Abstract Number: Esoc2026a51 Intravenous and Intra-Arterial Thrombolysis for Retinal Artery Occlusion

Abstract Background and aims Retinal artery occlusion (RAO) is a painless ocular ischemic stroke, causing sudden, often severe vision loss. With limited treatment options, the American Heart Association (AHA) recommends intravenous thrombolysis (IVT) within 4.5 hours or intra-arterial thrombolysis (IAT) within 6 hours of symptom onset. Here we describe clinical characteristics and management of patients diagnosed with acute RAO. Methods This retrospective study reviewed adult patients diagnosed with acute RAO from 2012 to September 2025 at a comprehensive stroke center. Patients with RAO were eligible for IVT within 4.5 hours or for IAT within 6.5 hours of symptom onset. Diagnosis was confirmed by ophthalmologic examination. Results 53 patients met inclusion criteria (35.8% branch RAO, 64.2% central RAO). Most (85%) presented outside the treatment window, had unknown time of onset, or were on DOAC. Among 8 treated, average time from symptom onset to diagnosis was 2.2+1.1 hours, and to treatment was 3.5+0.9 hours. Treatment included IV tPA (50.0%), IA tPA (25.0%), both IV tPA and IA tPA (12.5%), and IV TNK (12.5%). The most common mechanisms were significant ipsilateral carotid stenosis (28.3%) and atrial fibrillation (22.6%). Conclusions This retrospective analysis of patients with acute RAO reveals that the majority presented outside the therapeutic window, significantly limiting eligibility for intervention. In the small subset who received treatment, diagnosis and management were achieved promptly, within an average of 3.5 hours from symptom onset. These findings emphasize the need for heightened awareness, early recognition, and rapid triage to expand treatment opportunities and improve outcomes in acute RAO. Conflict of interest Jason Schick: nothing to disclose. Saad Umar: nothing to disclose. Carlos Santos: nothing to disclose. Emily Salacina: nothing to disclose. Muhammad Farooq: nothing to disclose. Ronel Santos: nothing to disclose. Aileen Antonio: nothing to disclose.