TENecteplase in Central Retinal Artery Occlusion Stuy (TenCRAOS)

  • End date
    Jan 31, 2024
  • participants needed
  • sponsor
    Oslo University Hospital
Updated on 15 March 2021


TENecteplase in Central Retinal Artery Occlusion (TenCRAOS): A Prospective, randomized-controlled, double-dummy, double-blind phase 3 multi-centre trial of TNK 0.25 mg/kg + placebo vs. ASA + placebo (2 arms with 1:1 block randomization).

A Prospective, randomized-controlled, double-dummy, double-blind phase 3 multi-centre trial of TNK 0.25 mg/kg + placebo vs. ASA + placebo (2 arms with 1:1 block randomization). At all participating centers, ophthalmologists are involved in the diagnosis and visual outcome measurements using a standardized protocol. The patients will be promptly examined by the ophthalmologist. As soon as the CRAO is diagnosed by the ophthalmologist, the patients will be managed in the stroke unit during treatment, monitoring, and medical investigations. After treatment in the stroke unit, the patients will be re-examined by an ophthalmologist and a neurologist as an out-patient at (30 5) and 90 (15) days


Central retinal artery occlusion (CRAO) is an ophthalmologic emergency that, without prompt revascularization, bears high risk of permanent blindness. The condition is typically the result of an artery-to-artery embolism from a carotid plaque or cardio embolism. A recent meta-analysis of observational data indicates that prompt revascularization with systemic thrombolysis might improve outcome. A randomized controlled trial of early systemic thrombolysis for CRAO is therefore warranted. The aim of this project is to assess the effect of systemic tissue plasminogen activator tenecteplase versus placebo administered within 4.5 hours of CRAO onset in patients admitted to the participating hospitals in Europe. The main endpoint is the proportion of patients with 0.7 logMAR visual acuity 30 (5) days after treatment, representing an improvement in visual acuity of at least 0.3 logMAR, equal to at least 15 letters/three lines on a visual acuity chart. In addition, we will access differences in visual field parameters and patient reported outcome measures between the groups. This study is based on a broad collaboration and interaction between leading ophthalmologists and neurologists in European centres.

Condition Retinal Artery Occlusion
Treatment Intravenous injection of Tenecteplase and one dose of placebo tablet, One tablet of Acetylsalicylic Acid and one dose of IV placebo
Clinical Study IdentifierNCT04526951
SponsorOslo University Hospital
Last Modified on15 March 2021


Yes No Not Sure

Inclusion Criteria

Non-arteritic central retinal artery occlusion with 1.0 logMAR visual acuitiy and symptoms lasting less than 4.5 hours
Ability to administer the Investigator Medicinal Product (IMP) within 4.5 hours of symptom onset
Age 18 years
Informed written consent of the patient
A woman of childbearing potential (WOCBP) must confirm that in her opinion, she cannot be pregnant, OR if there is a possibility that she is pregnant, a negative pregnancy test must be confirmed before any IMP is given

Exclusion Criteria

No other active intervention targeting CRAO
Branch retinal artery occlusion, cilioretinal artery supplying the macula, combined arterial-venous occlusion, proliferative diabetic retinopathy, elevated intraocular pressure (> 30 mmHg) or clinical suspicion of ophthalmic artery occlusion occlusion (e.g. choroidal nonperfusion, absence of cherry red spot, no light perception)
Systemic diseases; severe general diseases, systemic arterial hypertension (blood pressure >185/110 mmHg), despite medical therapy, or clinical suspicion of acute systemic inflammation
Presence of intracranial haemorrhage on brain MRI/CT
Medical history: heart attack within the last 6 weeks, intracerebral bleeding or neurosurgical operation within the last 4 weeks, therapy with anticoagulation, allergic reaction to contrast agent, hemorrhagic diathesis, aneurysms, inflammatory vascular diseases (eg, giant cell arteritis, granulomatosis with polyangitis), endocarditis, or gastric ulcer
No willingness and ability of the patient to participate in all follow-up examinations
Pregnancy (if suspicion of pregnancy s-hCG or u-hCG must be negative)
Allergy or intolerance to any ingredients of IMP or placebo or gentamicin
Other conditions / circumstances likely to lead to poor treatment adherence (eg, history of poor compliance, alcohol or drug dependency, no fixed abode)
Significant bleeding disorder either at present or within the past 6 months
Effective oral anticoagulant treatment, eg, warfarin sodium (INR >1.3)
Effective anticoagulant treatment with heparin or low molecular weight heparin the last 48 hours
Any history of central nervous system damage (ie, neoplasm, aneurysm, intracranial or spinal surgery)
Known hemorrhagic diathesis
Major surgery, biopsy of a parenchymal organ, or significant trauma within the past 2 months (this includes any trauma associated with acute myocardial infarction)
Recent non-compressible vessel puncture within 2 weeks
Recent trauma to the head or cranium
Prolonged cardiopulmonary resuscitation (>2 minutes) within the past 2 weeks
Acute pericarditis and/or subacute bacterial endocarditis
Acute pancreatitis
Severe hepatic dysfunction, including hepatic failure, cirrhosis, portal hypertension (oesophageal varices) and active hepatitis
Active peptic ulceration
Arterial aneurysm and known arterial/venous malformation
Neoplasm with increased bleeding risk
Any known history of hemorrhagic stroke or stroke of unknown origin
Known history of ischemic stroke or transient ischemic attack in the preceding 3 months
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