The effect of interventional thrombolytic therapy for central retinal artery occlusion with ipsilateral internal carotid artery occlusion via supratrochlear artery retrogradely or external carotid artery anterogradely_Chinese Journal of Ocular Fundus Diseases

Authors：

Lei Tao ,  Wang Runsheng , Li Yu , Li Juan , Wang Yi , Wang Junming , Yang Lijuan , Lyu Peilin , Du Shanshuang

Department of Neurology (Lei Tao, Li Yu, Li Juan), Department of Ophthalmology, [Wang Runsheng, Lyu Peilin (now working at the Department of Ophthalmology, The First Hospital of Xi’an), Du Shanshuang], Radiological Department (Wang Junming,Yang Lijuan), The Fourth Hospital of Xi’an, Xi’an 710004, China;

Corresponding author：

Wang Runsheng, Email: wangrunsheng0602@126.com

Keywords：

Retinal artery occlusion/drug therapy; Carotid stenosis/drug therapy; Thrombolytic therapy; Radiography, interventional; Angiography, digital subtraction; Fluorescein angiography

DOI：

10.3760/cma.j.issn.1005-1015.2018.03.005

Video：

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ObjectiveTo observe the effect of interventional thrombolytic therapy for central retinal artery occlusion (CRAO) with ipsilateral internal carotid artery occlusion via supratrochlear artery retrogradely or external carotid artery anterogradely.MethodsNine CRAO patients (9 eyes) were enrolled in this study, including 5 males and 4 females. The mean age was (45.2±18.1) years. The mean onset duration was 24 hours. There were 4 eyes with vision of no light perception, 3 eyes with light perception and 2 eyes with hand movement. Fundus fluorescein angiography (FFA) examination showed that the retinal artery was filled with delayed fluorescence. The peak of fluorescence was seen in the anterior part of the artery, and some of the eyes showed retrograde filling. The arm-retinal circulation time (A-Rct) was ≥35 s in 4 eyes, ≥35 s - ＜25 s in 5 eyes. The filling time of retinal artery and its branches (FT) was ≥15 s in 2 eyes, ≥12 s - ＜15 s in 3 eyes, ≥9 s - ＜12 s in 4 eyes. All the patients received the treatment of interventional thrombolytic therapy via supratrochlear artery retrogradely (8 eyes) or external carotid artery anterogradely (1 eye) according to the indications and contraindications of thrombolytic therapy in acute cerebral infraction patients. Urokinase (0.4 million U in total) was intermittently injected into the arteries. After artery thrombolysis, the changes of digital subtraction angiography (DSA), filling time of retinal artery and its branches on FFA within 24 hours and the visual acuity were observed. According to the A-Rct and FT on FFA, the therapeutic effects on retinal circulation were defined as effective markedly (A-Rct≤15 s, FT≤2 s) , effective (A-Rct was improved but in the range of 16 - 20 s, FT was in 3 - 8 s) and no effect (A-Rct was improved but ≥21 s, FT≥9 s). The related local or systemic complications were recorded.ResultsAfter the injection of urokinase into the catheter, the ophthalmic artery and its branches were increased in 6 eyes (66.7%), and the development of the eye ring was significantly more than that of the eyes before thrombolysis. The circulation time in ophthalmic artery was speeded up for 2 s before thrombolysis in 3 eyes, 3 s in 3 eyes, and 4 s in 2 eyes. Within 24 hours after thrombolysis treatment, the A-Rct was significantly decreased than that of before interventional therapy. The retinal circulation was effective markedly in 4 eyes (44.4%), effective in 4 eyes (44.4%) and no effect in 1 eyes (11.2%) . The vision was improved 3 lines in 4 eyes (44.4%), 2 lines in 3 eyes (33.3%), 1 line in 1 eye (11.2%) and no change in 1 eye (11.2%). There were no abnormal eye movements, vitreous hemorrhage and incision hematoma, intracranial hemorrhage, cerebral embolism, and other local and systemic adverse effectives during the follow-up.ConclusionsThe interventional thrombolytic therapy via supratrochlear artery retrogradely or external carotid artery anterogradely for CRAO with the ipsilateral internal carotid artery occlusion can improve retinal circulation and vision. There are no related local or systemic complications.

Citation： Lei Tao, Wang Runsheng, Li Yu, Li Juan, Wang Yi, Wang Junming, Yang Lijuan, Lyu Peilin, Du Shanshuang. The effect of interventional thrombolytic therapy for central retinal artery occlusion with ipsilateral internal carotid artery occlusion via supratrochlear artery retrogradely or external carotid artery anterogradely. Chinese Journal of Ocular Fundus Diseases, 2018, 34(3): 228-232. doi: 10.3760/cma.j.issn.1005-1015.2018.03.005 Copy

1.	雷涛,王润生,吕沛霖,等.缺血性脑血管病患者眼动脉及其主要分支的数字减影血管造影观察[J].中华眼底病杂志,2012,28(5):489-492.DOI:10.3760/cma.j.issn.1005-1015.2012.05.014.Lei T, Wang RS, Lyu PL, et al. Digital subtraction angiography characteristics of ophthalmic artery and its main branches in ischemic cerebrovascular disease[J]. Chin J Ocul Fundus Dis, 2012, 28(5):489-492. DOI:10.3760/cma.j.issn.1005-1015.2012.05.014.
2.	王润生,雷涛,王毅,等.超选择性眼动脉及选择性颈内动脉溶栓治疗视网膜中央动脉阻塞的疗效观察[J].中华眼底病杂志,2014,30(5):450-453.DOI:10.3760/cma.j.issn.1005-1015.2014.05.005.Wang RS, Lei T, Wang Y, et al. Super-selective ophthalmic artery or selective carotid artery t hrombolytic therapy for central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2014,30(5):450-453.DOI:10.3760/cma.j.issn.1005-1015.2014.05.005.
3.	王润生,钱露,王毅,等.眼动脉分支逆行介入溶栓治疗视网膜中央动脉阻塞疗效观察[J].中华眼底病杂志,2016,32(4):377-381.DOI:10.3760/cma.j.issn.1005-1015.2016.04.008.Wang RS, Qian L, Wang Y, et al.Ophthalmic artery branch retrograde interventional therapy for central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2016,32(4):377-381.DOI:10.3760/cma.j.issn.1005-1015.2016.04.008.
4.	罗树明,汪凯.脑血管病[M]//贾建平.神经病学.北京:人民卫生出版社,2010:182-183.Luo SM, Wang K. Cerebrovascular disease[M]//Jia JP.Neurology. Beijing:People's Medical Publishing House, 2010:182-183.
5.	王润生,吕沛霖,张娅萍,等.以尿激酶静脉溶栓为主治疗视网膜中央动脉阻塞115例临床疗效观察[J].中华眼底病杂志,2012,28(5):466-471.DOI:10.3760/cma.j.issn.1005-1015.2012.05.009.Wang RS, Lyu PL, Zhang YP, et al. Intravenous thrombolysis with urokinase for central retinal artery occlusion in 115 patients[J]. Chin J Ocul Fundus Dis, 2012,28(5):466-471. DOI:10.3760/cma.j.issn.1005-1015.2012.05.009.
6.	王润生,吕沛霖,王宾,等.视网膜中央动脉阻塞患者视网膜循环时间与中心视力损害的关系[J].中华眼底病杂志,2007,23(3):177-179.Wang RS, Lyu PL, Wang B, et al. Relationship between retinal circulation time and visual loss in patients with central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2007,23(3):177-179.
7.	潘为领,王学廷,冯丽,等. 256层CTA对颈动脉不同部位闭塞患者侧支循环的评价[J]. 实用放射学杂志,2014,30(9):1458-1461. DOI:10.3969/j.issn.1002-1671.2014.09.009.Pan WL, Wang XT, Feng L, et al. Diagnostic value of 256-slice CT angiography in collateral circulation about carotid artery different segment occlusion[J]. Journal of Practical Radiology, 2014,30(9):1458-1461. DOI:10.3969/j.issn.1002-1671.2014.09.009.
8.	Durst CR, Starke RM, Gaughen J, et al. Vision outcomes and major complications after endovascular coil embolization of ophthalmic segment aneurysms[J]. AJNR Am J Neuroradiol, 2014, 35(11):2140-2145. DOI: 10.3174/ajnr.A4032.
9.	Rouchaud A, Leclerc O, Benayoun Y, et al. Visual outcomes with flow-diverter stents covering the ophthalmic artery for treatment of internal carotid artery aneurysms[J]. AJNR Am J Neuroradiol, 2015, 36(2):330-336. DOI: 10.3174/ajnr.A4129.
10.	王润生, 李官禄, 王为农, 等.眼动脉逆行药物灌注术临床小结[J]. 中国实用眼科杂志, 2000, 18(4):223-224. DOI:10.3760/cma.j.issn.1006-4443.2000.04.012.Wang RS, Li GL, Wang WN, et al. Clinical observation on operation of drugs perfusion retrogracle into ophthalmol artery[J]. Chin J Pract Ophthalmo, 2000, 18(4):223-224. DOI:10.3760/cma.j.issn.1006-4443.2000.04.012.
11.	王润生, 李官禄, 王煊, 等.犬眶下动脉终末支逆行插管导药入眼实验研究[J]. 眼科新进展, 2000, 20(4):255-256. DOI:10.3969/j.issn.1003-5141.2000.04.006.Wang RS, Li GL, Wang X, et al.Experimental study of retrograde catheterization and administration of drugs into eyes through the infraorbital arteries in dogs[J]. Rec Adv Ophthalmol, 2000, 20(4):255-256. DOI:10.3969/j.issn.1003-5141.2000.04.006.
12.	Ahn JH, Cho YD, Kang HS, et al. Endovascular treatment of ophthalmic artery aneurysms: assessing balloon test occlusion and preservation of vision in coil embolization[J]. AJNR Am J Neuroradiol, 2014, 35(11):2146-2152. DOI: 10.3174/ajnr.A3999.
13.	Shaibani A, Khawar S, Bendok B, et al. Temporary balloon occlusion to test adequacy of collateral flow to the retina and tolerance for endovascular aneurysmal coiling[J]. AJNR Am J Neuroradiol, 2004, 25(8):1384-1386.
14.	刘华坤,张磊,刘朝来,等.介入分期开通症状性颈内动脉闭塞可行性临床研究[J]. 介入放射学杂志,2016,25（12）:1031-1034. DOI:10.3969/j.issn.1008-794X.2016.12.002.Liu HK, Zhang L, Liu ZL, et al. Clinical feasibility study of interventional staged revascularization for symptomatic internal carotid artery occlusion[J]. Journal of Interventional Radiology, 2016, 25(12):1031-1034. DOI:10.3969/j.issn.1008-794X.2016.12.002.

1. 雷涛,王润生,吕沛霖,等.缺血性脑血管病患者眼动脉及其主要分支的数字减影血管造影观察[J].中华眼底病杂志,2012,28(5):489-492.DOI:10.3760/cma.j.issn.1005-1015.2012.05.014.Lei T, Wang RS, Lyu PL, et al. Digital subtraction angiography characteristics of ophthalmic artery and its main branches in ischemic cerebrovascular disease[J]. Chin J Ocul Fundus Dis, 2012, 28(5):489-492. DOI:10.3760/cma.j.issn.1005-1015.2012.05.014.
2. 王润生,雷涛,王毅,等.超选择性眼动脉及选择性颈内动脉溶栓治疗视网膜中央动脉阻塞的疗效观察[J].中华眼底病杂志,2014,30(5):450-453.DOI:10.3760/cma.j.issn.1005-1015.2014.05.005.Wang RS, Lei T, Wang Y, et al. Super-selective ophthalmic artery or selective carotid artery t hrombolytic therapy for central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2014,30(5):450-453.DOI:10.3760/cma.j.issn.1005-1015.2014.05.005.
3. 王润生,钱露,王毅,等.眼动脉分支逆行介入溶栓治疗视网膜中央动脉阻塞疗效观察[J].中华眼底病杂志,2016,32(4):377-381.DOI:10.3760/cma.j.issn.1005-1015.2016.04.008.Wang RS, Qian L, Wang Y, et al.Ophthalmic artery branch retrograde interventional therapy for central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2016,32(4):377-381.DOI:10.3760/cma.j.issn.1005-1015.2016.04.008.
4. 罗树明,汪凯.脑血管病[M]//贾建平.神经病学.北京:人民卫生出版社,2010:182-183.Luo SM, Wang K. Cerebrovascular disease[M]//Jia JP.Neurology. Beijing:People's Medical Publishing House, 2010:182-183.
5. 王润生,吕沛霖,张娅萍,等.以尿激酶静脉溶栓为主治疗视网膜中央动脉阻塞115例临床疗效观察[J].中华眼底病杂志,2012,28(5):466-471.DOI:10.3760/cma.j.issn.1005-1015.2012.05.009.Wang RS, Lyu PL, Zhang YP, et al. Intravenous thrombolysis with urokinase for central retinal artery occlusion in 115 patients[J]. Chin J Ocul Fundus Dis, 2012,28(5):466-471. DOI:10.3760/cma.j.issn.1005-1015.2012.05.009.
6. 王润生,吕沛霖,王宾,等.视网膜中央动脉阻塞患者视网膜循环时间与中心视力损害的关系[J].中华眼底病杂志,2007,23(3):177-179.Wang RS, Lyu PL, Wang B, et al. Relationship between retinal circulation time and visual loss in patients with central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2007,23(3):177-179.
7. 潘为领,王学廷,冯丽,等. 256层CTA对颈动脉不同部位闭塞患者侧支循环的评价[J]. 实用放射学杂志,2014,30(9):1458-1461. DOI:10.3969/j.issn.1002-1671.2014.09.009.Pan WL, Wang XT, Feng L, et al. Diagnostic value of 256-slice CT angiography in collateral circulation about carotid artery different segment occlusion[J]. Journal of Practical Radiology, 2014,30(9):1458-1461. DOI:10.3969/j.issn.1002-1671.2014.09.009.
8. Durst CR, Starke RM, Gaughen J, et al. Vision outcomes and major complications after endovascular coil embolization of ophthalmic segment aneurysms[J]. AJNR Am J Neuroradiol, 2014, 35(11):2140-2145. DOI: 10.3174/ajnr.A4032.
9. Rouchaud A, Leclerc O, Benayoun Y, et al. Visual outcomes with flow-diverter stents covering the ophthalmic artery for treatment of internal carotid artery aneurysms[J]. AJNR Am J Neuroradiol, 2015, 36(2):330-336. DOI: 10.3174/ajnr.A4129.
10. 王润生, 李官禄, 王为农, 等.眼动脉逆行药物灌注术临床小结[J]. 中国实用眼科杂志, 2000, 18(4):223-224. DOI:10.3760/cma.j.issn.1006-4443.2000.04.012.Wang RS, Li GL, Wang WN, et al. Clinical observation on operation of drugs perfusion retrogracle into ophthalmol artery[J]. Chin J Pract Ophthalmo, 2000, 18(4):223-224. DOI:10.3760/cma.j.issn.1006-4443.2000.04.012.
11. 王润生, 李官禄, 王煊, 等.犬眶下动脉终末支逆行插管导药入眼实验研究[J]. 眼科新进展, 2000, 20(4):255-256. DOI:10.3969/j.issn.1003-5141.2000.04.006.Wang RS, Li GL, Wang X, et al.Experimental study of retrograde catheterization and administration of drugs into eyes through the infraorbital arteries in dogs[J]. Rec Adv Ophthalmol, 2000, 20(4):255-256. DOI:10.3969/j.issn.1003-5141.2000.04.006.
12. Ahn JH, Cho YD, Kang HS, et al. Endovascular treatment of ophthalmic artery aneurysms: assessing balloon test occlusion and preservation of vision in coil embolization[J]. AJNR Am J Neuroradiol, 2014, 35(11):2146-2152. DOI: 10.3174/ajnr.A3999.
13. Shaibani A, Khawar S, Bendok B, et al. Temporary balloon occlusion to test adequacy of collateral flow to the retina and tolerance for endovascular aneurysmal coiling[J]. AJNR Am J Neuroradiol, 2004, 25(8):1384-1386.
14. 刘华坤,张磊,刘朝来,等.介入分期开通症状性颈内动脉闭塞可行性临床研究[J]. 介入放射学杂志,2016,25（12）:1031-1034. DOI:10.3969/j.issn.1008-794X.2016.12.002.Liu HK, Zhang L, Liu ZL, et al. Clinical feasibility study of interventional staged revascularization for symptomatic internal carotid artery occlusion[J]. Journal of Interventional Radiology, 2016, 25(12):1031-1034. DOI:10.3969/j.issn.1008-794X.2016.12.002.

Chinese Journal of Ocular Fundus Diseases

The effect of interventional thrombolytic therapy for central retinal artery occlusion with ipsilateral internal carotid artery occlusion via supratrochlear artery retrogradely or external carotid artery anterogradely

Abstract Full text Figures/Tables Video References Cited by

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