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  • Contrast conservation measures during the global iohexol contrast shortage crisis did not affect stroke thrombectomy outcomes

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Ischemic stroke
Original research
Contrast conservation measures during the global iohexol contrast shortage crisis did not affect stroke thrombectomy outcomes
  1. Eyad Almallouhi1,2,
  2. Mithun Sattur1,
  3. Orgest Lajthia1,
  4. Kimberly P Kicielinski1,
  5. Christine Holmstedt2,
  6. Jonathan R Lena1,
  7. Sami Al Kasab1,2,
  8. Alejandro M Spiotta1
  1. 1 Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2 Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
  1. Correspondence to Dr Alejandro M Spiotta, Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA; spiotta{at}musc.edu

Abstract

Background The current global shortage in iohexol contrast material (Omnipaque) used in performing CT-based triage images and mechanical thrombectomy (MT) represents a challenge to the healthcare system. A study was undertaken to assess the safety and feasibility of implementing protocol-based changes in pre-MT and MT workflow at a comprehensive stroke center.

Methods A retrospective cohort study was undertaken of all patients with stroke who underwent MT during a 3-week period before implementing the contrast shortage protocol and for 3 weeks while implementing the protocol. The contrast shortage protocol included not performing perfusion images for MT selection and using diluted iohexol (50% contrast mixed with 50% heparinized saline) during the MT procedure. Procedural variables were compared between the two groups.

Results A total of 27 patients underwent MT during the study period, 12 pre-contrast shortage and 15 post-contrast shortage. The average contrast volume used during the MT procedure was reduced from 83 mL to 68 mL after implementing the contrast shortage protocol (p=0.04). No difference was noted in the rate of successful reperfusion (11/15 vs 10/12), average time to recanalization (21 vs 23 min), average radiation dose (1143 vs 1117mGy) and time under fluoroscopy (20.7 vs 20.5 min) in the pre- and post-contrast shortage groups. A favorable discharge outcome was observed in 3/12 patients and 4/15 patients in the pre- and post-shortage periods, respectively (p=0.92).

Conclusions Modifying stroke workflow to adapt to the current global shortage in iohexol is feasible. Using diluted iohexol (50% contrast mixed with 50% heparinized saline) did not affect MT outcomes.

  • Stroke
  • Thrombectomy

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

https://doi.org/10.1136/jnis-2022-019210

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    Data availability statement

    The data that support the findings of this study are available from the corresponding author upon reasonable request.

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    Footnotes

    • Contributors EA: study design, drafting the manuscript, statistical analysis. MS: revising the manuscript critically for important intellectual content. OL: data collection. CH: revising the manuscript critically for important intellectual content. KPK: revising the manuscript critically for important intellectual content. JRL: revising the manuscript critically for important intellectual content. SA: revising the manuscript critically for important intellectual content. AMS: guaranator, study design, revising the manuscript critically for important intellectual content. All authors have approved this submission to JNIS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.