Neurology (C.H., M.G., M.P.), University Hospital of Tours, Tours, France.
Department of Diagnostic Neuroradiology (A.H., C.M., C.C.), University Regional Hospital of Orleans, Orléans, France.
AJNR Am J Neuroradiol. 2023 Dec 29;45(1):30-36. doi: 10.3174/ajnr.A8081.
Iodine contrast extravasation (ICE) is common in patients with acute ischemic stroke (AIS) after endovascular-thrombectomy (EVT). The aim of our study was to evaluate the incidence of ICE assessed by dual-energy CT (DECT), its determinants, and associations with clinical outcome.
We retrospectively examined imaging parameters and clinical factors from consecutive patients with AIS treated with EVT who had a DECT 24 hours thereafter, identified at a single academic center. Associations between ICE, clinical, imaging, and procedural parameters, as well as clinical outcome were explored by using univariable and multivariable models.
A total of 197 consecutive patients were included (period 2019-2020), of which 53 (27%) demonstrated ICE that was pure ICE in 30/53 (57%) and mixed with intracranial hemorrhage (ICH) in 23/53 (43%). Low initial-ASPECTS, high per-procedural-contrast volume injected, and high admission-glycemia were independently associated with ICE (respectively, OR = 0.43, 95% CI, 0.16-1.13, = .047; OR = 1.02, 95% CI, 1.00-1.04, = .003; OR = 8.92, 95% CI, 0.63-125.77, = .043). ICE was independently associated with ICH ( = .047), but not with poorer clinical outcome (6-month mRS >2, = .223). Univariate analysis demonstrated that low ADC, higher ischemic volume, ICA occlusion, mass effect, longer procedure duration, combined thrombectomy technique, higher number of device passes, and lower recanalization rate were associated with ICE (respectively, = .002; <.001; .002; <.001; .002; 0.011; <0.001; 0.015).
ICE evaluated with DECT is a relatively frequent finding after EVT, present in almost one-third of patients. Lower admission ASPECTS, higher glycemia, and high contrast volume injected per procedure were associated with ICE. We also found an association between ICE and ICH, confirming blood-brain barrier alteration as a major determinant of ICH.
碘对比剂外渗（ICE）在急性缺血性脑卒中（AIS）患者血管内血栓切除术（EVT）后很常见。本研究旨在评估双能 CT（DECT）评估的 ICE 发生率、其决定因素及其与临床结局的相关性。
我们回顾性地检查了单家学术中心连续接受 EVT 治疗的 AIS 患者的影像学参数和临床因素，这些患者在之后的 24 小时内进行了 DECT。通过单变量和多变量模型探讨 ICE 与临床、影像和程序参数之间的关系，以及与临床结局的关系。
共纳入 197 例连续患者（2019-2020 年期间），其中 53 例（27%）出现 ICE，其中 30/53（57%）例为纯 ICE，23/53（43%）例为 ICE 合并颅内出血（ICH）。低初始 ASPECTS、高术中对比剂注射量和高入院血糖与 ICE 独立相关（分别为 OR = 0.43，95%CI，0.16-1.13， =.047；OR = 1.02，95%CI，1.00-1.04， =.003；OR = 8.92，95%CI，0.63-125.77， =.043）。ICE 与 ICH 独立相关（ =.047），但与较差的临床结局无关（6 个月 mRS>2， =.223）。单变量分析表明，低 ADC、更高的缺血体积、ICA 闭塞、占位效应、手术时间延长、联合血栓切除术技术、更多的器械通过次数和更低的再通率与 ICE 相关（分别为 =.002；<.001；.002；<.001；.002；0.011；<.001；0.015）。
用 DECT 评估的 ICE 是 EVT 后一种相对常见的发现，近三分之一的患者存在 ICE。较低的入院 ASPECTS、较高的血糖和术中每单位体积注射的造影剂与 ICE 相关。我们还发现 ICE 与 ICH 之间存在关联，证实血脑屏障的改变是 ICH 的主要决定因素。
