Do Not Use Thrombolysis For CRAO

Absolutely not appropriate outside of a rigorous experimental setting.

The “all artery occlusions can be treated with thrombolysis” scope has expanded over the years – coronary arteries, peripheral arteries, intracranial arteries – and, well, why not the central retinal artery? It is, after all, just a “stroke of the eye”. Based on its seeming equivalence to other cerebral ischemia, off-label use of thrombolysis for CRAO has spread.

Now, please stop.

This trial puts tenecteplase to the test for CRAO, with most patients treated within 3 hours and all within 4.5. There was no difference in visual outcomes between groups:

In addition, there was one case of fatal intracranial hemorrhage – a fact the authors note is similar to the ~1% risk found with thrombolysis of any minor stroke.

It remains frustrating there are no obviously efficacious treatments for CRAO, but there’s certainly no role for thrombolysis.