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Risk of contrast-induced nephropathy in patients undergoing endovascular treatment of acute ischemic stroke
  1. Jitendra Sharma1,
  2. Ashish Nanda2,
  3. Richard S Jung3,4,
  4. Sonal Mehta5,
  5. Javad Pooria4,
  6. Daniel P Hsu6
  1. 1Department of Neurology, Sanford Health Medical Center, University of South Dakota, Sioux Falls, South Dakota, USA
  2. 2Department of Neurology, University of Missouri, Columbia, Missouri, USA
  3. 3Department of Radiology, Neurological Institute, Cleveland, Ohio, USA
  4. 4Department of Diagnostic Radiology, University Hospitals Case Western Reserve University, Cleveland, Ohio, USA
  5. 5Department of Neurology, St. Louis University Hospital, St. Louis, Missouri, USA
  6. 6Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University Health Methodist Hospital, Indianapolis, Indiana, USA
  1. Correspondence to Dr Daniel P Hsu, Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd, Indianapolis, IN 46202, USA; dhsu{at}goodmancambell.com

Abstract

Background and purpose We report the incidence and risk factors for contrast-induced nephropathy after the use of iodinated contrast for endovascular treatment of acute ischemic stroke.

Methods A retrospective chart review was performed in 194 consecutive patients who underwent endovascular treatment for acute ischemic stroke between January 2006 and January 2011. No patients were excluded from treatment for elevated creatinine (Cr). Each patient received approximately 150 ml intra-arterial non-ionic low-osmolar contrast agent (Optiray 320) during the endovascular procedure. Contrast-induced nephropathy (CIN) was defined according to the Acute Kidney Injury Network criteria as a relative increase of serum Cr 50% above the baseline or an absolute increase of 0.3 mg/dl at 48 h following the endovascular procedure.

Results Of 194 patients (mean age 65±14 years), 52% were women (n=100) and 25% (n=48) were diabetic. Baseline Cr levels for 191 patients ranged between 0.4 and 2.7 mg/dl. Three patients on chronic hemodialysis had baseline Cr levels ranging between 5.3 and 6.1 mg/dl. Cr was ≤1.5 mg/dl in 163 patients (84%) and ≥ 1.5 mg/dl in 31 (16%). Three of the 191 patients (1.5%) developed CIN as noted from Cr measurements between baseline and within 48 h. One patient who developed an elevated Cr level had a known history of chronic renal insufficiency (Cr > 1.5 mg/dl) and two had baseline Cr levels within the normal range. An additional CT angiogram was obtained in 44 patients, none of which developed CIN. Female gender and diabetes were not associated with a higher risk of developing CIN.

Conclusions The risk of developing CIN is low among patients with acute stroke who undergo emergency endovascular treatment. Treatment of acute stroke should be performed irrespective of Cr levels.

  • Stroke
  • Intervention
  • Complication

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