Préterre Cécile, Godeneche Gaelle, Vandamme Xavier, Ronzière Thomas, Lamy Matthias, Breuilly Christophe, Urbanczyk Cédric, Wolff Valérie, Lebranchu Pierre, Sevin-Allouet Mathieu, Guillon Benoit
1 Department of Neurology, CHU de Nantes - Laënnec Nantes, France.
2 Department of Neurology, CHG La Rochelle-Ré-Aunis, La Rochelle, France.
Int J Stroke. 2017 Oct;12(7):720-723. doi: 10.1177/1747493016687578. Epub 2017 Jan 9.
Background Although acute central retinal artery occlusion is as a stroke in the carotid territory (retinal artery), its management remains controversial. The aim of this study was to assess the feasibility and safety of intravenous thrombolysis delivered within 6 h of central retinal artery occlusion in French stroke units. Methods We performed a retrospective analysis of patients treated with intravenous alteplase (recombinant tissue-plasminogen activator), based on stroke units thrombolysis registers from June 2005 to June 2015, and we selected those who had acute central retinal artery occlusion. The feasibility was assessed by the ratio of patients that had received intravenous alteplase within 6 h after central retinal artery occlusion onset among those who had been admitted to the same hospital for acute central retinal artery occlusion. All adverse events were documented. Results Thirty patients were included. Visual acuity before treatment was limited to "hand motion", or worse, in 90% of the cases. The mean onset-to-needle time was 273 min. The individuals treated with intravenous alteplase for central retinal artery occlusion represented 10.2% of all of the patients hospitalized for central retinal artery occlusion in 2013 and 2014. We observed one occurrence of major bleeding, a symptomatic intracerebral hemorrhage. Conclusion When applied early on, intravenous thrombolysis appears to be feasible and safe, provided that contraindications are given due consideration. Whether intravenous thrombolysis is more effective than conservative therapy remains to be determined. In order to conduct a well-designed prospective randomized control trial, an organized network should be in place.
尽管急性视网膜中央动脉阻塞属于颈动脉区域（视网膜动脉）的卒中，但对其治疗仍存在争议。本研究旨在评估在法国卒中单元中，于视网膜中央动脉阻塞6小时内进行静脉溶栓治疗的可行性和安全性。方法：我们基于2005年6月至2015年6月卒中单元溶栓登记册，对接受静脉注射阿替普酶（重组组织型纤溶酶原激活剂）治疗的患者进行回顾性分析，并选取那些患有急性视网膜中央动脉阻塞的患者。通过在因急性视网膜中央动脉阻塞入住同一家医院的患者中，在视网膜中央动脉阻塞发作后6小时内接受静脉注射阿替普酶的患者比例来评估可行性。记录所有不良事件。结果：纳入30例患者。90%的病例治疗前视力限于“手动”或更差。平均从发病到用药时间为273分钟。2013年和2014年，接受静脉注射阿替普酶治疗视网膜中央动脉阻塞的患者占所有因视网膜中央动脉阻塞住院患者的10.2%。我们观察到1例严重出血，即有症状的脑出血。结论：早期应用时，静脉溶栓似乎是可行且安全的，前提是充分考虑禁忌证。静脉溶栓是否比保守治疗更有效仍有待确定。为了开展精心设计的前瞻性随机对照试验，应建立一个有组织的网络。
