Implementation of a retinal stroke-code protocol results in visual recovery in patients receiving reperfusion therapies

Implementation of a retinal stroke-code protocol results in visual recovery in patients receiving reperfusion therapies

Introduction: Reperfusion therapies represent promising treatments for patients with Central Retinal Artery Occlusion (CRAO), but access is limited due to low incidence and lack of protocols. We aimed to describe the benefit of implementing a Retinal Stroke-Code protocol regarding access to reperfus...

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Published in:European stroke journal Vol. 9; no. 2; pp. 486 - 493
Main Authors: Bustamante, Alejandro, Balboa, Marta, Ezcurra, Garbiñe, Sánchez-Fortún, Adrián, Ruiz, Judith, Castellví, Jordi, Castillo-Acedo, Susana, Matas, Èric, Bouchikh, Rachid, Martínez-Sánchez, Marina, Castaño, Carlos, Remollo, Sebastiá, Werner, Mariano, Salgado, Maria Carmen, Villodres, Samuel, Gea, Mireia, Millán, Mònica, Pérez de la Ossa, Natàlia, Ruiz-Bilbao, Susana
Format: Journal Article
Language:English
Published: London, England SAGE Publications 01-06-2024
Subjects:
Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Original s
Prospective Studies
Recovery of Function
Reperfusion - methods
Retinal Artery Occlusion - therapy
Stroke - therapy
Treatment Outcome
Visual Acuity
aetiology
Central retinal artery occlusion
retinal ischemia
complications
reperfusion therapies
retinal stroke
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Summary:Introduction: Reperfusion therapies represent promising treatments for patients with Central Retinal Artery Occlusion (CRAO), but access is limited due to low incidence and lack of protocols. We aimed to describe the benefit of implementing a Retinal Stroke-Code protocol regarding access to reperfusion, visual acuity and aetiological assessment. Patients and methods: Prospective cohort study performed at a Comprehensive Stroke Centre. Criteria for activation were sudden monocular, painless vision loss within 6 h from onset. Eligible patients received IAT when immediately available and IVT otherwise. All patients were followed by ophthalmologists to assess best-corrected visual acuity (BCVA) and visual complications, and by neurologists for aetiological workup. Visual amelioration was defined as improvement of at least one Early Treatment Diabetic Retinopathy Study (ETDRS) letter from baseline to 1 week. Results: Of 49 patients with CRAO, 15 (30.6%) received reperfusion therapies (12 IVT, 3 IAT). Presentation beyond 6 h was the main contraindication. Patients receiving reperfusion therapies had better rates of visual improvement (33.3% vs 5.9%, p = 0.022). There were no complications related to reperfusion therapies. Rates of neovascular glaucoma were non-significantly lower in patients receiving reperfusion therapies (13.3% vs 20.6%, p = 0.701). Similar rates of atherosclerotic, cardioembolic and undetermined aetiologies were observed, leading to 10 new diagnosed atrial fibrillation and five carotid revascularizations. Conclusion: A comprehensive acute management of CRAO is feasible despite low incidence. In our study, reperfusion therapies were safe and associated with higher rates of visual recovery. A similar etiological workup than ischemic stroke led to of high proportion of underlying aetiologies. Graphical abstract
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ISSN:2396-9873
2396-9881
2396-9881
DOI:10.1177/23969873231221366