Treatment of central retinal artery thrombus with superselective local intra-arterial fibrinolysis: A report of 20 cases

Objective: To investigate the treatment of endovascular intervene therapy in central retinal artery (CRA) thrombus, by combining with the references as to evaluating the possibility, the effectiveness, and the technology of local intra-arterial fibrinolysis. Methods: From January 1997 to July 2002, superselective local intra-arterial fibrinolysis were performed in 20 patients, including male 14, female 6, with an age range of 19 to 71 years old, averaging 46 years. The duration from onset of symptoms to fibrinolysis were 16 hours ≃ 28 days, with a mean time of 9 days. First, the patients were given an immediate cerebral angiography to localize the lesion sites. Then microcatheters were navigated to the lesions, and urokinase was administered locally through the microcatheters by the pump at a rate of 10 000 unit · ml^-1 · min^-1. The total dosage of UK was 180 000 to 1 million units. The average dosage was 700 000 units. Angiographys were performed repeatedly several times during the infusion of UK as to identifying whether the occluding vessels were recanalized or not. Results: After treatment, there appeared an instant effectiveness in 5 cases (25%), effective in 8 (40%), and uneffective in 7 (35%), with total effectiveness of 65%, Paralysis, dysphasia occurred in one patient who recovered after fibrinolysis. Conclusion: Superselective local intra-arterial fibrinolysis should be an effective treatment of CRA thrombus, resulting in high concentration of medicine to location of thrombus, good effectiveness, less doses, and less complications. The efficiency of this modality might be more improved by the accompanying accumulation of experiences, exploitation of the new type of medicine and application of the neural protection means.