Safety of intravenous thrombolysis in central retinal artery occlusion patients with concomitant acute cerebral infarctions

Authors: Hamza Jubran, Philipp Baumgartner, Elena Ardila Jurado, Elias Auer, Lucie DellaSchiava, Christian H. Nolte, Aviva Alpernas, Giulio Volpe, Anton Schmick, Issa Metanis, Georg Kägi, Adrian Scutelnic, Charlotte Cordonnier, Christoph Riegler, Jeremy Molad, Tamer Jubeh, Mirjam R. Heldner, Ainat Klein, Marcel Arnold, Gian Marco De Marchis, Carlo Cereda, Yoel Schwarsmann, Konstantin Mayr, Susanne Wegener, Ronen R. Leker

Editor's Choice
Journal of the Neurological Sciences.  REVIEW ARTICLE| VOLUME 471, 123437, April 15, 2025

DOI: https://doi.org/10.1016/j.jns.2025.123441

Highlights

• The authors explored the safety of IVT among CRAO patients in a multicenter study.
• IVT-treated patients were compared to those that didn't receive IVT.
• Cerebral ischemia was seen in 23 % with similar proportion between controls and IVT.
• There were no safety concerns among patients treated with IVT.
• There was a trend towards better visual outcomes in patients treated with IVT.

A multi-center, international registry study evaluated the safety of intravenous thrombolysis (IVT) in 66 patients with central retinal artery occlusion (CRAO) who presented within 4.5 hours of symptom onset. Researchers compared IVT-treated patients (55) with non-IVT patients (11), assessing visual acuity (VA) changes and the incidence of cerebral infarctions using MR or CT imaging. The primary outcome was symptomatic intracranial hemorrhage (sICH), with additional safety measures including other types of hemorrhages and major extracranial bleeding.

Results showed that acute cerebral ischemia was found in 23% of patients, with no significant difference between the IVT and non-IVT groups (p = 0.69). One intracranial hemorrhage occurred in each group, but only one, in the non-IVT group, was classified as sICH. No other safety concerns were reported, and a non-significant trend toward greater VA improvement was observed in IVT-treated patients. The study concludes that IVT is safe for CRAO patients despite a high prevalence of new DWI lesions.