%0 Journal Article
%T Computed Tomography Angiography before Intravenous Thrombolysis Does Not Increase the Risk of Renal Dysfunction
%A Pilar Sobrino Garc¨ªa
%A Andr¨¦s Garc¨ªa Pastor
%A Juan Pablo Cuello
%A Silvia Gil Navarro
%A Gema Vicente Peracho
%A Pedro Mar¨ªa Rodriguez Cruz
%A Javier Ricardo P¨¦rez S¨¢nchez
%A Fernando D¨ªaz Otero
%A Pilar V¨¢zquez Alen
%A Jose Antonio Villanueva Osorio
%A Antonio Gil Nu£¿ez
%J ISRN Stroke
%D 2013
%R 10.1155/2013/704526
%X Our aim is to determine whether computed tomography angiography (CTA) before intravenous thrombolysis (IVT) affects renal function in acute ischemic stroke (AIS) patients. We performed an observational analysis of AIS patients treated with IVT for three years. Patients were classified into 2 groups: those who underwent CTA (CTA-group) and those who did not (control-group). Differences in creatinine levels between baseline and 24¨C72 hours after IVT were calculated. Acute renal dysfunction (ARD) was defined as an increase in serum creatinine level of ¡Ý0.5£¿mg/dL and/or ¡Ý25% above baseline within 24¨C72 hours after IVT. 190 patients were treated with IVT. Renal function (before and after IVT) was assessed in 162 (115 in control-group; 47 in CTA-group). Nine patients (5.5%) developed ARD (2 (4.2%) in CTA-group and 7 (6.1%) in control-group; ). CTA was not associated with a higher risk of ARD and did not affect the efficacy or safety of IVT. Previous chronic renal insufficiency, baseline creatinine levels, and previous use of nonsteroidal anti-inflammatory drugs were associated with a significant increase in creatinine levels, independently of contrast use. In conclusion, CTA does not seem to increase the risk of renal dysfunction. This technique may be used safely without knowledge of baseline creatinine levels. 1. Introduction Computed tomography angiography (CTA) is commonly used in patients with acute ischemic stroke (AIS) to diagnose cerebral arterial occlusion before thrombolysis. This technique makes it possible to identify intracranial and extracranial vascular stenoses or occlusions, which are a relevant prognostic factor indicating intra-arterial interventions such as thrombolysis or mechanical thrombectomy [2¨C4]. Computed tomography perfusion (CTP) has proven useful for assessing the extent of brain ischemia and for identifying ¡°tissue at risk¡± that is potentially salvageable with recanalization. CTP also enables clinicians to optimize acute stroke therapy and to predict clinical outcome [5, 6]. The advantages of CTA and CTP over magnetic resonance-based techniques are that they are accessible in the emergency department, inexpensive, fast, and well tolerated. In addition, the spatial resolution of both techniques is high [6]. However, administration of nonionic contrast agents can lead to elevated serum creatinine levels, which are associated with poor outcome and increased mortality in patients with AIS [4, 7, 8], and contrast-induced nephropathy (CIN), which has been associated with higher morbidity and mortality in patients undergoing
%U http://www.hindawi.com/journals/isrn.stroke/2013/704526/