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Central Retinal Artery OcclusionPhase 3REVISIONNCT04965038

Early Reperfusion Therapy With Intravenous Thrombolysis for Recovery of VISION in Acute Central Retinal Artery Occlusion

A Phase 3 study testing Tenecteplase (until trial protocol V04: Alteplase) in people with Central Retinal Artery Occlusion, run by University Hospital Tuebingen at 1 site in Germany.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

Non-arteritic, thromboembolic central retinal artery occlusion (CRAO) is an acute neurovascular-ophthalmological emergency which leads to severe and permanent vision loss; no evidence-based therapy does exist. Two recent meta-analyses indicate early intravenous thrombolysis to be beneficial in CRAO. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Central Retinal Artery Occlusion
What is being tested?
Tenecteplase (until trial protocol V04: Alteplase)
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
127 participants
Where
1 siteGermany
Study dates
10 Oct 2022to 29 Apr 2026
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Acute non-arteritic CRAO (i.e. sudden, painless monocular vision loss) ≤ 12 hours after symptom onset confirmed by an experienced ophthalmologist through assessment of: BCVA, intraocular pressure, swinging flash light test (relative afferent pupil defect), slit-lamp biomicroscopy, fundoscopy, and OCT of the macula of both eyes* (*within the 4.5-hour time window: to be skipped if not feasible ≤ 10 minutes; beyond the 4.5-hour time window: mandatory)
  • BCVA of LogMAR ≥ 1.3 in the affected eye (functional blindness according to WHO ICD-11)
  • Reading must have been possible with the affected eye before CRAO (LogMAR ≤ 0.5)
  • Neurological examination performed by an experienced stroke neurologist
  • Brain imaging as per local standard for acute retinal ischemia/stroke assessment, either cranial computed tomography (CT) or cranial magnetic resonance imaging (MRI)

Who cannot join

  • Suspected giant cell arteritis
  • Other-than-CRAO cause of acute visual loss (e.g., retinal detachment, vitreous hemorrhage, acute glaucoma, acute optic neuritis)
  • BCVA of LogMAR < 1.3 or rapidly improving vision in the affected eye
  • Acute ischemic stroke with indication for on-label intravenous thrombolysis (IVT)
  • Any co-existing or terminal disease with anticipated life expectancy of < 3 months
  • Prior participation in the REVISION trial

Trial locations and contacts

1 site in 1 country.

Germany1 site
  • University Hospital Tuebingen

    Tübingen, 72076

Other trials in Germany

About this study

Non-arteritic, thromboembolic central retinal artery occlusion (CRAO) is an acute neurovascular-ophthalmological emergency which leads to severe and permanent vision loss; no evidence-based therapy does exist. Two recent meta-analyses indicate early intravenous thrombolysis to be beneficial in CRAO. Therefore, the REVISION randomized placebo-controlled interventional trial will investigate intravenous alteplase in CRAO as it is practiced in acute ischemic stroke, i.e. within 4.5 hours after symptom onset.

The REVISION observational study will evaluate retinal changes on optical coherence tomography (OCT) in patients within 12 hours of CRAO onset, and the REVISION substudy, which will be conducted adjunct to either the interventional or the observational study, will evaluate the value of the retrobulbar spot sign for prediction of outcome and treatment response.

Read the detailed description

Non-arteritic, thromboembolic central retinal artery occlusion (CRAO) is an acute neurovascular-ophthalmological emergency which leads to severe and permanent vision loss in the affected eye in ~ 95% of cases. Despite a variety of widely practiced "conservative standard treatments", such as hemodilution, ocular massage, and paracentesis, there is no evidence-based therapy for non-arteritic CRAO. Animal models have proven a limited ischemic tolerance of the retina with irreversible damage occurring within only four hours after disruption of blood flow. This is why rapid reperfusion represents THE logical therapeutic approach. Two recent meta-analyses indicate early intravenous thrombolysis to be beneficial in CRAO. Therefore, the REVISION trial will investigate intravenous alteplase in CRAO as it is practiced in acute ischemic stroke, i.e. within 4.5 hours after symptom onset.

Sequential evaluation by optical coherence tomography (OCT) will visualize dynamic ischemic changes of the retina during and after CRAO. The REVISION observational study will enroll patients within 12 hours of symptom onset and aims at comparing late time window retinal findings to early ischemic changes found in patients of the randomized REVISION interventional trial. Ultimately, OCT may become the preferred tool when it comes to assess retinal tissue viability in patients with an unknown CRAO onset (e.g. wake-up CRAO), and CRAO patients who present in an extended time window beyond 4.5 hours.

The REVISION substudy, which will be conducted adjunct to either the interventional or the observational study, will evaluate the value of the retrobulbar spot sign for prediction of outcome and treatment response.

Being tested
Tenecteplase (until trial protocol V04: Alteplase)
Keywords
Central Retinal Artery Occlusion, Thrombolysis, Alteplase
Medical subject headings
Retinal Artery Occlusion

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Tenecteplase (until trial protocol V04: Alteplase)Drug

    Intravenous thrombolysis within 4.5 hours of symptom onset

Study groups in NCT04965038
Study groupRoleWhat they receive
Thrombolysis (interventional study)Active comparatorTenecteplase (0.25 mg per kg body weight as bolus; until trial protocol V04: Alteplase [0.9 mg per kg body weight; 10% as bolus; remaining over one hour] will be administered intravenously within 4.5 hours of symptom onset
Receives: Drug: Tenecteplase (until trial protocol V04: Alteplase)
Placebo (interventional study)Placebo comparatorPlacebo (0.25 mg per kg body weight as bolus; until trial protocol V04: 0.9 mg per kg body weight; 10% as bolus; remaining over one hour) will be administered intravenously within 4.5 hours of symptom onset
Receives: Drug: Tenecteplase (until trial protocol V04: Alteplase)
Observational studyNo interventionThe prospective REVISION observational study will enroll patients within 12 hours of symptom onset

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Functional recovery at visit 3

    Functional recovery to best corrected visual acuity of logarithm of the minimum angle of resolution ≤ 0.5 in the affected eye, which corresponds to normal to mild vision impairment (intention-to-treat analysis).

    Measured: 30 days

Secondary outcomes (17)
  1. best corrected visual acuity (BCVA) at visits 2, 3, and 4

    Functional recovery to best corrected visual acuity of logarithm of the minimum angle of resolution ≤ 0.5 in the affected eye, which corresponds to normal to mild vision impairment (intention-to-treat and per-protocol analyses).

    Measured: 90 days

  2. Shift in visual outcome categories at visits 2, 3, and 4

    Shift in visual outcome categories: normal vision (logarithm of the minimum angle of resolution (LogMAR) ≤ 0), mild vision impairment (LogMAR > 0 and ≤ 0.5), moderate vision impairment (LogMAR > 0.5 and ≤ 1.0), severe vision impairment (LogMAR > 1.0 and ≤ 1.3), counting fingers (LogMAR > 1.3 and ≤ counting fingers), hand motion or light perception, and no light perception.

    Measured: 90 days

  3. Dichotomized analysis of visual outcome at visits 2, 3, and 4

    Dichotomized analysis of visual outcome: 'normal vision to moderate vision impairment' vs. 'severe vision impairment or functional blindness' and 'normal vision to severe vision impairment' vs. 'functional blindness'.

    Measured: 90 days

  4. Visual field at visits 3 and 4

    Kinetic visual field using III4e mark

    Measured: 90 days

  5. Central retinal artery recanalization at visits 2, 3, and 4

    Central retinal artery recanalization assessed using optical coherence tomography angiography (OCTA) of the optic nerve head and the macula.

    Measured: 90 days

  6. Retinal arterial perfusion at visits 3 and 4

    Retinal arterial perfusion assessed using fluorescein angiography.

    Measured: 90 days

  7. National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) at visits 3 and 4

    NEI-VFQ-25 for assessment of relevant visual impairment

    Measured: 90 days

  8. National Institutes of Health Stroke Scale (NIHSS) score at visit 2

    NIHSS for assessment of neurological deficits due to ischemic stroke or intracranial hemorrhage

    Measured: 72 hours

  9. Modified Rankin Scale (mRS) score at visits 3 and 4

    Dichotomized analysis and shift analyses of mRS (categories 0 - 1 (excellent outcome) vs. 2 - 6, 0 - 2 (functional independence) vs. 3 - 6, 0 - 3 (walking) vs. 4 - 6, and 0 - 4 vs. 5 - 6 (bedridden or death), and shift analysis)

    Measured: 90 days

  10. Fresh ischemic lesions on cranial magnetic resonance imaging (MRI) at visit 2

    Fraction of patients with and number of acute ischemic lesions on follow-up diffusion-weighted cranial MRI

    Measured: 72 hours

  11. Death at visits 3 and 4

    All-cause and stroke-related death

    Measured: 90 days

  12. Any intracranial hemorrhage (ICH) at visit 2

    Any ICH (except microhemorrhages) on follow-up magnetic resonance imaging; in case of missing follow-up brain imaging due to premature death, ICH will be replaced by "ICH or death without repeat scan")

    Measured: 72 hours

  13. Symptomatic intracranial hemorrhage (ICH) until visit 2

    Symptomatic ICH (as per ECASS III and Heidelberg bleeding classification) until follow-up magnetic resonance imaging; in case of missing follow-up brain imaging due to premature death, symptomatic ICH will be replaced by "symptomatic ICH or death without repeat scan")

    Measured: 72 hours

  14. Intraocular hemorrhage in the affected eye at visit 2

    Intraocular hemorrhage in the affected eye

    Measured: 72 hours

  15. Major bleeding until visit 2

    Major bleeding, defined as clinically overt bleeding associated with at least one of the following features: decrease in hemoglobin levels of ≥ 2 g/dL over 24 hours, bleeding requiring transfusion of ≥ 2 units of packed red cells, bleeding at a critical site (i.e., intracranial, intraspinal, intraocular, pericardial, intra-articular, intramuscular with compartment syndrome, or retroperitoneal), or bleeding resulting in the death of the patient

    Measured: 72 hours

  16. Retinal neovascularization requiring therapy at visit 3 and 4

    Retinal neovascularization requiring therapy

    Measured: 90 days

  17. (Serious) adverse events ((S)AE)

    AE until visit 2, serious AE and AE of special interest until visit 3 and 4

    Measured: 90 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Jul 2021
  2. Study start10 Oct 2022
  3. Primary completion23 Mar 2026
  4. Study completion29 Apr 2026

Why it stopped: Stopped after prespecified interim analysis due to futility

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
127 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04965038
Sponsor's protocol ID
2021-000183-29
Acronym
REVISION
Status last verified
Apr 2026
First submitted
15 Jun 2021
Last updated
18 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Poli S, Grohmann C, Wenzel DA, Poli K, Tunnerhoff J, Nedelmann M, Fiehler J, Burghaus I, Lehmann M, Glauch M, Schadwinkel HM, Kalmbach P, Zeller J, Peters T, Eschenfelder C, Agostini H, Campbell BC, Fischer MD, Sykora M, Mac Grory B, Feltgen N, Kowarik M, Seiffge D, Strbian D, Albrecht M, Alzureiqi MS, Auffarth G, Bazner H, Behnke S, Berberich A, Bode F, Bohmann FO, Cheng B, Czihal M, Danyel LA, Dimopoulos S, Pinhal Ferreira de Pinho JD, Fries FN, Gamulescu MA, Gekeler F, Gomez-Exposito A, Gumbinger C, Guthoff R, Hattenbach LO, Kellert L, Khoramnia R, Kohnen T, Kurten D, Lackner B, Laible M, Lee JI, Leithner C, Liegl R, Lochner P, Mackert M, Mbroh J, Muller S, Nagel S, Prasuhn M, Purrucker J, Reich A, Mundiyanapurath S, Royl G, Salchow DJ, Schafer JH, Schlachetzki F, Schmack I, Thomalla G, Tieck Fernandez MP, Wakili P, Walter P, Wolf A, Wolf M, Bartz-Schmidt KU, Schultheiss M, Spitzer MS. Early REperfusion therapy with intravenous alteplase for recovery of VISION in acute central retinal artery occlusion (REVISION): Study protocol of a phase III trial. Int J Stroke. 2024 Aug;19(7):823-829. doi: 10.1177/17474930241248516. Epub 2024 Jun 25.

    PubMed 38591748
  • Mac Grory B, Preterre C, Lebranchu P, Ryan SJ, Jorstad OK, Moe MC, Tunnerhoff J, Spitzer MS, Grohmann C, Dumitrascu OM, Biousse V, Guillon B, Aamodt AH, Poli S, Schrag M; Central Retinal ArterY OcclusioN (CRAYON) Collaborators. Intravenous thrombolysis for acute central retinal artery occlusion: Protocol for a systematic review and individual participant data meta-analysis of randomized controlled trials. PLoS One. 2026 Mar 10;21(3):e0342739. doi: 10.1371/journal.pone.0342739. eCollection 2026.

    PubMed 41805966

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Tenecteplase (until trial protocol V04: Alteplase) in people with Central Retinal Artery Occlusion, run by University Hospital Tuebingen at 1 site in Germany.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 18 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was stopped early (reason given: Stopped after prespecified interim analysis due to futility). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Functional recovery at visit 3 (time frame: 30 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04965038, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 May 2026.

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