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DE Rubeis G, Zilahi DE Gyurgyokai S, Fabiano S, Bertaccini L, Wlderk A, Pezzella FR, Anticoli S, Biondi-Zoccai G, Versaci F, Saba L, Pampana E. Intraprocedural continuous saline infusion lines significantly reduce the incidence of acute kidney injury during endovascular procedures for stroke and myocardial infarction: evidence from a systematic review and meta-regression. Minerva Med 2024; 115:151-161. [PMID: 38563606 DOI: 10.23736/s0026-4806.23.09093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Contrast media used in mechanical therapies for stroke and myocardial infarction represent a significant cause of acute kidney injury (AKI) in acute medical scenarios. Although the continuous saline infusion line (CSIL) is a standard procedure to prevent thrombus formation within the catheter during neurovascular interventions of mechanical thrombectomy (MT), it is not utilized in percutaneous coronary interventions (PCI). METHODS A systematic review of the incidence of AKI after MT for stroke treatment was performed. These data were compared with those reported in the literature regarding the incidence of AKI after PCI for acute myocardial infarction. A random-effect model meta-regression was performed to explore the effects of CSIL on AKI incidence, using clinical details as covariates. RESULTS A total of 18 and 33 studies on MT and PCI were included, respectively, with 69,464 patients (30,138 [43.4%] for MT and 39,326 [56.6%] for PCI). The mean age was 63.6 years±5.8 with male 66.6%±12.8. Chronic kidney disease ranged 2.0-50.3%. Diabetes prevalence spanned 11.1% to 53.0%. Smoking status had a prevalence of 7.5-72.0%. Incidence of AKI proved highly variable (I2=98%, Cochrane's Q 2985), and appeared significantly lower in the MT subgroup than in the PCI subgroups (respectively 8.3% [95% confidence interval: 4.7-11.9%] vs. 14.7 [12.6-16.8%], P<0.05). Meta-regression showed that CSIL was significantly associated with a decreased incidence of AKI (OR=0.93 [1.001-1.16]; P=0.03). CONCLUSIONS Implementation of CSIL during endovascular procedures in acute settings was associated with a significant decrease in the risk of AKI, and its safety should be routinely considered in such interventions.
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Affiliation(s)
- Gianluca DE Rubeis
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy -
| | | | - Sebastiano Fabiano
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Luca Bertaccini
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Andrea Wlderk
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
| | - Francesca R Pezzella
- UOSD Stroke Unit, Emergency Department, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Sabrina Anticoli
- UOSD Stroke Unit, Emergency Department, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Francesco Versaci
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari, Monserrato, Cagliari, Italy
| | - Enrico Pampana
- Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy
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Oliveira M, Rocha A, Barbosa F, Barros P, Fonseca L, Ribeiro M, Afreixo V, Gregório T. Acute kidney injury after endovascular therapy in acute stroke patients: systematic review with meta-analysis. J Neurointerv Surg 2023; 15:e468-e474. [PMID: 36797049 DOI: 10.1136/jnis-2022-019955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
AIMS Endovascular therapy (EVT) is a highly effective stroke treatment, but it requires the administration of contrast media which puts patients at risk of acute kidney injury (AKI). AKI is associated with increased morbidity and mortality in cardiovascular patients. METHODS PubMed, Scopus, ISI and the Cochrane Library were systematically searched for observational and experimental studies assessing the occurrence of AKI in adult acute stroke patients submitted to EVT. Two independent reviewers collected study data regarding study setting, period, source of data, and AKI definition and predictors, the outcomes of interest being AKI incidence and 90-day death or dependency (modified Rankin Scale score ≥3). These outcomes were pooled using random effect models, and heterogeneity was measured using the I2 statistic. RESULTS 22 studies were identified and included in the analysis, involving 32 034 patients. Pooled incidence of AKI was 7% (95% CI 5% to 10%), but heterogeneity was high across studies (I2=98%), and not accounted for by the definition of AKI used. The most frequently reported AKI predictors were impaired baseline renal function (5 studies) and diabetes (3 studies); 3 studies (2103 patients) reported data on death and 4 studies (2424 patients) reported data on dependency. Overall, AKI was associated with both outcomes, with ORs of 6.21 (95% CI 3.52 to 10.96) and 2.86 (95% CI 1.88 to 4.37), respectively. Heterogeneity was low for both analyses (I2=0%). CONCLUSIONS AKI affects 7% of acute stroke patients submitted to EVT and identifies a subgroup of patients for which treatment outcomes are suboptimal, with an increased risk of death and dependency.
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Affiliation(s)
- Marta Oliveira
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Ana Rocha
- Department of Medical Sciences, Universidade de Aveiro, Aveiro, Portugal
| | - Flávia Barbosa
- Department of Medical Sciences, Universidade de Aveiro, Aveiro, Portugal
| | - Pedro Barros
- Stroke Unit, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
- Neurology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
| | - Luísa Fonseca
- Stroke Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manuel Ribeiro
- Cerebrovascular Interventional Neuroradiology Unit, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
| | - Vera Afreixo
- Center for Research and Development in Mathematics and Applications, University of Aveiro, Aveiro, Portugal
| | - Tiago Gregório
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
- Stroke Unit, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
- MEDCIDS, Universidade do Porto Faculdade de Medicina, Porto, Portugal
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Lee JS, Hwang YH, Sohn SI. Factors Contributing to an Efficacious Endovascular Treatment for Acute Ischemic Stroke in Asian Population. Neurointervention 2021; 16:91-110. [PMID: 33765729 PMCID: PMC8261106 DOI: 10.5469/neuroint.2020.00339] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
Although randomized control trials about endovascular treatment (EVT) of emergent large vessel occlusion (LVO) have demonstrated the success of mechanical thrombectomy as the choice of treatment, a wide range of caveats remain unaddressed. Asian patients were rarely included in the trials, thereby raising the question of whether the treatment could be generalized. In addition, there remains a concern on the feasibility of the method with respect to its application against intracranial atherosclerosis (ICAS)-related LVO, frequently observed in the Asian population. It is important to include evidence on ICAS LVO from Asian countries in the future for a comprehensive understanding of LVO etiology. Besides the issues with EVT, prognostic concerns in diabetes patients, acute kidney injury following EVT, neuroprotective management against reperfusion injury, and other peri-EVT issues should be considered in clinical practice. In the current article, we present an in-depth review of the literature that revises information pertaining to such concerns.
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Affiliation(s)
- Jin Soo Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Hospital, Kyemyung University School of Medicine, Daegu, Korea
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Nozaki T, Noda M, Ishibashi T, Otani K, Kogiku M, Abe K, Kishi H, Morita A. Distal Vessel Imaging via Intra-arterial Flat Panel Detector CTA during Mechanical Thrombectomy. AJNR Am J Neuroradiol 2021; 42:306-312. [PMID: 33361373 DOI: 10.3174/ajnr.a6906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Obtaining information on invisible vasculature distal to the occlusion site helps to deploy a stent retriever safely during mechanical thrombectomy for large-vessel occlusion. It is essential to reduce the amount of contrast used for detecting the vessels distal to the occlusion site because acute ischemic stroke patients tend to have chronic kidney disease and patients with severe chronic kidney disease are at an increased risk of contrast-associated acute kidney injury. We assessed whether vessels distal to the occlusion site during acute ischemic stroke with large-vessel occlusion could be visualized on angiographic images using flat panel detector CT acquired following intra-arterial diluted contrast injection, compared with MRA findings. MATERIALS AND METHODS Between May 2019 and January 2020, we enrolled 28 consecutive patients with large-vessel occlusions of the anterior circulation eligible for mechanical thrombectomy following MR imaging. The patients underwent CBV imaging using flat panel detector CT with an intra-arterial diluted contrast injection instead of intravenous injection. Flat panel detector CT angiographic images reconstructed from the same dataset were evaluated for image quality, collateral status of the MCA territory, and visualization of the vessels distal to the occlusion site. These findings were compared with MRA findings. RESULTS Twenty-two patients were retrospectively examined. Flat panel detector CT angiographic image quality in 20 patients (91%) was excellent or good. The distal portion of the occluded vessel segment was visualized in 14 patients (70%), while the proximal portion of the segment adjacent to the occluded vessel in 3 (15%) was visualized. No visualization was observed in only 1 patient (5%) with no collateral supply. Flat panel detector CT angiographic images were shown to evaluate vessels distal to the occlusion site more accurately than MRA. CONCLUSIONS In acute ischemic stroke with large-vessel occlusion, flat panel detector CT angiographic images could successfully visualize vessels distal to the occlusion site with a small amount of contrast material.
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Affiliation(s)
- T Nozaki
- From the Department of Neurosurgery (T.N., M.N., M.K., K.A., H.K.), Yokohama Shin-Midori General Hospital, Kanagawa, Japan
- Department of Neurological Surgery (T.N., A.M.), Nippon Medical School Hospital, Tokyo, Japan
| | - M Noda
- From the Department of Neurosurgery (T.N., M.N., M.K., K.A., H.K.), Yokohama Shin-Midori General Hospital, Kanagawa, Japan
| | - T Ishibashi
- Department of Neurosurgery (T.I.), Jikei University School of Medicine, Tokyo, Japan
| | - K Otani
- Siemens Healthcare K.K. (K.O.), Tokyo, Japan
| | - M Kogiku
- From the Department of Neurosurgery (T.N., M.N., M.K., K.A., H.K.), Yokohama Shin-Midori General Hospital, Kanagawa, Japan
| | - K Abe
- From the Department of Neurosurgery (T.N., M.N., M.K., K.A., H.K.), Yokohama Shin-Midori General Hospital, Kanagawa, Japan
| | - H Kishi
- From the Department of Neurosurgery (T.N., M.N., M.K., K.A., H.K.), Yokohama Shin-Midori General Hospital, Kanagawa, Japan
| | - A Morita
- Department of Neurological Surgery (T.N., A.M.), Nippon Medical School Hospital, Tokyo, Japan
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Li X, Partovi S. Save the Brain First: CTA and Mechanical Thrombectomy in Patients at Risk for Contrast-Induced Nephropathy. AJNR Am J Neuroradiol 2020; 41:637-638. [PMID: 32217552 DOI: 10.3174/ajnr.a6515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/07/2022]
Affiliation(s)
- X Li
- Section of Interventional Radiology, Imaging InstituteCleveland Clinic FoundationCleveland, Ohio
| | - S Partovi
- Section of Interventional Radiology, Imaging InstituteCleveland Clinic FoundationCleveland, Ohio
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Myung JW, Kim JH, Cho J, Park I, Kim HY, Beom JH. Contrast-Induced Acute Kidney Injury in Radiologic Management of Acute Ischemic Stroke in the Emergency Setting. AJNR Am J Neuroradiol 2020; 41:632-636. [PMID: 32165364 DOI: 10.3174/ajnr.a6472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 02/05/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE The use of invasive cerebral angiography with CTA for active treatment of patients with suspected ischemic strokes has been increasing recently. This study aimed to identify the incidence of postcontrast acute kidney injury using baseline renal function when CTA and cerebral angiography were performed sequentially. MATERIALS AND METHODS This retrospective observational study evaluated adults (18 years of age or older) with ischemic stroke who underwent CTA and cerebral angiography sequentially between 2010 and 2018. The incidence of postcontrast acute kidney injury was determined using the baseline estimated glomerular filtration rate. The value of the baseline estimated glomerular filtration rate at which the occurrence of postcontrast acute kidney injury increased was also determined. RESULTS Postcontrast acute kidney injury occurred in 57/601 (9.5%) patients. Those with a baseline estimated glomerular filtration rate of <30 mL/min/1.73 m2 showed a higher incidence of acute kidney injury. Age, chronic kidney disease, medication (nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β blockers, statins, and insulin) use following contrast media exposure, and serum albumin affected the incidence of postcontrast acute kidney injury. The incidence of postcontrast acute kidney injury increased when the baseline estimated glomerular filtration rate was <43 mL/min/1.73 m2. CONCLUSIONS Patients with low baseline renal function had the highest incidence of postcontrast acute kidney injury after CTA and cerebral angiography, but no fatal adverse effects were documented. Thus, patients suspected of having a stroke should be actively managed with respect to neurovascular function.
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Affiliation(s)
- J W Myung
- From the Department of Emergency Medicine (J.W.M., J.H.K., J.C., I.P., J.H.B.)
| | - J H Kim
- From the Department of Emergency Medicine (J.W.M., J.H.K., J.C., I.P., J.H.B.)
| | - J Cho
- From the Department of Emergency Medicine (J.W.M., J.H.K., J.C., I.P., J.H.B.)
| | - I Park
- From the Department of Emergency Medicine (J.W.M., J.H.K., J.C., I.P., J.H.B.)
| | - H Y Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (H.Y.K.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J H Beom
- From the Department of Emergency Medicine (J.W.M., J.H.K., J.C., I.P., J.H.B.),
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Weber R, van Hal R, Stracke P, Hadisurya J, Nordmeyer H, Chapot R. Incidence of Acute Kidney Injury After Computed Tomography Angiography±Computed Tomography Perfusion Followed by Thrombectomy in Patients With Stroke Using a Postprocedural Hydration Protocol. J Am Heart Assoc 2020; 9:e014418. [PMID: 32067579 PMCID: PMC7070223 DOI: 10.1161/jaha.119.014418] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The risk of contrast-induced acute kidney injury (AKI) in patients with stroke receiving both computed tomography (CT) angiography and mechanical thrombectomy has been investigated only in small case series. No studies have investigated whether additional CT perfusion or chronic kidney disease (CKD) are associated with higher rates of AKI. Methods and Results Retrospective analysis of the AKI incidence in 1089 consecutive patients receiving CT angiography and mechanical thrombectomy from 2015 to 2017 and in subgroups with CKD (n=99) and CT perfusion (n=104) was performed. Patients received a standardized hydration protocol. Data on kidney function after mechanical thrombectomy were available in 1017 patients. A total of 59 (5.8%) patients developed AKI, and only 4 (6.8%) patients needed hemodialysis, all with known CKD. Patients with AKI significantly more often had known CKD (20.3% versus 8.4%, P=0.002), diabetes mellitus (33.9% versus 20.9%, P=0.018), and tandem occlusion (32.2% versus 16.2%, P=0.003) and a significantly higher in-hospital mortality (20.3% versus 7.0%, P<0.001) compared with patients without AKI. However, there were no significant independent predictors for AKI in multivariable logistic regression analysis. Sex (odds ratio [OR], 2.03; 95% CI, 1.17-3.52 [P=0.012]), higher National Institutes of Health Stroke Scale (OR, 1.10; 95% CI, 1.05-1.14 [P<0.001]), AKI (OR, 3.52; 95% CI, 1.63-7.64 [P=0.001]), diuretic use (OR, 1.80; 95% CI, 1.02-3.19), futile or incomplete recanalization (OR, 0.19; 95% CI, 0.09-0.40 [P<0.001]), and total volume of contrast agent volume (OR, 1.007; 95% CI, 1.002-1.011 [P=0.004]) were independently associated with in-hospital death. Two thirds of the patients with AKI died of severe brain damage and not AKI itself. Conclusions Post-contrast AKI rarely occurs in patients with stroke receiving a contrast agent for CT angiography/CT perfusion and subsequent mechanical thrombectomy. Patients with known CKD had higher rates of AKI and only these patients needed hemodialysis, but CKD was not independently associated with AKI or in-hospital mortality.
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Affiliation(s)
- Ralph Weber
- Department of Neurology Alfried Krupp Krankenhaus Essen Germany.,Faculty of Medicine Ruhr-University Bochum Germany
| | - Robert van Hal
- Department of Neurology Alfried Krupp Krankenhaus Essen Germany
| | - Paul Stracke
- Department of Neuroradiology Alfried Krupp Krankenhaus Essen Germany.,Faculty of Medicine University Hamburg Germany
| | | | - Hannes Nordmeyer
- Department of Neuroradiology Alfried Krupp Krankenhaus Essen Germany.,Faculty of Medicine University Witten-Herdecke Germany
| | - René Chapot
- Department of Neuroradiology Alfried Krupp Krankenhaus Essen Germany
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