Abstract Details

Title Effect of “Opt-out” CT-Angiography (CT-A) Protocol for Evaluation of Large Vessel Occlusion (LVO) in the Emergency Department on Incidence of Contrast-induced Acute Kidney Injury (CI-AKI) and Rate of Endovascular Therapy (EVT): Single Center Cohort Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S26 - Cerebrovascular Disease: Systems of Stroke Care (2:12 PM-2:24 PM)

Poster/Presentation
Number 007

Objective To examine incidence of CI-AKI using KDIGO (Kidney Disease: Improving Global Outcomes) criteria and rate of EVT before/after implementation of protocolized CT-A in evaluation of LVO in the emergency department.

Background Recent clinical trials demonstrated safety/efficacy of EVT for management of LVO. Screening for EVT candidates relies on clinical examination and CT-A. Using protocolized CT-A for EVT evaluation raises the question of CI-AKI risk.

Design/Methods “Stroke-alert” cases from 04/2017-06/2019 at our academic institution were reviewed as a cohort study with exposure groups defined as before/after implementation of protocolized CT-A. Our hypothesis was that there would be no difference in primary outcomes of AKI by KDIGO criteria at 6-48 hours and EVT within 24 hours. We also collected data on initial blood pressure, contrast dose, and co-morbidities, performing univariable analyses with unpaired-t, chi-squared/Fisher’s exact, and binomial tests.

Results

1059 stroke-alerts were reviewed; 647 met inclusion criteria (258/647, 39.8% pre-protocol; 389/647, 60.2% post-protocol) with no demographic differences.

There was an increase in contrast-exposure post-protocol (71.2% vs 30.6%, p<0.0001) with less average contrast administered (278.3±118.3 vs 329.4±116.8, milligrams, p=0.0008).

CKD patients were less likely than non-CKD patients to receive contrast post-protocol (55.8% vs 73.6%, p=0.0082) but more likely to receive contrast than pre-protocol CKD patients (55.8% vs 25.7%, p=0.0075).

There was an increased rate of EVT post-protocol (7.46%, 29/389 vs 4.26%, 11/258; p=0.0037) with no increase in incidence of CI-AKI (3.34%, 13/389 vs 1.73%, 5/289; p=0.2234).

Three risk factors for CI-AKI were identified: diabetes (10.6% vs 2.8%, p=0.029); contrast dose≥200mg (6.4% vs 2.5%, p=0.0151); contrast-exposure with initial MAP≥130 (11.9% vs 3.7%; p=0.0092).

Conclusions

Our data suggests an increased rate of EVT post-protocol with no significant risk of CI-AKI despite increased contrast-exposure rate, which could be explained by lower average contrast dose. Diabetes, contrast dose, and contrast-exposure with initial MAP≥130 were significant risk factors for CI-AKI.

Authors/Disclosures
Nathanael Lee, MD (Thomas Jefferson University) PRESENTER	No disclosure on file
Fred Rincon, MD (Thomas Jefferson University)	Dr. Rincon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for NeuroCrit, LLC. Dr. Rincon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for NeuroCrit, LLC.
Robin N. Dharia, MD	Dr. Dharia has nothing to disclose.

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