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Microcatheter contrast injections during intra-arterial thrombolysis may increase intracranial hemorrhage risk

Pooja Khatri1, Joseph P Broderick, Jane C Khoury

  • 1Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio 45267-0525, USA. pooja.khatri@uc.edu

Stroke
|September 6, 2008
PubMed

Insights

Microcatheter contrast injections (MCIs) during stroke treatment may increase the risk of intracranial hemorrhage (ICH). Minimizing MCIs during intra-arterial revascularization is recommended to reduce potential complications.

Area of Science:

  • Neurointerventional radiology
  • Cerebrovascular disease management
  • Stroke treatment outcomes

Background:

  • Intra-arterial revascularization for stroke utilizes contrast injections for visualization.
  • Neurointerventionalists exhibit variability in employing microcatheter contrast injections (MCIs).

Purpose of the Study:

  • To investigate whether MCIs are a risk factor for intracranial hemorrhage (ICH).
  • To assess the association between MCIs and ICH in patients receiving combined intravenous/intra-arterial therapy for stroke.

Main Methods:

  • Retrospective analysis of 98 arteriograms from the Interventional Management of Stroke (IMS) I and II trials.
  • Quantification of MCIs administered at or beyond the occlusion site.
  • Review of postprocedure CT scans for contrast extravasation and ICH, with specific definitions for each.

Main Results:

  • The overall rate of ICH was 58% in the studied IMS subset.
  • A higher number of MCIs was observed in patients with ICH (median 2 vs. 1, P=0.04).
  • MCIs demonstrated a significant association with increased ICH rates (P=0.03) and contrast extravasation, even in multivariable analysis.

Conclusions:

  • MCIs may pose a risk for ICH in stroke patients undergoing combined therapy, potentially due to contrast toxicity or pressure effects.
  • Minimizing the use of MCIs during intra-arterial revascularization is advised.
  • Prospective validation of these findings is planned for the IMS III trial.
Abstract

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