Krol Andrea L, Dzialowski Imanuel, Roy Jayanta, Puetz Volker, Subramaniam Suresh, Coutts Shelagh B, Demchuk Andrew M
Stroke. 2007 Aug;38(8):2364-6. doi: 10.1161/STROKEAHA.107.482778. Epub 2007 Jun 28.
Minimal research has evaluated the renal safety of emergent computed tomography angiography (CTA) procedures, consecutive contrast medium application, and the long-term outcome in acute stroke patients. We investigated the incidence of contrast-induced renal impairment in these populations.
We retrospectively reviewed patients with acute stroke syndrome who received a CTA of the brain with or without the neck within 24 hours from onset of symptoms. All creatinine results and additional conventional angiography findings were recorded. With a positive history of renal disease, contrast administration was delayed until creatinine results were available. Radiocontrast nephropathy (RCN) was defined as a >/=25% increase in serum creatinine from the baseline value up to 5 days after CTA.
Four hundred eighty-one patients were reviewed, and 224 met the inclusion criteria. There were 7 of 224 (3%) who fulfilled the criteria for RCN. A number of patients underwent emergent CTA without knowledge of their creatinine value; 2 of 93 (2%) developed RCN. There were 36 patients who received an additional digital subtraction angiogram, and none of these developed subsequent RCN. No patients required dialysis, and 9 of 68 (13%) had a >25% increase in their creatinine levels at a late (>30 days) follow-up.
Overall, these results illustrate that there is a low incidence of RCN in acute stroke patients undergoing emergency CTA.
关于急性卒中患者进行急诊计算机断层血管造影（CTA）检查、连续应用造影剂及其长期预后的肾脏安全性，相关研究极少。我们调查了这些人群中对比剂所致肾损伤的发生率。
我们回顾性分析了症状发作后24小时内接受脑部CTA检查（有或无颈部检查）的急性卒中综合征患者。记录所有肌酐结果及其他传统血管造影检查结果。对于有肾脏疾病史的患者，延迟给予造影剂直至获得肌酐结果。放射性造影剂肾病（RCN）定义为CTA检查后5天内血清肌酐较基线值升高≥25%。
共评估了481例患者，224例符合纳入标准。224例中有7例（3%）符合RCN标准。有一些患者在未了解其肌酐值的情况下接受了急诊CTA检查；93例中有2例（2%）发生了RCN。有36例患者接受了额外的数字减影血管造影检查，这些患者均未发生后续RCN。无患者需要透析，68例中有9例（13%）在晚期（>30天）随访时肌酐水平升高>25%。
总体而言，这些结果表明，接受急诊CTA检查的急性卒中患者中RCN的发生率较低。
