Nonrenal Complications of Contrast Media

Marycz, Damien; Ziada, Khaled M.

doi:10.1016/j.iccl.2014.03.004

Cited by 1 publication

(1 citation statement)

References 34 publications

(32 reference statements)

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“…Mean age was 69 ± 15 years (range: 18-100). Median National Institute of Health Stroke Scale (NIHSS) at admission was 17 (Interquartile range or IQR [12][13][14][15][16][17][18][19][20][21].…”

Section: Resultsmentioning

confidence: 99%

Safety and Effectiveness of Neuro-thrombectomy on Single compared to Biplane Angiography Systems

Guenego

Mosimann²,

Wintermark

et al. 2020

Sci Rep

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An increasing number of centers not necessarily equipped with biplane (BP) angiosuites are performing mechanical thrombectomy (MT) in acute ischemic stroke patients. We assessed whether MT performed on single-plane (SP) is equivalent in terms of safety, effectiveness, radiation and contrast agent exposure. Consecutive patients treated by MT in four high volume centers between January 2014 and May 2017 were included. Demographic and MT characteristics were assessed and compared between SP and BP. Of 906 patients treated by MT, 576 (64%) were handled on a BP system. After multivariate analysis, contrast load and fluoroscopy duration were significantly lower in the BP group [100vs200mL, relative effect 0.85 (CI: 0.79-0.92), p = 0.0002; 22 vs 27 min, relative effect 0.84 (CI: 0.76-0.93), p = 0.0008, respectively]. There was no difference in recanalization (modified Thrombolysis-In-Cerebral-Infarction 2b-3), good clinical outcome (modified Rankin Scale 0-2), complications rates, procedure duration or radiation exposure. A three-vessel diagnostic angiogram performed prior to MT led to a significant increase in procedure duration (15% increase, p = 0.05), radiation exposure (33% increase, p < 0.0001) and contrast load (125% increase, p < 0.0001). Mechanical neuro-thrombectomy seems equally safe and effective on a single or biplane angiography system despite increased contrast load and fluoroscopy duration on the former. Multiple randomized controlled trials have demonstrated the benefits of cerebrovascular mechanical thrombectomy (MT) in acute ischemic stroke patients with emergent large vessel occlusion (AIS-ELVO) 1-6. Two further randomized trials evaluating late-onset strokes with favorable perfusion imaging 7,8 , have broadened its indications 9,10. Adequate training is necessary for these procedures, which are often more complicated than may be anticipated 11,12. Most neuro-interventionalists prefer working on biplane (BP) angiosuites since two simultaneous projections of the material and anatomical structures per contrast injection tends to reduce the risk of arterial perforation compared to single plane (SP) procedures 12,13. Nonetheless, X-ray and contrast agent exposure remain a major public health concern in terms of carcinogenesis 14-17 , risk of renal failure 18-20 or toxic reactions, respectively 21,22. Since an increasing number of centers are performing MT 12 in the context of ELVO without necessarily being equipped with BP angiosuites, there is a need to understand whether MT performed on SP is equivalent in terms of safety, effectiveness, radiation and contrast agent exposure 22 .

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