Safety of Computed Tomographic Angiography in the Evaluation of Patients With Acute Stroke

Abstract

Background and Purpose-Noncontrasted head computed tomography (NCHCT) has long been the standard of care for acute stroke imaging. New guidelines recommending advanced vascular imaging to identify eligible patients for endovascular therapy have renewed safety concerns on the use of contrast in the emergent setting without laboratory confirmation of renal function. Methods-We compared computed tomographic angiography (CTA) versus NCHCT alone during acute stroke evaluation with focus on renal safety and timeliness of therapy delivery. We reviewed data on all emergency department patients for whom the Acute Stroke Intervention Team was activated between December 2013 and September 2014. Primary outcomes included acute kidney injury and change in serum creatinine from presentation to 24 to 48 hours (Δ serum creatinine [Cr]). We assessed therapy delay using door-to-CT and door-to-needle times. Results-Of

Risk of Acute Kidney Injury with Consecutive, Multidose Use of Iodinated Contrast in Patients with Acute Ischemic Stroke

“…The Student t test or the Mann-Whitney U test (for unevenly distributed categoric variables) was used to identify the difference in continuous variables. The difference in each of the categoric variables between the 2 groups was tested using a 2 or Fisher exact test. Two-tailed P Ͻ .05 was considered statistically significant.…”

“…C TA and CTP are the most frequently used noninvasive vascular imaging techniques to evaluate acute ischemic stroke (AIS). 1,2 Analyses from a number of observational studies suggest that the risk of contrast-induced acute kidney injury (AKI) secondary to CTA/CTP imaging is relatively low in patients with AIS, particularly those with no history of renal impairment. [1][2][3] Apart from CTA/CTP, most patients with AIS, within the time window of recanalization, undergo intra-arterial thrombectomy, which is associated with exposure to additional iodinated contrast medium during DSA.…”

“…1,2 Analyses from a number of observational studies suggest that the risk of contrast-induced acute kidney injury (AKI) secondary to CTA/CTP imaging is relatively low in patients with AIS, particularly those with no history of renal impairment. [1][2][3] Apart from CTA/CTP, most patients with AIS, within the time window of recanalization, undergo intra-arterial thrombectomy, which is associated with exposure to additional iodinated contrast medium during DSA. [4][5][6][7][8] Because the potential risk from iodinated contrast exposure is proportional to the dose of contrast medium administered, multiple, consecutive doses of contrast medium could imply a greater risk for AKI.…”

Evaluation and Management of Atherosclerotic Carotid Stenosis

“…10 With the recent demonstration of the efficacy of mechanical thrombectomy for treating acute ischemic stroke in selected patients, 11 CTA is being used with greater frequency in the initial evaluation of patients. 12 Thus, patients with non-disabling stroke who are being considered for carotid revascularization may have a CTA available for review.…”

Acute kidney injury and stroke: unresolved issues

“…Patients with stroke are likely to be more prone to some specific forms of AKI, for example the one caused by mannitol toxicity [13]. Moreover, the potential toxicity of iodinated contrast media used for diagnostic, interventional and monitoring purposes, with the ensuing problem of radiocontrast-induced nephropathy, is to be underscored, although this issue is still highly debated [10,[14][15][16].…”