Management of Acute Central Retinal Artery Occlusion, a "Retinal Stroke" : An Institutional Series and Literature Review
Copyright © 2020 Elsevier Inc. All rights reserved..
OBJECTIVES: Acute central retinal artery occlusion (CRAO) is an ophthalmologic emergency that often results in permanent vision loss. Over 25% are associated with acute cerebral ischemia. In the absence of existing Level I treatment options, this study aims to examine institutional practice patterns and review the literature to develop a formalized approach to the treatment of CRAO in the era of ischemic stroke protocols.
MATERIALS AND METHODS: This is a retrospective review of institutional practices in the workup and treatment of patients diagnosed with acute non-arteritic (NA) CRAO at a single center from January 2017 to August 2020.
RESULTS: Of 91 patients managed for acute NA-CRAO, 62.6% were male and average age was 66.4 years. Only 20.9% of patients presented within 4 h of symptom onset. 12.1% of patients had evidence of acute stroke on MRI, and 27.5% had ipsilateral internal carotid artery stenosis >50%. Half (52.7%) did not receive any acute treatment for CRAO, excluding antiplatelet/anticoagulation. 48.5% of patients undergoing acute medical treatment had improved visual acuity compared to 29.4% without treatment (p=0.14).
CONCLUSIONS: There is a lack of clear protocol for the management of NA-CRAO. While not reaching statistical significance, our experience mirrors the literature with patients undergoing medical treatment demonstrating improved visual acuity over those without treatment. Given the presence of acute ischemic stroke, carotid disease, and/or stroke risk factors in over 25% of patients with CRAO, multidisciplinary involvement and modern stroke algorithms should be considered for this disease.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
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| Enthalten in: |
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association - 30(2021), 2 vom: 25. Feb., Seite 105531 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lee, Katriel E [VerfasserIn] |
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| Links: |
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| Themen: |
Algorithms |
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| Anmerkungen: |
Date Completed 25.01.2021 Date Revised 25.01.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jstrokecerebrovasdis.2020.105531 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM318758903 |
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| 024 | 7 | |a 10.1016/j.jstrokecerebrovasdis.2020.105531 |2 doi | |
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| 100 | 1 | |a Lee, Katriel E |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Management of Acute Central Retinal Artery Occlusion, a "Retinal Stroke" |b An Institutional Series and Literature Review |
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| 500 | |a Date Revised 25.01.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVES: Acute central retinal artery occlusion (CRAO) is an ophthalmologic emergency that often results in permanent vision loss. Over 25% are associated with acute cerebral ischemia. In the absence of existing Level I treatment options, this study aims to examine institutional practice patterns and review the literature to develop a formalized approach to the treatment of CRAO in the era of ischemic stroke protocols | ||
| 520 | |a MATERIALS AND METHODS: This is a retrospective review of institutional practices in the workup and treatment of patients diagnosed with acute non-arteritic (NA) CRAO at a single center from January 2017 to August 2020 | ||
| 520 | |a RESULTS: Of 91 patients managed for acute NA-CRAO, 62.6% were male and average age was 66.4 years. Only 20.9% of patients presented within 4 h of symptom onset. 12.1% of patients had evidence of acute stroke on MRI, and 27.5% had ipsilateral internal carotid artery stenosis >50%. Half (52.7%) did not receive any acute treatment for CRAO, excluding antiplatelet/anticoagulation. 48.5% of patients undergoing acute medical treatment had improved visual acuity compared to 29.4% without treatment (p=0.14) | ||
| 520 | |a CONCLUSIONS: There is a lack of clear protocol for the management of NA-CRAO. While not reaching statistical significance, our experience mirrors the literature with patients undergoing medical treatment demonstrating improved visual acuity over those without treatment. Given the presence of acute ischemic stroke, carotid disease, and/or stroke risk factors in over 25% of patients with CRAO, multidisciplinary involvement and modern stroke algorithms should be considered for this disease | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Algorithms | |
| 650 | 4 | |a Brain ischemia | |
| 650 | 4 | |a Fibrinolysis | |
| 650 | 4 | |a Retinal artery occlusion | |
| 650 | 4 | |a Stroke | |
| 650 | 4 | |a Thrombolytic therapy | |
| 700 | 1 | |a Tschoe, Christine |e verfasserin |4 aut | |
| 700 | 1 | |a Coffman, Stephanie A |e verfasserin |4 aut | |
| 700 | 1 | |a Kittel, Carol |e verfasserin |4 aut | |
| 700 | 1 | |a Brown, Patrick A |e verfasserin |4 aut | |
| 700 | 1 | |a Vu, Quang |e verfasserin |4 aut | |
| 700 | 1 | |a Fargen, Kyle M |e verfasserin |4 aut | |
| 700 | 1 | |a Hayes, Bartlett H |e verfasserin |4 aut | |
| 700 | 1 | |a Wolfe, Stacey Q |e verfasserin |4 aut | |
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