Current knowledge and perspectives of contrast-induced neurotoxicity: A survey of Australian clinicians

Mariajoseph, Frederick P.; Lai, Leon T.; Moore, Justin; Chandra, Ronil V.; Goldschlager, Tony; Praeger, Adrian; Slater, Lee-Anne

doi:10.1016/j.jocn.2023.08.014

Cited by 4 publications

(1 citation statement)

References 21 publications

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“…A better understanding of the pathophysiology of CIN is essential to providing optimal care. A recent survey demonstrated that 75% of clinicians believed that the pathophysiology of CIN was poorly understood in the clinical setting [ 13 ]. CIN remains a poorly understood clinical entity, and there remains a lack of formalized diagnostic criteria.…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology of Contrast-Induced Neurotoxicity: A Narrative Review of Possible Mechanisms

Mariajoseph,

Lai,

Moore

et al. 2023

Eur Neurol

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Background: Contrast-induced neurotoxicity (CIN) is an increasingly observed event following the administration of iodinated contrast. It presents as a spectrum of neurological symptoms, that closely mimic ischaemic stroke, however, CIN remains poorly understood clinical phenomenon. An appreciation of underlying pathophysiological mechanisms is essential to improve clinical understanding and enhance decision making. Methods: A broad literature search of Medline (1946 to December 2022) and Embase (1947 to December 2022) was conducted. Articles discussing the pathophysiology of CIN were reviewed. Summary: Under normal circumstances, contrast agents do not pass the blood-brain barrier. Proposed mechanisms of CIN include blood-brain barrier (BBB) disruption due to factors including ischaemic stroke, uncontrolled hypertension, and possibly contrast agents themselves, amongst others. This is followed by passage of contrast agents across the BBB leading to chemotoxic sequelae of on neural tissue. Key Messages: This review provides a clinically-oriented review on the pathophysiology of CIN to enhance knowledge and improve decision making amongst clinicians.

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Section: Introductionmentioning

confidence: 99%

Pathophysiology of Contrast-Induced Neurotoxicity: A Narrative Review of Possible Mechanisms

Mariajoseph,

Lai,

Moore

et al. 2023

Eur Neurol

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Clinical management of contrast-induced neurotoxicity: a systematic review

Mariajoseph,

Chung,

Lai

et al. 2024

Acta Neurol Belg

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Background Contrast-induced neurotoxicity (CIN) is an increasingly recognised complication following endovascular procedures utilising contrast. It remains poorly understood with heterogenous clinical management strategies. The aim of this review was to identify commonly employed treatments for CIN to enhance clinical decision making. Methods A systematic search of Embase (1947–2022) and Medline (1946–2022) was conducted. Articles describing (i) patients with a clinical diagnosis of CIN, (ii) with radiological exclusion of other pathologies, (iii) detailed report of treatments, and (iv) discharge outcomes, were included. Data relating to demographics, procedure, symptoms, treatment and outcomes were extracted. Results A total of 73 patients were included, with a median age of 64 years. The most common procedures were cerebral angiography (42.5%) and coronary angiography (42.5%), and the median volume of contrast administered was 150 ml. The most common symptoms were cortical blindness (38.4%) and reduced consciousness (28.8%), and 84.9% of patients experienced complete resolution at the time of discharge. Management included intravenous fluids to dilute contrast in the cerebrovasculature (54.8%), corticosteroids to reduce blood–brain barrier damage (47.9%), antiseizure (16.4%) and sedative (16.4%) medications. Mannitol (13.7%) was also utilised to reduce cerebral oedema. Intensive care admission was required for 19.2% of patients. No statistically significant differences were observed between treatment and discharge outcomes. Conclusions The clinical management of CIN should be considered on a patient-by-patient basis, but may consist of aggressive fluid therapy alongside corticosteroids, as well as other supportive therapy as required. Further examination of CIN management is required to define best practice.

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Incidence of contrast-induced neurotoxicity following endovascular treatment of unruptured intracranial aneurysms: a single-centre cohort study

Mariajoseph,

Lai,

Moore

et al. 2024

Acta Neurol Belg

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Background Contrast-induced neurotoxicity (CIN) is a recognised complication of endovascular procedures and has been increasingly observed in recent years. Amongst other clinical gaps, the precise incidence of CIN is unclear, particularly following intracranial interventional procedures. Methods A retrospective study of consecutive patients undergoing elective endovascular treatment of unruptured intracranial aneurysms (UIAs) was performed. Patients with previously ruptured aneurysms were excluded. The primary aim of this study was to determine the incidence of CIN following endovascular UIA treatment. Our secondary aim was to isolate potential predictive factors for developing CIN. Results From 2017 to 2023, a total of 158 patients underwent endovascular UIA treatment, with a median age of 64 years (IQR: 54–72), and 70.3% of female sex. Over the study period, the crude incidence of CIN was 2.5% (95% CI: 0.7 – 6.4%). The most common clinical manifestation of CIN was confusion (75%) and seizures (50%). Statistical analysis was conducted, and prolonged procedural duration was found be significantly associated with developing CIN (OR 12.55; p = 0.030). Conclusion Clinicians should be aware of the risk of CIN following endovascular neurointervention, particularly following technically challenging cases resulting in prolonged procedural time.

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Current knowledge and perspectives of contrast-induced neurotoxicity: A survey of Australian clinicians

Cited by 4 publications

References 21 publications

Pathophysiology of Contrast-Induced Neurotoxicity: A Narrative Review of Possible Mechanisms

Pathophysiology of Contrast-Induced Neurotoxicity: A Narrative Review of Possible Mechanisms

Clinical management of contrast-induced neurotoxicity: a systematic review

Incidence of contrast-induced neurotoxicity following endovascular treatment of unruptured intracranial aneurysms: a single-centre cohort study

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