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Int J Stroke. 2015 Oct;10(7):1014-7. doi: 10.1111/ijs.12605. Epub 2015 Aug 26.

Multi-modal CT in acute stroke: wait for a serum creatinine before giving intravenous contrast? No!

Author information

1
Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.
2
Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
3
University of Newcastle, Newcastle, New South Wales, Australia.
4
Neurology, Monash Medical Centre, Melbourne, Victoria, Australia.
5
Monash University, Melbourne, Victoria, Australia.
6
Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
7
Royal Melbourne Hospital, Melbourne, Victoria, Australia.
8
University of Melbourne, Melbourne, Victoria, Australia.
9
The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.

Abstract

BACKGROUND:

Multi-modal CT (MMCT) to guide decision making for reperfusion treatment is increasingly used, but there remains a perceived risk of contrast-induced nephropathy (CIN). At our center, MMCT is used empirically without waiting for serum-creatinine (sCR) or renal profiling.

AIMS:

To determine the incidence of CIN, examine the risk factors predisposing to its development, and investigate its effects on clinical outcome in the acute stroke population.

METHODS:

An institution-wide protocol was implemented for acute stroke presentations to have MMCT (100-150 ml nonionic tri-iodinated contrast, perfusion CT and CT angiography) without waiting for serum-creatinine to minimize delays. Intravenous saline is routinely infused (80-125 ml/h) for at least 24-h after MMCT. Serial creatinine levels were measured at baseline, risk period, and follow-up. Renal profiles and clinical progress were reviewed up to 90 days.

RESULTS:

We analyzed 735 consecutive patients who had MMCT for the evaluation of acute ischemic or hemorrhagic stroke during the last five-years. A total of 623 patients met the inclusion criteria for analysis: 16 cases (2·6%) biochemically qualified as CIN; however, the risk period serum-creatinine for 15 of these cases was confounded by dehydration, urinary tract infection, or medications. None of the group had progression to chronic kidney disease or required dialysis.

CONCLUSIONS:

The incidence of CIN is low when MMCT is used routinely to assess acute stroke patients. In this population, CIN was a biochemical phenomenon that did not have clinical manifestations, cause chronic kidney disease, require dialysis, or negatively impact on 90-day mRS outcomes. Renal profiling and waiting for a baseline serum-creatinine are an unnecessary delay to emergency reperfusion treatment.

KEYWORDS:

CT angiography; acute stroke imaging; contrast nephropathy; multimodal CT perfusion; renal failure; stroke

PMID:
26306403
DOI:
10.1111/ijs.12605
[Indexed for MEDLINE]

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