Does administration of intravenous contrast impact outcomes upon large vessel occlusion patients undergoing intra-arterial therapy?
Shah K, Mayer SA, Kole MK, Marin HL, Schultz L, and Miller DJ. Does administration of intravenous contrast impact outcomes upon large vessel occlusion patients undergoing intra-arterial therapy? Interventional Neurology 2017; 6(Suppl 1):91.
Introduction: Recent guidelines published by the American Heart Association/American Stroke Association strongly recommend urgent noninvasive vascular imaging in patients eligible for intra-arterial therapy (IAT) who present with a suspected large vessel occlusion (LVO)1. CT Angiography (CTA) is typically the most expedient test; however, it requires administration of intravenous (IV) contrast. Additional contrast is administered if the patient undergoes digital subtraction angiography (DSA) for IAT. This has raised concerns about possible development of acute kidney injury (AKI) and/or contrast induced nephropathy (CIN)2-4. We sought to investigate what impact IV contrast had upon renal function and resultant outcomes of LVO patients undergoing IAT. Methods: A retrospective chart review was conducted upon 130 consecutive patients who underwent IAT for LVO from 1/2014-8/2017. Primary outcomes included discharge and 90-day modified rankin scales (mRS). Patients were grouped into favorable (mRS ≤2) and unfavorable (mRS >3). 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 hours5. Results: Of 130 patients (mean age 67.1 ± 16), 59 (45%) were males and 71 (55%) were females. At discharge, 30 (23%) had a favorable mRS. Of the 96 patients with 90-day follow-up available, 31 (32%) had a favorable mRS. A total of 12 patients (9%) suffered AKI while 4 patients (3%) suffered CIN during their admission; however, there was no significant difference in discharge outcomes (p = 0.203 and 0.791, respectively). Of the 96 patients with 90-day mRS, a total of 8 (8%) suffered AKI while 2 (2%) suffered CIN. Again, there was no significant difference in outcomes (p = 0.211 and 0.343, respectively). Conclusions: IAT is associated with AKI and/or CIN in a small percentage of our patients; however, there was no significant impact upon outcome.