ORIGINAL ARTICLE   

Minerva Medica 2024 April;115(2):151-61

DOI: 10.23736/S0026-4806.23.09093-6

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

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

Gianluca DE RUBEIS ¹ ✉, Simone ZILAHI DE GYURGYOKAI ², Sebastiano FABIANO ¹, Luca BERTACCINI ¹, Andrea WLDERK ¹, Francesca R. PEZZELLA ³, Sabrina ANTICOLI ³, Giuseppe BIONDI-ZOCCAI ^{4, 5}, Francesco VERSACI ⁴, Luca SABA ⁶, Enrico PAMPANA ¹

¹ Unit of Diagnostic and Interventional Neuroradiology, Department of Diagnostic, San Camillo-Forlanini Hospital, Rome, Italy; ² Department of Radiology, Santa Maria Goretti Hospital, Latina, Italy; ³ UOSD Stroke Unit, Emergency Department, S. Camillo-Forlanini Hospital, Rome, Italy; ⁴ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy; ⁵ Mediterranea Cardiocentro, Naples, Italy; ⁶ Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari, Monserrato, Cagliari, Italy; ⁷ Department of Medical Imaging, Cagliari-Polo di Monserrato University Hospital, Cagliari, Italy

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.

KEY WORDS: Acute kidney injury; Mechanical thrombectomy; Percutaneous coronary intervention; Saline solution