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Ischemic stroke
Original research
Cerebral angiographic features of central retinal artery occlusion patients treated with intra-arterial thrombolysis
  1. Jongshin Kim1,
  2. Seunguk Jung2,
  3. Kyu Hyung Park1,
  4. Se Joon Woo1,
  5. Cheolkyu Jung3
  1. 1 Ophthalmology, Seoul National University Bundang Hospital, Seongnam, The Republic of Korea
  2. 2 Neurology, Gyeongsang National University Changwon Hospital, Changwon, The Republic of Korea
  3. 3 Radiology, Seoul National University Bundang Hospital, Seongnam, The Republic of Korea
  1. Correspondence to Dr Cheolkyu Jung, Radiology, Seoul National University Bundang Hospital, Seongnam, The Republic of Korea; jck0097{at}gmail.com; Dr Se Joon Woo, Ophthalmology, Seoul National University Bundang Hospital, Seongnam, The Republic of Korea; sejoon1{at}snu.ac.kr

Abstract

Background Central retinal artery occlusion (CRAO) is an ischemic stroke of the eye. The atherosclerotic lesions in the intracranial segment of the carotid artery (CA) and the ophthalmic artery (OphA) are not well defined. We aimed to investigate the cerebral angiographic features of CRAO patients and assess the relationship between the angiographic features and outcomes after intra-arterial thrombolysis (IAT).

Methods We included 101 acute non-arteritic CRAO patients treated with IAT. We analyzed the detailed angiographic features of the OphA and ipsilateral CA, visual acuity, fundus photography, and fluorescein angiography.

Results Of the 101 patients, 38 patients (37.6%) had steno-occlusive lesions in the OphA, and 62 patients (61.4%) had atherosclerotic lesions in the ipsilateral CA. The patients with a higher degree of stenosis in the OphA showed a higher degree of stenosis (P=0.049) and a more severe morphology of plaque (P=0.000) in the ipsilateral CA. Additionally, although the visual outcome was not associated with these angiographic features, the lower degree of stenosis and less severe morphology of plaque in the ipsilateral CA resulted in a significant improvement in early reperfusion rate (P=0.018 and P=0.014, respectively) and arm-to-retina circulation (P=0.016 and P=0.002, respectively) of the eye after IAT.

Conclusions There was a significant correlation in the severity of steno-occlusive lesions between the OphA and the ipsilateral CA in patients with CRAO. The patients with less severe angiographic features in the CA showed a more improved retinal reperfusion after IAT. The angiographic findings in the CA may serve as a predictive marker for the vessel integrity of the OphA and recanalization outcome after IAT.

  • atherosclerosis
  • thrombolysis
  • artery
  • embolic
  • stroke

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/neurintsurg-2021-017767

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • JK and SJ contributed equally.

    • Contributors JK, SJ, SJW, and CJ designed the study. JK, SJ, KHP, SJW, and CJ collected and analyzed the data. JK, SJ, SJW, and CJ wrote and edited the manuscript. SJW and CJ directed and supervised the study. All authors read and approved the final manuscript.

    • Funding This study was supported by grants from the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (SJW: Grant No. 2018M3A9B5021319 and 2020R1F1A1072795), a grant from the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health and Welfare (SJW: Grant No. HI20C2092), and grants from the Seoul National University Bundang Hospital (SJW: Grant No. SNUBH‐13-2019-003; CJ: Grant No. SNUBH‐02-2012-067).

    • Competing interests KHP reported receiving personal fees from Allergan, Bayer, and Novartis and owning shares of Oculight, all of which are outside the submitted work. SJW reported receiving consulting fees from Samsung Bioepis, Curacle, Alteogen, Novelty Nobility, Allergan, Panolos Bioscience, Novartis, Janssen, and Philophos; lecture fees from Bayer, Novartis, Abbvie, and Alcon; grants from Samsung Bioepis, Alteogen, Curacle, Novelty Nobility, and Novartis; and owning shares of RetiMark and Panolos Bioscience, all of which are outside the submitted work.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.