Code Stroke Activation Following Cardiac Catheterization Procedures: Contrast-Induced Encephalopathy Versus Stroke

Area of Science:

• Neurology
• Cardiology
• Radiology

Background:

• Contrast-induced encephalopathy (CIE) is a rare complication of iodinated contrast media administration.
• CIE often presents with symptoms mimicking acute ischemic stroke (IS).
• The incidence of CIE following cardiac catheterization is not well-defined.

Purpose of the Study:

• To determine the incidence of CIE after cardiac catheterization.
• To characterize the clinical presentation, diagnostic features, and outcomes of CIE.
• To identify risk factors and propose management strategies for CIE.

Main Methods:

• A single-center retrospective cohort study of code stroke activations from January 2016 to December 2022.
• Reviewed 16 cases post-cardiac catheterization for CIE based on clinical, neuroimaging, and exclusion criteria.
• Diagnosis adjudicated by a stroke neurologist.

Main Results:

• Identified 2 cases of probable CIE among 34,760 coronary procedures, yielding an incidence of 0.006%.
• Both affected patients were elderly with hypertension, receiving <100 mL of contrast.
• Symptoms resolved completely within 24-48 hours with conservative management.

Conclusions:

• CIE is a rare but challenging diagnosis post-cardiac catheterization due to stroke-like symptoms.
• Hypertension and contrast volume are potential risk factors; early recognition and conservative management are key.
• Interdisciplinary awareness and integrated protocols can prevent misdiagnosis and inappropriate interventions, with CIE generally having an excellent prognosis.