Abstract WP87: Renal Safety of Multimodal Brain Imaging Followed by Endovascular Therapy

Abstract

Introduction: Contrast-enhanced non-invasive angiography and perfusion imaging are recommended to identify eligible patients for endovascular therapy (EVT) in extended time windows (>6h or wake-up). If eligible, additional IA contrast exposure will occur during EVT. In this emergency setting, where the use of IV contrast often occurs prior to laboratory confirmation of renal function, renal safety concerns have been raised. Hypothesis: We hypothesized that in the DEFUSE 3 study population, patients who received additional IA contrast during EVT would not have evidence of acute contrast-associated kidney injury compared with the medical control group and that there would also be no differences in renal function between the CT perfusion and MR perfusion selected patients. Methods: In the randomized DEFUSE 3 trial population , we compared changes in serum creatinine between baseline (prior to randomization to EVT vs medial therapy) and 24 hours later. The primary outcome was the relative change in creatinine level between baseline and 24 hours in the EVT vs. medical arm. The secondary outcome was a comparison between CT vs. MRI selection in the EVT arm. Results: In the DEFUSE 3 population (n=182, age 69±13, 51% female), mean creatinine decreased from a baseline of 0.98±0.33 mg/dL to 0.88±0.28 mg/dL at 24 hours (p<0.001). There was no difference in change between treatment groups: absolute decrease -0.08±0.18 in EVT vs. -0.12±0.18 in medical, p=0.135; relative to baseline there was a 6.3% reduction in the EVT group vs. 9.2% in medical, p=0.294. Among patients treated with EVT, there was no difference in 24-hour creatinine level changes between patients who were selected with CTA/CTP (-0.08±0.18) vs. MRI (-0.07 ±0.19), p=0.808; or 6.8% reduction vs. 4.8%, p=0.700. The maximum increase in Cr in an EVT treated patient was 0.42 mg/dL in the CT group and 0.58 mg/dL in the MRI group. Conclusions: Perfusion imaging prior to EVT was not associated with evidence any decline in renal function.