A rapid but complete neuro-ophthalmologic assessment was performed, including fluorescein angiography and hematological evaluation yielding the diagnosis of CRAO, possibly embolic. No clinical or laboratory evidence was suggestive of giant cell arteritis. Because the diagnosis for this patient was obtained “hyperacutely”, close to the “golden window” of time for thrombolysis, cerebral angiography was performed by the interventional radiology service at UMDNJ-NJMS with the intention of using superselective arterial thrombolysis. At the time of angiography, carotid arterial evaluation before advancement of the catheter revealed no significant carotid stenosis or plaque that might increase the risk of further embolization or prevent catheter advancement. The patient was awake during the procedure and described a sudden improvement in her vision in the right eye after the ninth milligram of the continually infused TPA was administered. The infusion was discontinued after 10,000 units (ten milligrams).