Background Combining non-contrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) imaging (referred to as a CT stroke study, CTSS) provides a rapid evaluation of the cerebrovascular axis during acute ischemic stroke. Iodinated contrast-enhanced CT imaging is not without risk, which includes renal injury. If a patient's CTSS identifies vascular pathology, digital subtraction angiography (DSA) is often performed within 24–48 h. Such patients may receive multiple administrations of iodinated contrast material over a short time period.
Objective We aimed to evaluate the incidence of acute kidney injury (AKI) in patients who underwent a CTSS and DSA for evaluation of acute ischemic symptoms or for stroke intervention within a 48 h period between August 2012 and December 2014.
Methods We identified 84 patients for inclusion in the analysis. Patients fell into one of two cohorts: AKI, defined as a rise in the serum creatinine level of ≥0.5 mg/dL from baseline, or non-AKI. Clinical parameters included pre- and post-imaging serum creatinine level, time between CTSS and DSA, and type of angiographic procedure (diagnostic vs intervention) performed.
Results Four patients (4.7%) experienced AKI, one of whom had baseline renal dysfunction (defined as baseline serum creatinine level ≥1.5 mg/dL). The mean difference between baseline and peak creatinine values was found to be significantly greater in patients with AKI than in non-AKI patients (1.65 vs −0.09, respectively; p=0.0008).
Conclusions This study provides preliminary evidence of the safety and feasibility of obtaining CTSS with additional DSA imaging, whether for diagnosis or intervention, to identify possible acute ischemic stroke.
- CT Angiography
- CT perfusion
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Contributors Conception and design: SAM, SLH, MCC. Data acquisition: all authors. Data interpretation: all authors. Drafting the manuscript: SAM, SLH, MCC. Critically revising the manuscript: all authors. Final approval of the manuscript: all authors.
Competing interests EIL: Shareholder/ownership interests: Intratech Medical, Blockade Medical, NeXtGen Biologics. Principal investigator: Covidien US SWIFT PRIME trials. Honoraria for training and lecturing: Covidien. Consultant: Pulsar, Blockade Medical. Other financial support: Abbott for carotid training for physicians. Advisory boards: Stryker, NeXtGen Biologics, MEDX. AHS: Grants: National Institutes of Health/NINDS/NIBIB, University at Buffalo (none related to present study). Financial interests: Hotspur, Intratech Medical, StimSox, Valor Medical, Blockade Medical, and Lazarus Effect. Consultant: Codman & Shurtleff, Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, Penumbra, Stryker, Pulsar Vascular, MicroVention, Lazarus Effect, Blockade Medical. Speakers’ bureau: Codman & Shurtleff. Speakers’ bureau: National Steering Committee–Penumbra 3D Separator Trial, Covidien SWIFT PRIME trial, MicroVention FRED trial. Advisory boards: Codman & Shurtleff, Covidien Neurovascular. Honoraria: Abbott Vascular, Codman & Shurtleff, Penumbra, Snyder, Boston Scientific. Research and stockholder: Cordis: research and financial interest; EndoTex: research and financial interest; Medtronic: research and consultant support; Abbott Vascular: research and consultant support; ev3: research and consultant support; Toshiba: research and consultant support; Micrus: research and consultant support and financial interest; Zimmer: research and consultant support; Access Closure: financial interest and stockholder; Niagara Gore Medical: stockholder; EPI: research and financial interest; Primus: financial interest; Guidant: research; Kerberos: research.
Ethics approval Ethics approval was received from the University at Buffalo Health Sciences Institutional Review Board (Project No. 735471-1).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data may be available for sharing on a per-request basis.
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