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(Stroke. 2007;38:2364.)
© 2007 American Heart Association, Inc.

Research Letters

Incidence of Radiocontrast Nephropathy in Patients Undergoing Acute Stroke Computed Tomography Angiography

Andrea L. Krol, BSc; Imanuel Dzialowski, MD; Jayanta Roy, MD; Volker Puetz, MD; Suresh Subramaniam, MD; Shelagh B. Coutts, MD Andrew M. Demchuk, MD

From the Seaman Family MR Research Centre (A.L.K., I.D., J.R., V.P., S.S., S.B.C., A.M.D.), Foothills Medical Centre, Calgary Health Region, and the Department of Clinical Neurosciences (V.P., S.S., S.B.C., A.M.D.), University of Calgary, Canada; the Department of Neurology (I.D.), University of Dresden, Germany; and the National Neurosciences Center (J.R.), Kolkata, India.

Correspondence to Dr Andrew Demchuk, Seaman Family MR Centre, Foothills Hospital, 1403 29th St NW, Calgary, Alberta T2N 2T9, Canada. E-mail ademchuk{at}ucalgary.ca

Abstract

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.

Key Words: CT angiography • digital subtraction angiography • radiocontrast nephropathy • renal impairment