Abstract:Background and Purpose
CT angiography (CTA) and conventional angiography provide timely vascular anatomical information in stroke patients. However, iodinated contrast dye may cause acute kidney injury (AKI). Within a large, biracial population, we examined in-hospital incidence of new or worsening kidney disease in stroke patients and its association with administration of intravenous (IV) dye.
Methods
All adult residents of the Greater Cincinnati/Northern Kentucky (GCNK) region with acute ischemic stroke (… Show more
“…21 In fact, the use of CM during imaging is the third most common trigger for iatrogenic acute kidney injury. Contrast-induced nephropathy (CIN) is a main cause of acute renal failure, occurring within 72 hours after the use of iodinated radiographic contrast material (CM).…”
Section: Discussionmentioning
confidence: 99%
“…Contrast-induced nephropathy (CIN) is a main cause of acute renal failure, occurring within 72 hours after the use of iodinated radiographic contrast material (CM). 21 In fact, the use of CM during imaging is the third most common trigger for iatrogenic acute kidney injury. 22 The pathophysiology of CIN is not fully understood, but it may be caused by direct tubular toxicity and renal ischemic injury.…”
Mechanical thrombectomy (MT) can significantly improve the prognosis of patients with large vessel occlusion (LVO) stroke. It is still unclear whether repeated MT in a short period of time is safe and effective in patients with renal failure and atrial fibrillation (AF). We present the case of an LVO patient with AF and uremia who was successfully treated with MT for M1 segment occlusion of the right middle cerebral artery (MCA) and achieved a good outcome. Fifteen days after the first MT, the patient's stroke recurred; angiography at that time revealed M1 segment, and branch occlusion of the right MCA, and a second MT was performed. This patient was given oral warfarin to maintain her international normalized ratio (INR) between 2 and 3, and over a 9-month follow-up period, no further vascular events occurred. It may be safe and effective to perform repeated MTs in patients with uremia and AF who have suffered two cardiogenic strokes in a short period of time. It might be beneficial to treat a patient of this description with anticoagulant therapy after careful assessment of the patient's condition. Nephrologists and medical staff at hemodialysis centers should recognize the importance of MT for patients with acute ischemic stroke (AIS). In this way, health care providers can take measures in a timely, effective manner when they encounter hemodialysis patients with AIS.
“…21 In fact, the use of CM during imaging is the third most common trigger for iatrogenic acute kidney injury. Contrast-induced nephropathy (CIN) is a main cause of acute renal failure, occurring within 72 hours after the use of iodinated radiographic contrast material (CM).…”
Section: Discussionmentioning
confidence: 99%
“…Contrast-induced nephropathy (CIN) is a main cause of acute renal failure, occurring within 72 hours after the use of iodinated radiographic contrast material (CM). 21 In fact, the use of CM during imaging is the third most common trigger for iatrogenic acute kidney injury. 22 The pathophysiology of CIN is not fully understood, but it may be caused by direct tubular toxicity and renal ischemic injury.…”
Mechanical thrombectomy (MT) can significantly improve the prognosis of patients with large vessel occlusion (LVO) stroke. It is still unclear whether repeated MT in a short period of time is safe and effective in patients with renal failure and atrial fibrillation (AF). We present the case of an LVO patient with AF and uremia who was successfully treated with MT for M1 segment occlusion of the right middle cerebral artery (MCA) and achieved a good outcome. Fifteen days after the first MT, the patient's stroke recurred; angiography at that time revealed M1 segment, and branch occlusion of the right MCA, and a second MT was performed. This patient was given oral warfarin to maintain her international normalized ratio (INR) between 2 and 3, and over a 9-month follow-up period, no further vascular events occurred. It may be safe and effective to perform repeated MTs in patients with uremia and AF who have suffered two cardiogenic strokes in a short period of time. It might be beneficial to treat a patient of this description with anticoagulant therapy after careful assessment of the patient's condition. Nephrologists and medical staff at hemodialysis centers should recognize the importance of MT for patients with acute ischemic stroke (AIS). In this way, health care providers can take measures in a timely, effective manner when they encounter hemodialysis patients with AIS.
“…Second, patients with reduced renal function (baseline eGFR \60 ml/min/ 1.73 m 2 ) were thrice as frequent among AKI developers compared to the rest of the cohort. Pre-existing CKD is a frequent finding among stroke patients [10], and this very fact is reasonable, given the high cardiovascular disease burden intrinsic to CKD per se. CKD stage 2 or higher is a well known major risk factor for cardiovascular diseases including stroke [11], and bears a worse post-stroke prognosis [12]; however, the causes of CKD are not fully ascertained based on the data presented by Wang et al [9].…”
mentioning
confidence: 96%
“…Patients with stroke are likely to be more prone to some specific forms of AKI, for example the one caused by mannitol toxicity [13]. Moreover, the potential toxicity of iodinated contrast media used for diagnostic, interventional and monitoring purposes, with the ensuing problem of radiocontrast-induced nephropathy, is to be underscored, although this issue is still highly debated [10,[14][15][16].…”
“…1,2 Analyses from a number of observational studies suggest that the risk of contrast-induced acute kidney injury (AKI) secondary to CTA/CTP imaging is relatively low in patients with AIS, particularly those with no history of renal impairment. [1][2][3] Apart from CTA/CTP, most patients with AIS, within the time window of recanalization, undergo intra-arterial thrombectomy, which is associated with exposure to additional iodinated contrast medium during DSA. [4][5][6][7][8] Because the potential risk from iodinated contrast exposure is proportional to the dose of contrast medium administered, multiple, consecutive doses of contrast medium could imply a greater risk for AKI.…”
Currently, CTA is the imaging technique most frequently used to evaluate acute ischemic stroke, and patients with intracranial large-vessel occlusion usually undergo endovascular treatment. This single-center, prospective, cohort study showed that consecutive, multidose use of contrast during CTA and DSA does not increase the incidence of acute kidney injury in patients with acute ischemic stroke, though acute kidney injury tended to have a higher incidence in the contrast multiexposure group (P ϭ .172).
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