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Reducing the delay in thrombolysis: is it necessary to await the results of renal function tests before computed

Manu Mehdiratta1, Gottfried Schlaug, Sandeep Kumar

  • 1Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. mmehdira@bidmc.harvard.edu

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|August 30, 2008
PubMed

Insights

Contrast agents are safe for most stroke patients. Only 8.4% of stroke patients were excluded due to renal function, and contrast-induced nephropathy occurred in only 3% of those receiving contrast.

Area of Science:

  • Neurology
  • Nephrology
  • Radiology

Background:

  • Code stroke protocols expedite evaluation and treatment for acute ischemic stroke.
  • Computed tomography angiography (CTA) and computed tomography perfusion (CTP) are crucial for stroke assessment.
  • Renal function is a key consideration for contrast agent administration in imaging.

Purpose of the Study:

  • To determine the proportion of code stroke patients excluded from CTA/CTP due to renal function.
  • To assess the incidence of contrast-induced nephropathy (CIN) in code stroke patients receiving contrast.

Main Methods:

  • Retrospective analysis of a prospective code stroke database.
  • Inclusion of 131 consecutive code stroke patients.
  • Evaluation of emergency department laboratory results (creatinine, glomerular filtration rate).

Main Results:

  • 8.4% of patients (11/131) would be excluded from contrast imaging based on creatinine > 1.5 mg/dL.
  • 91% of excluded patients (10/11) had a known history of renal disease.
  • 3% of patients who received contrast developed CIN.

Conclusions:

  • Contrast administration in code stroke patients without known renal disease appears safe prior to definitive renal function tests.
  • Pre-imaging renal function screening may exclude a small percentage of stroke patients.
  • The incidence of CIN in this cohort is low, supporting judicious contrast use.
Abstract

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