Does Administration of IV Contrast Impact Outcomes on Acute Ischemic Stroke Patients? A Propensity Score Matched Single Center Study

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Conference Proceeding

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Introduction: The AHA/ASA strongly recommend urgent noninvasive vascular imaging for suspected LVO patients.1 There remains concern about developing acute kidney injury (AKI) and/or contrast induced nephropathy (CIN) secondary to contrast exposure for CTA or DSA.2-8 It is unclear if contrast has any impact upon outcomes of endovascular thrombectomy (ET) patients, and if this differs from patients who do not undergo ET. Methods: A retrospective chart review was conducted upon 2384 consecutive patients who were admitted with acute ischemic stroke from 1/2014-8/2017. Patients were grouped into: ET (CTA+DSA), CTA Only, and No Contrast. Propensity score matching (PSM) was conducted for a 1:1:1 match between these 3 groups. The primary outcome was 90-day modified rankin scal (mRS). Patients were grouped into favorable (mRS ≤ 2) and unfavorable (mRS > 2). AKI was defined as an increase in serum creatinine (SCr) ≥ 0.3 within 48 hours while CIN was defined as an increase in SCr ≥ 0.5 or 25% at 48-72 hours9. Results: 124 patients were matched into each group. Patients that received contrast had higher rates of AKI at 48-72 hours; however, this was not statistically significant (8% CTA+DSA, 5% CTA only, and 3% no contrast, p = 0.228). Patients with poor outcome amongst all groups had statistically significant higher rates of baseline CKD (37% vs 24%, p = 0.038) and AKI (22% vs 11%, p = 0.025). Multivariable analysis for the ET subgroup shows no significant difference in outcomes with or without AKI; however, in the non-ET subgroup, presence of AKI was significantly associated with poor outcome (OR 1.25 (0.36, 4.34) and 19.05 (2.13, 170.72), respectively; p < 0.05). Conclusion: Rates of AKI do not differ significantly based on the administration of contrast. In our PSM population, those not undergoing ET have poorer outcomes if they suffer AKI; however, there is no difference in outcomes if patients receive ET.



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