Central Retinal Artery Occlusion: Current Practice, Awareness and Prehospital Delays in Switzerland

Publication

Central Retinal Artery Occlusion: Current Practice, Awareness and Prehospital Delays in Switzerland

Journal Paper/Review - May 23, 2022

Ardila Jurado Elena, Niederhauser Julien, Bonvin Christophe, Mono Marie-Luise, Rodic Biljana, Tarnutzer Alexander A, Schwegler Guido, Salmen Stephan, Luft Andreas R, Peters Nils, Vehoff Jochen, Kägi Georg, Renaud Susanne, Schelosky Ludwig, Berger Christian, Sturm Veit, Brugger Florian, Nedeltchev Krassen, Arnold Marcel, Bonati Leo H, Carrera Emmanuel, Michel Patrik, Cereda Carlo W, Bolognese Manuel, Albert Sylvan, Medlin Friedrich, Swiss Stroke Registry Investigators

Citation

Ardila Jurado E, Niederhauser J, Bonvin C, Mono M, Rodic B, Tarnutzer A, Schwegler G, Salmen S, Luft A, Peters N, Vehoff J, Kägi G, Renaud S, Schelosky L, Berger C, Sturm V, Brugger F, Nedeltchev K, Arnold M, Bonati L, Carrera E, Michel P, Cereda C, Bolognese M, Albert S, Medlin F, Swiss Stroke Registry Investigators. Central Retinal Artery Occlusion: Current Practice, Awareness and Prehospital Delays in Switzerland. Front Neurol 2022; 13:888456.

Type

Journal Paper/Review (English)

Journal

Front Neurol 2022; 13

Publication Date

May 23, 2022

Issn Print

1664-2295

Pages

888456

Brief description/objective

Background and Purpose
Central retinal artery occlusion (CRAO) often leads to permanent monocular blindness. Hence, early recognition and rapid re-perfusion is of paramount importance. This study aims to describe prehospital pathways in CRAO compared to stroke and study the knowledge about CRAO.

Methods
(1) Description of baseline characteristics, prehospital pathways/delays, and acute treatment (thrombolysis/thrombectomy vs. standard of care) of patients with CRAO and ischemic stroke registered in the Swiss Stroke Registry. (2) Online survey about CRAO knowledge amongst population, general practitioners (GPs) and ophthalmologists in Eastern Switzerland.

Results
Three hundred and ninety seven CRAO and 32,816 ischemic stroke cases were registered from 2014 until 2019 in 20 Stroke Centers/Units in Switzerland. In CRAO, 25.6% arrived at the hospital within 4 h of symptom onset and had a lower rate of emergency referrals. Hence, the symptom-to-door time was significantly longer in CRAO compared to stroke (852 min. vs. 300 min). The thrombolysis/thrombectomy rate was 13.2% in CRAO and 30.9% in stroke. 28.6% of the surveyed population recognized CRAO-symptoms, 55.4% of which would present directly to the emergency department in contrast to 90.0% with stroke symptoms. Almost 100% of the ophthalmologist and general practitioners recognized CRAO as a medical emergency and 1/3 of them considered IV thrombolysis a potentially beneficial therapy.

Conclusions
CRAO awareness of the general population and physician awareness about the treatment options as well as the non-standardized prehospital organization, seems to be the main reason for the prehospital delays and impedes treating CRAO patients. Educational efforts should be undertaken to improve awareness about CRAO.