Intra-Arterial Iodinated Radiographic Contrast Material Injection Administration in a Rat Middle Cerebral Artery Occlusion and Reperfusion Model

Abstract

Background and Purpose Observations in human interventional stroke treatment led us to hypothesize that iodinated radiographic contrast material use may contribute to intracerebral hemorrhage. Effects of intra-arterial iodinated radiographic contrast material on hemorrhagic transformation after middle cerebral artery occlusion and reperfusion were studied in a placebo-controlled, blinded preclinical study in rats. Methods Four groups of male Sprague-Dawley rats were studied: saline group (n=8), contrast group (n=12), heparin group (n=9), and contrast+heparin group (n=9). The middle cerebral artery was occluded for 5 hours using suture placement. Heparin was infused before suture removal and reperfusion. Saline and/or contrast were infused immediately during reperfusion. Incidence, location, and size of hemorrhage were determined by brain necropsy inspection at 24 hours. Results There was a significant increase in incidence of cortical hemorrhage from control (37.5%), contrast (75.0%), heparin (77.8%) to contrast+heparin (100%; Cochran-Mantel-Haenszel correlation, P<0.01). Both pooled contrast groups (85.7%) and pooled heparin groups (88.9%) had higher rates of cortical intracerebral hemorrhage compared with the control group (P<0.05). Similar trends for increased cortical intracerebral hemorrhage were seen in the contrast-only (P=0.18) and heparin-only (P=0.18) groups. There was a trend for decreased infarct edema in rats receiving contrast versus those without (P=0.06). Conclusion Intraarterial iodinated radiographic contrast material may increase cortical intracerebral hemorrhage, similar to heparin. Iodinated radiographic contrast material effect may be additive to heparin effect on the incidence of cortical intracerebral hemorrhage.

Hyperattenuated Intracerebral Lesions after Mechanical Recanalization in Acute Stroke

“…Furthermore, in vitro studies indicate that the type of contrast media applied has an influence on the occurrence and extent of intracerebral hemorrhage. 16 However, our study cannot give further evidence in this regard, because low-osmolar, nonionic contrast was used consistently. Here, additional evaluation is needed.…”

Reperfusion Rates Following Intra-Arterial Thrombolysis for Acute Ischemic Stroke: The Influence of the Method for Alteplase Delivery

“…No more than 0.1-0.2 mL is required for adequate evaluation of the microcatheter position within the clot. Careful attention to alteplase infusion within the thrombus is underscored by a study suggesting that microcatheter injection may result in higher rates of hemorrhage, 9 which were not found in this study. A microwire maceration technique was sometimes used in conjunction with RMP.…”

Iodinated Contrast Media and Cerebral Hemorrhage After Intravenous Thrombolysis

“…16,17 A recent study in transient middle cerebral artery occlusion in rats reported that intra-arterial contrast administration, heparin administration, and coadministration of heparin and contrast significantly increased the incidence of cortical hemorrhage compared with control. 18 It should be noted that our retrospective cohort of patients is very different from those enrolled in the IMS trials. In the IMS studies, the median NIHSS score at admission was higher.…”