandhi
authors.affiliation: 1 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Prestigiacomo
mesh_terms: D000368:Aged; D001766:Blindness / Q000209:etiology / Q000503:physiopathology; D057510:Endovascular Procedures; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D007261:Infusions, Intra-Arterial; D020127:Recovery of Function; D015356:Retinal Artery Occlusion / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014785:Vision, Ocular
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: central retinal arterial occlusion; endovascular; intra-arterial fibrinolysis; management