Nationwide Incidence and Trends in Central Retinal Arterial Occlusion Management: A 5000-Patient Analysis.
Galadu SubahPatricia XuSabrina ZellerBridget NolanAiden LuiMichael FortunatoEric FeldsteinMartin KafinaEvan R SchlossDaniel ElefantJi ChongChirag GandhiFawaz Al-MuftiPublished in: Cardiology in review (2024)
Central retinal artery occlusion (CRAO) is a rare and visually debilitating vascular condition characterized by sudden and severe vision loss. CRAO is a compelling target for intravenous alteplase (tPA) and endovascular mechanical thrombectomy (MT) due to pathophysiological similarities with acute ischemic stroke; however, the utility of these interventions in CRAO remains dubious due to limited sample sizes and potential risks. To assess usage and outcomes of tPA and MT in CRAO, we queried the National Inpatient Sample database using International Classification of Disease, Ninth and Tenth edition for patients with CRAO and acute ischemic stroke between 2010 and 2019. Our cohort of 5009 CRAO patients were younger with higher rates of obesity, hypertension, long-term anticoagulant use, and tobacco use compared to acute ischemic stroke patients. CRAO patients had lower rates of tPA administration (3.41% vs 6.21%) and endovascular MT (0.38% vs 1.31%) but fewer complications, including deep vein thrombosis, pneumonia, urinary tract infection, acute kidney injury, and acute myocardial infarction (all P < 0.01). CRAO patients had lower rates of poor functional outcome (31.74% vs 58.1%) and in-hospital mortality (1.2% vs 5.64%), but higher rates of profound blindness (9.24% vs 0.58%). A multivariate regression showed no relationship between tPA and MT and profound blindness, although the limited sample size of patients receiving interventions may have contributed to this apparent insignificance. Further investigation of larger patient cohorts and alternative treatment modalities could provide valuable insights for revascularization therapies in CRAO to optimize visual restoration and clinical outcomes.
Keyphrases
- acute ischemic stroke
- end stage renal disease
- chronic kidney disease
- acute myocardial infarction
- newly diagnosed
- ejection fraction
- acute kidney injury
- peritoneal dialysis
- machine learning
- adipose tissue
- mental health
- computed tomography
- percutaneous coronary intervention
- body mass index
- magnetic resonance imaging
- diabetic retinopathy
- insulin resistance
- optical coherence tomography
- deep learning
- high dose
- magnetic resonance
- venous thromboembolism
- brain injury
- palliative care
- patient reported outcomes
- aortic dissection
- coronary artery disease
- patient reported
- smoking cessation
- cerebral ischemia
- combination therapy