Yamamoto Yuki, Yamamoto Nobuaki, Kanematsu Yasuhisa, Kuroda Kazutaka, Yamaguchi Izumi, Miyamoto Takeshi, Sogabe Shu, Shimada Kenji, Takagi Yasushi, Izumi Yuishin
Department of Neurology, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan,
Department of Neurology, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan.
Cerebrovasc Dis Extra. 2020;10(2):59-65. doi: 10.1159/000507918. Epub 2020 Jul 1.
Although mechanical thrombectomy is a standard endovascular therapy for patients with acute ischemic stroke (AIS), the incidence of and risk factors for contrast-induced nephropathy (CIN) following mechanical thrombectomy are infrequently reported.
The aim of this study was to investigate the incidence and risk factors for CIN following mechanical thrombectomy for AIS, and whether the incidence of CIN is related to a poor prognosis.
We examined consecutive patients who underwent a mechanical thrombectomy in the period from January 2014 to March 2018. The patients' clinical backgrounds, treatments, and clinical prognoses were analyzed. CIN was defined as an increase in the serum creatinine level of ≥44.2 μmol/L (0.5 mg/dL) or 25% above baseline within 72 h after exposure to the contrast medium.
In total, 80 patients (46 men and 34 women aged 74.5 ± 11.5 years) who met our inclusion criteria were analyzed. CIN occurred in 8.8% (7/80) of the patients following mechanical thrombectomy. Although no patients needed permanent dialysis, 1 required temporary dialysis. The median amount of contrast medium was 109 mL. A comparison between the groups with and without CIN showed a significant difference in white blood cell (WBC) count at the time of admission (11.6 ± 2.7 × 103/μL and 8.1 ± 2.7 × 103/μL; p < 0.01) and the cut-off value was 9.70 × 103/μL. In multivariate analysis, contrast volume/estimated glomerular filtration rate by creatinine and WBC count were significantly associated with the incidence of CIN, with odds ratios of 1.64 (95% CI 1.02-2.65; p = 0.04) and 1.61 (95% CI 1.15-2.25; p < 0.01), respectively.
This study found that CIN occurred in 8.8% of patients with AIS following mechanical thrombectomy. High WBC count was associated with an increased risk of CIN and may be helpful for predicting CIN.
尽管机械取栓术是急性缺血性卒中（AIS）患者的标准血管内治疗方法，但机械取栓术后对比剂肾病（CIN）的发生率及危险因素鲜有报道。
本研究旨在调查AIS患者机械取栓术后CIN的发生率及危险因素，以及CIN的发生率是否与预后不良相关。
我们对2014年1月至2018年3月期间接受机械取栓术的连续患者进行了检查。分析了患者的临床背景、治疗情况及临床预后。CIN定义为在接触对比剂后72小时内血清肌酐水平升高≥44.2μmol/L（0.5mg/dL）或高于基线水平25%。
总共分析了80例符合纳入标准的患者（46例男性和34例女性，年龄74.5±11.5岁）。机械取栓术后8.8%（7/80）的患者发生了CIN。虽然没有患者需要长期透析，但有1例需要临时透析。对比剂的中位数用量为109mL。CIN组和非CIN组之间的比较显示，入院时白细胞（WBC）计数存在显著差异（11.6±2.7×10³/μL和8.1±2.7×10³/μL；p<0.01），临界值为9.70×10³/μL。多因素分析显示，对比剂用量/肌酐估算的肾小球滤过率和WBC计数与CIN的发生率显著相关，比值比分别为1.64（95%CI 为1.02-2.65；p=0.04）和1.61（95%CI 为1.15-2.25；p<0.01）。
本研究发现，AIS患者机械取栓术后8.8%的患者发生了CIN。高WBC计数与CIN风险增加相关，可能有助于预测CIN。
