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Risk of acute kidney injury associated with neuroimaging obtained during triage and treatment of patients with acute ischemic stroke symptoms
  1. Shelby L Hall1,2,
  2. Stephan A Munich1,2,
  3. Marshall C Cress1,2,
  4. Leonardo Rangel-Castilla1,2,
  5. Elad I Levy1,2,3,4,
  6. Kenneth V Snyder1,2,3,4,5,
  7. Adnan H Siddiqui1,2,3,4,6
  1. 1Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
  2. 2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
  3. 3Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
  4. 4Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
  5. 5Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
  6. 6Jacobs Institute, Buffalo, New York, USA
  1. Correspondence to Dr Adnan H Siddiqui, University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY 14203 USA; asiddiqui{at}


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.

  • Stroke
  • CT
  • CT Angiography
  • CT perfusion
  • Angiography

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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.