Incidence of Radiocontrast Nephropathy in Patients Undergoing Acute Stroke Computed Tomography Angiography

Abstract

Background and Purpose-Minimal research has evaluated the renal safety of emergent computed tomography angiography (CTA) procedures, consecutive contrast medium application, and the long-term outcome in acute stroke patients. We investigated the incidence of contrast-induced renal impairment in these populations. Methods-We retrospectively reviewed patients with acute stroke syndrome who received a CTA of the brain with or without the neck within 24 hours from onset of symptoms. All creatinine results and additional conventional angiography findings were recorded. With a positive history of renal disease, contrast administration was delayed until creatinine results were available. Radiocontrast nephropathy (RCN) was defined as a Ն25% increase in serum creatinine from the baseline value up to 5 days after CTA. Results-Four hundred eighty-one patients were reviewed, and 224 met the inclusion criteria. There were 7 of 224 (3%) who fulfilled the criteria for RCN. A number of patients underwent emergent CTA without knowledge of their creatinine value; 2 of 93 (2%) developed RCN. There were 36 patients who received an additional digital subtraction angiogram, and none of these developed subsequent RCN. No patients required dialysis, and 9 of 68 (13%) had a Ͼ25% increase in their creatinine levels at a late (Ͼ30 days) follow-up. Conclusions-Overall, these results illustrate that there is a low incidence of RCN in acute stroke patients undergoing emergency CTA. Key Words: CT angiography Ⅲ digital subtraction angiography Ⅲ radiocontrast nephropathy Ⅲ renal impairment C omputed tomography (CT) bolus techniques have the advantage of minimizing treatment delays but require the use of a nonionic contrast agent. One apprehension surrounding these techniques is the concern of causing radiocontrast nephropathy (RCN). RCN is defined as an increase in the serum creatinine value by Ͼ25% occurring within 3 days after the administration of contrast medium. 1 First, the time from stroke onset to thrombolysis treatment is strongly associated with subsequent outcome in acute stroke. 2 In acute stroke when time is critical, treatment delay due to waiting for a creatinine result is not desirable. 3 Only 1 study has examined the rate of RCN in patients with unknown baseline creatinine levels. 4 Second, it is known that the risk for RCN is proportional to the dose of radiocontrast medium administered. [5][6][7] It has been suggested that multiple, consecutive procedures requiring the use of contrast medium application implies a greater risk for RCN. 8 There have been no large studies examining the safety of consecutive contrast media application in acute stroke for CT angiography (CTA) and digital subtraction angiography (DSA).Third, the long-term outcome in patients undergoing radiocontrast application is unknown. Although serum creatinine levels may return to baseline shortly after receiving contrast medium, some patients may encounter permanent renal sequelae requiring additional medical care. 9 This study sought to determine the freque...

Prolonged Carotid Sinus Reflex Is a Risk Factor for Contrast-Induced Nephropathy following Carotid Artery Stenting

“…While CIN has been reported to occur mainly in association with coronary procedures, several studies have described the incidence of CIN after CTA, CTP, and catheter intervention in patients with stroke. [24][25][26][27][28][29][30] CIN occurred in 3% of cases (7/224) within 5 days in patients with acute stroke syndrome who underwent CTA within 24 hours from the onset of symptoms. 24 With the use of CTA and CTP to guide emergency management of acute stroke, CIN occurred in 2.9% of 175 patients within 72 hours.…”

“…[24][25][26][27][28][29][30] CIN occurred in 3% of cases (7/224) within 5 days in patients with acute stroke syndrome who underwent CTA within 24 hours from the onset of symptoms. 24 With the use of CTA and CTP to guide emergency management of acute stroke, CIN occurred in 2.9% of 175 patients within 72 hours. 26 In our study, CIN developed in 8.8% of patients, a rate higher than that in these reports, despite adequate fluid replacement beginning preoperatively to prevent renal sequelae.…”

Active extravasation of contrast within the hemorrhage (spot sign): a multidetector computed tomography finding that predicts growth and a worse prognosis in non-traumatic intracerebral hemorrhage

“…The use of this technique is supported by the current literature 4,[6][7][8][9] . Delgado-Almandoz et al 4,15 defined CTA-SI parameters appropriate for the diagnosis of the spot sign within ICH.…”

“…This imaging sign has also been reproduced on MDCT angiography as a robust predictor of expansion and as an indicator of worse prognosis and mortality 3,4 . MDCT angiography has been proven to be a rapid and reproducible alternative to catheter angiography that reduces the risks to the enrolled patients and offers significant benefits to the decision-making process [6][7][8][9] . A higher incidence of hemorrhagic stroke has been repor ted in the Latin American population [10][11][12][13] .…”

Multimodal Diagnostic Imaging for Hyperacute Stroke

“…62 Multiple studies have demonstrated that administration of a contrast-enhanced protocol involving CTA/ CTP and DSA in select patients does not appear to increase the incidence of contrast-induced nephropathy. 63,64 The risk of contrast-induced nephropathy is overestimated, and a significant proportion of transient creatinine elevation is due to expected fluctuation and underlying disease. 65 Hence the concern regarding the need to verify renal function before administering iodinated contrast in the acute stroke setting is overstated.…”