PT  - JOURNAL ARTICLE
AU  - Shelby L Hall
AU  - Stephan A Munich
AU  - Marshall C Cress
AU  - Leonardo Rangel-Castilla
AU  - Elad I Levy
AU  - Kenneth V Snyder
AU  - Adnan H Siddiqui
TI  - Risk of acute kidney injury associated with neuroimaging obtained during triage and treatment of patients with acute ischemic stroke symptoms
AID  - 10.1136/neurintsurg-2015-012118
DP  - 2016 Dec 01
TA  - Journal of NeuroInterventional Surgery
PG  - 1231--1234
VI  - 8
IP  - 12
4099  - http://jnis.bmj.com/content/8/12/1231.short
4100  - http://jnis.bmj.com/content/8/12/1231.full
SO  - J NeuroIntervent Surg2016 Dec 01; 8
AB  - 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.