Objective:

We aim to better understand the effectiveness of revascularization therapies in central retinal artery occlusion (CRAO) patients compared to acute ischemic stroke (AIS) patients.

Background:

CRAO is a rare and visually debilitating vascular condition characterized by sudden and severe vision loss. Sharing pathological similarities with AIS, this condition is a compelling target for treatments such as intravenous alteplase (tPA) and endovascular mechanical thrombectomy (MT). However, there is a limited understanding of the utility of these interventions in CRAO.

Design/Methods:

To assess the usage and outcomes of tPA and MT in CRAO, we queried the National Inpatient Sample (NIS) database using International Classification of Disease Ninth and Tenth editions.

Results:

Between 2010 and 2019, the NIS database recorded 1,609,817 cases of AIS and 5009 cases of CRAO. Compared to AIS patients, CRAO patients were younger and had higher rates of obesity, hypertension, long-term anticoagulant use, and tobacco use. Our analysis revealed lower rates of tPA administration (3.41% vs. 6.21%) and endovascular MT (0.38% vs. 1.31%) in the CRAO group. Moreover, CRAO patients experienced fewer complications, including deep vein thrombosis, pneumonia, urinary tract infection, acute kidney injury, and acute myocardial infarction (all p < 0.01). Regarding clinical outcomes, CRAO patients exhibited lower rates of poor functional outcome (31.74% vs. 58.1%) and in-hospital mortality (1.2% vs. 5.64%), but higher occurrences of profound blindness (9.24% vs. 0.58%). A multivariate regression found no relationship between tPA and MT and profound blindness.

Conclusions:

CRAO is a rare vascular condition with fewer complications compared to AIS. The limited sample size of patients receiving interventions may have contributed to their apparent insignificance in protecting against profound blindness in the multivariate analysis. Future studies investigating larger patient cohorts and exploring alternative treatment modalities will be valuable to provide insights for optimizing visual restoration and enhancing outcomes in CRAO cases.