Abstract
Endovascular therapy is an alternative for the treatment of AIS resulting from large intracranial arterial occlusions that depends on the use of iodinated RCM. The risk of RCM-mediated AKI following endovascular therapy for AIS may be different from that following coronary interventions because patients may not have identical risk factors. All consecutive patients with large-vessel AIS undergoing endovascular therapy were prospectively recorded. We recorded the baseline kidney function, and RCM-AKI was assessed according to the AKIN criteria at 48 hours after RCM administration. We compared the rate of RCM-AKI 48 hours after the procedure and sought to determine whether any preexisting factors increased the risk of RCM-AKI. We identified 99 patients meeting inclusion criteria. The average volume of contrast was 189 ± 71 mL, and the average creatinine change was -4.6% at 48 hours postangiography. There were 3 patients with RCM-AKI. Although all 3 patients died as a result of their strokes, return to baseline creatinine levels occurred before death. There was a trend toward higher rates of premorbid diabetes mellitus, chronic renal insufficiency, preadmission statin and NSAID use, and a higher serum creatinine level on admission for the RCM-AKI group. The volume of procedural contrast was similar between groups (those with and those without RCM-AKI) (P = .5). In this small study, the rate of RCM-AKI following endovascular intervention for AIS was very low. A much larger study is required to determine its true incidence.
Highlights
AND PURPOSE: Endovascular therapy is an alternative for the treatment of AIS resulting from large intracranial arterial occlusions that depends on the use of iodinated RCM
There was a trend toward higher rates of premorbid diabetes mellitus, chronic renal insufficiency, preadmission statin and NSAID use, and a higher serum creatinine level on admission for the RCM-AKI group
Dr Saver is a scientific consultant for CoAxia, Concentric Medical, Talecris, Ferrer, AGA Medical, BrainsGate, PhotoThera, and Cygnis; has received lecture honoraria from Ferrer and Boehringer Ingelheim; has received support for clinical trials from Concentric Medical; and is a site investigator in multicenter trials sponsored by AGA Medical and the National Institutes of Health, for which the University of California Regents received payments based on the number of subjects enrolled
Summary
All consecutive patients with large-vessel AIS undergoing endovascular therapy were prospectively recorded. We recorded the baseline kidney function, and RCM-AKI was assessed according to the AKIN criteria at 48 hours after RCM administration. All consecutive patients undergoing endovascular therapy for acute ischemic stroke were prospectively entered into the data base of our institution from September 2002 to January 2008, according to protocol approved by our local institutional review board. All patients or their proxies gave written informed consent. We defined RCMAKI according to the AKIN criteria,[14] which is a relative increase of 50% or an absolute increase of 0.3 mg/dL (28.2 mol/L) in the serum creatinine level at 48 hours following angiography compared with the. We dichotomized the study cohort into those with and without RCM-AKI
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