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Incidence of radiocontrast nephropathy in patients undergoing acute stroke computed tomography angiography.

Krol AL, Dzialowski I, Roy J, Puetz V, Subramaniam S, Coutts SB, Demchuk AM

BACKGROUND AND PURPOSE: Minimal research has evaluated the renal safety of emergent computed tomography angiography (CTA) procedures, consecutive contrast medium application, and the long-term outcome in acute stroke patients. We investigated the incidence of contrast-induced renal impairment in these populations. METHODS: We retrospectively reviewed patients with acute stroke syndrome who received a CTA of the brain with or without the neck within 24 hours from onset of symptoms. All creatinine results and additional conventional angiography findings were recorded. With a positive history of renal disease, contrast administration was delayed until creatinine results were available. Radiocontrast nephropathy (RCN) was defined as a >/=25% increase in serum creatinine from the baseline value up to 5 days after CTA. RESULTS: Four hundred eighty-one patients were reviewed, and 224 met the inclusion criteria. There were 7 of 224 (3%) who fulfilled the criteria for RCN. A number of patients underwent emergent CTA without knowledge of their creatinine value; 2 of 93 (2%) developed RCN. There were 36 patients who received an additional digital subtraction angiogram, and none of these developed subsequent RCN. No patients required dialysis, and 9 of 68 (13%) had a >25% increase in their creatinine levels at a late (>30 days) follow-up. CONCLUSIONS: Overall, these results illustrate that there is a low incidence of RCN in acute stroke patients undergoing emergency CTA.

Published 31 July 2007 in Stroke, 38(8): 2364-6.
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