Abstract WP58: Telestroke Assessment Of Acute Monocular Visual Loss Fails To Routinely Diagnose Retinal Artery Occlusion And Recommend Thrombolytic Therapy

Introduction: Central retinal artery occlusion (CRAO) is a neurovascular emergency and acute monocular visual loss should trigger a stroke code activation. As thrombolytic therapy is considered for non-arteritic CRAO in the stroke therapeutic window, we aimed to review all telestroke encounters for acute visual loss in Mayo Clinic national telestroke network, focusing on the ocular diagnosis and the management recommendations. Hypothesis: patients evaluated via telestroke for acute visual loss are less likely to receive thrombolysis Methods: We conducted a retrospective review of the Mayo Clinic Arizona Telestroke/Teleneurology (2010-2017, 6364 encounters) and Mayo Clinic Enterprise Telestroke databases (2018-2020, 3147 encounters), searching for visits requested for acute visual loss. We recorded the subjects’ demographics, time from last seen normal to telestroke evaluation, preliminary diagnosis, and therapeutic/diagnostic recommendation. Results: From a total of 9511 audio-video telestroke encounters, 49 (0.51%) had an ocular diagnosis. Out of those, 6 patients (12.2%) had a provisional diagnosis of CRAO. 4/6 (66.6%) CRAO patients presented within 4.5h from symptom onset (median 2 hours) and none received thrombolytic therapy. All telestroke physicians recommended antiplatelet, ophthalmology consultation for diagnostic evaluation and comprehensive stroke work-up. Conclusions: Telestroke evaluations for CRAO, in routine practice, are less common than the disease prevalence would predict, suggesting that education is urgently mandated to increase the index of awareness. Even when CRAO subjects are evaluated via telestroke within 4.5 hours from symptom onset, they do not receive thrombolytic therapy nor timely ophthalmologic evaluation. Telestroke visits may benefit from the inclusion of tele-ophthalmologic consults to help with establishing the diagnosis in the narrow time-window of intravenous thrombolysis.