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

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

doi:10.3389/fneur.2022.888456

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

Front Neurol. 2022 May 23:13:888456. doi: 10.3389/fneur.2022.888456. eCollection 2022.

Authors

Elena Ardila Jurado¹, Veit Sturm², Florian Brugger¹, Krassen Nedeltchev³, Marcel Arnold⁴, Leo H Bonati⁵, Emmanuel Carrera⁶, Patrik Michel⁷, Carlo W Cereda⁸, Manuel Bolognese⁹, Sylvan Albert¹⁰, Friedrich Medlin¹¹, Christian Berger¹², Ludwig Schelosky¹³, Susanne Renaud¹⁴, Julien Niederhauser¹⁵, Christophe Bonvin¹⁶, Marie-Luise Mono¹⁷, Biljana Rodic¹⁸, Alexander A Tarnutzer¹⁹, Guido Schwegler²⁰, Stephan Salmen²¹, Andreas R Luft^{22

23}, Nils Peters²⁴, Jochen Vehoff¹, Georg Kägi^{1

4}; Swiss Stroke Registry Investigators

Affiliations

¹ Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
² Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
³ Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland.
⁴ Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁵ Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
⁶ Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
⁷ Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland.
⁸ Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland.
⁹ Neurocenter, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
¹⁰ Cantonal Hospital Graubuenden, Chur, Switzerland.
¹¹ Stroke Unit, Cantonal Hospital Fribourg, Fribourg, Switzerland.
¹² Spital Sarganserland Grabs, Grabs, Switzerland.
¹³ Division of Neurology, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland.
¹⁴ Division of Neurology, Cantonal Hospital Neuchatel, Neuchâtel, Switzerland.
¹⁵ Stroke Unit, Groupement Hospitalier de l'Ouest Lémanique, Nyon, Switzerland.
¹⁶ Hôpital du Valais, Sion, Switzerland.
¹⁷ Stadtspital Waid und Triemli, Zurich, Switzerland.
¹⁸ Cantonal Hospital Winterthur, Winterthur, Switzerland.
¹⁹ Cantonal Hospital of Baden, Baden, Switzerland.
²⁰ Division of Neurology, Hospital Limmattal, Schlieren, Switzerland.
²¹ Spitalzentrum Biel, Biel, Switzerland.
²² Department of Neurology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
²³ Cereneo Center for Neurology and Rehabilitaiton, Vitznau, Switzerland.
²⁴ Department of Neurology, Hirslanden Clinic, Zurich, Switzerland.

Abstract

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.

Keywords: awareness; central retinal artery occlusion (CRAO); incidence; ischemic stroke; prehospital.

Copyright © 2022 Ardila Jurado, Sturm, Brugger, Nedeltchev, Arnold, Bonati, Carrera, Michel, Cereda, Bolognese, Albert, Medlin, Berger, Schelosky, Renaud, Niederhauser, Bonvin, Mono, Rodic, Tarnutzer, Schwegler, Salmen, Luft, Peters, Vehoff, Kägi and the Swiss Stroke Registry Investigators.