UK Stroke Forum 2025 | Current management pathways for central retinal artery occlusion and evidence for thrombolysis

I think standard stroke management pathways have really focused on larger strokes. There’s been very little focus on central retinal artery occlusion. Partly this is because we rarely get to see patients in a time window in which you can treat central retinal artery occlusion. But I guess the question is, what would be an option if someone presented within a time window? So looking at the studies that have been done to date, they’ve generally been small, using different treatments, different thrombolysis regimens. And there’s been some suggestion from single-center studies that there might be a benefit from thrombolysis given within a time window. But we now have three randomized controlled trials, one of which has been published, one of which was presented at the European Stroke Conference, and one of which will be published in a large number to look at what the effect of thrombolysis within four and a half hours will be for central retinal artery occlusion. There is a suggestion from the first study that’s now being published that actually there was no significant difference. But actually, this was probably slightly statistically underpowered. And from the second, with tenecteplase, really no significant difference. But I think we need to wait for the larger trial to publish their data, anticipating about 400 patients. So I think there’s still an opportunity for thrombolysis to have a role here, but I think it has to be within a time window and we need a bit more data.

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