Tenecteplase for isolated central retinal artery occlusion secondary to internal carotid artery dissection: A case report

Central retinal artery occlusion (CRAO) is a blinding neuro-ophthalmologic emergency. Internal carotid artery dissection (ICAD) is a rare but underrecognized etiology of CRAO, frequently missed at initial presentation due to absence of pathognomonic clinical signs. While early intravenous thrombolysis confers benefit in CRAO, evidence for tenecteplase (TNK) in ICAD-associated cases remains exceedingly sparse. A 44-year-old previously healthy woman presented with isolated acute left CRAO after routine jogging. Intravenous TNK (0.25 mg/kg) administered within 3 h of onset achieved complete visual recovery the next day. Cervicocephalic vascular imaging confirmed left ICAD. Six-month follow-up after dual antiplatelet therapy demonstrated favorable recanalization, stable visual function, and no cerebral or ocular ischemic events occurred. This case suggests that intravenous TNK thrombolysis within the therapeutic window can yield favorable visual outcomes and acceptable safety in patients with ICAD-associated CRAO. For patients with acute visual loss occurring after exercise, ICAD must be actively suspected. Prompt cervicocephalic vascular etiological assessment alongside emergency care, delivered via multidisciplinary stroke pathways for improved long-term prognosis.