The effect of contrast agent used during vascular imaging and endovascular treatment on nephropathy and prognosis in acute stroke patients admitted to the emergency department

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aykaç ö., ozakin e., Ozdemir A. O., Karakılıç M. E., sezer eryıldız e.

Türk Beyin Damar Hastalıkları Dergisi, vol.29, no.2, pp.68-76, 2023 (Peer-Reviewed Journal) identifier


INTRODUCTION: The study investigated the incidence of contrast-induced nephropathy in patients with acute ischemic stroke who received recombinant tissue plasminogen activator (rt-PA) and/or endovascular therapy (EVT) after contrast-enhanced computed tomography (CT) angiography and identified potential risk factors for nephropathy. METHODS: A comparison was made between the groups who received and did not receive contrast material and who developed nephropathy and those who did not, regardless of the use of contrast. Binary logistic regression analysis was used to determine the risk factors for nephropathy. RESULTS: Of 421 patients, 291 (70.9%) were treated with IV rt-PA, and 119 (29%) received EVT. The number of patients receiving contrast media was 194 (75 in CTA and 119 in EVT). No relationship was found between the use of contrast media and the development of nephropathy (p=0.068) and no difference was found in terms of nephropathy between the treatment options (IV rt-PA/endovascular) (p=0.959). Mortality was higher (41.2% versus 15.7%; p<0.001) and mRS at 3rd months was worse (67.6 vs 46.5%; 25 p=0.018) in the group that developed nephropathy (41.2% versus 15.7%; p<0.001). The major risk factors for developing nephropathy in stroke patients were female gender, hemoglobin elevation, and high NIHS score at admission. DISCUSSION AND CONCLUSION: There is utility in obtaining baseline creatinine levels to identify patients at risk of contrast-associated acute kidney injury and to establish a diagnosis of contrast-associated acute kidney in patients with subsequent creatinine rises. However, contrast-requiring diagnostic imaging should not be delayed by waiting for the results of the baseline renal function.