Contrast-induced encephalopathy following bronchial arteriography and endovascular procedure

Risk factor analyses of contrast leakage and contrast-induced encephalopathy following coil embolization for unruptured intracranial aneurysm

BACKGROUND

Contrast-induced encephalopathy (CIE) following endovascular interventions is a rare but serious complication. This study aimed to investigate the risk factors of contrast leakage (CL) and CIE in patients who underwent coil embolization of unruptured intracranial aneurysms (UIAs).

METHODS

Patients with UIAs who underwent coil embolization at a single tertiary institute between January 2019 and January 2022 were enrolled retrospectively. CL was defined as cortical or subcortical contrast enhancement with effacement of the cortical sulci. CIE was defined as the new onset of neurological deficits associated with CL. Following the procedure, all patients underwent CT scans, and MRI scans were performed on those with symptoms. Patient and procedural risk factors were investigated.

RESULTS

In total, 459 patients were analyzed. The median procedure time and contrast dose were 69 min and 96 mL, respectively. CL was evident in 35 patients. In the multivariate analysis, hypertension, large aneurysm, longer procedure time, and greater contrast dose were associated with CL. CIE was diagnosed in 19 patients, and the risk factors included large aneurysm, longer procedure time, and greater contrast dose. The procedure time was predictive of both CL (P<0.001) and CIE (P=0.01). The optimal cut-off value for procedure time was 81.5 min. All CIE patients recovered completely within 8-96 hours.

CONCLUSIONS

A large aneurysm and prolonged procedure time may increase the patient's risk of CL and CIE due to increased contrast exposure. Patients who underwent a procedure that exceeded 1.5 hours necessitate post-procedure evaluation and monitoring.

Clinical Characteristics of Contrast Leakage and Contrast-Induced Encephalopathy Following Endovascular Treatment for Unruptured Intracranial Aneurysm

Objective

Contrast-induced encephalopathy (CIE) is a rare but severe complication that can occur following intravascular treatment of intracranial vascular disease. Although CIE is considered a transient neurological disorder, its natural history, pathophysiology, and risk factors are poorly understood. Contrast leakage (CL) is a more frequently observed adverse event than CIE and can lead to CIE. This retrospective study aimed to elucidate the clinical characteristics of CL and CIE and identify the risk factors for each.

Methods

We retrospectively reviewed the medical records of 61 patients with unruptured intracranial aneurysms who were treated at our institution between January 2019 and May 2023. Risk factors for CIE and CL were identified by Fisher's exact test for univariate analysis of categorical variables and by unpaired t-test for continuous variables. One-way analysis of variance (ANOVA) was conducted, followed by the Tukey-Kramer test for multiple comparisons.

Results

Of the 61 patients, 22 (36%) had CL and 4 (6%) had CIE. Among the clinical characteristics analyzed, older age (p = 0.031), larger aneurysm (p = 0.003), lower serum creatinine (p = 0.026), and use of a distal access catheter (p = 0.030) were significant risk factors for CL. CIE occurred only in CL-positive patients (p = 0.014). Of the 4 patients with CIE, neurological symptoms improved within 3 days in 3 patients, and neurological deficit persisted in 1 patient.

Conclusion

Older age, larger aneurysm, lower serum creatinine, and use of a distal access catheter are risk factors for developing CL, and female sex and greater volume of contrast medium are potential risk factors. No risk factors for developing CIE from CL were identified.

Contrast-Induced Encephalopathy in Patients with Chronic Kidney Disease and End-Stage Kidney Disease: A Systematic Review and Meta-Analysis

Background: Contrast-induced encephalopathy (CIE) is an infrequent but serious neurological condition that occurs shortly after the administration of contrast during endovascular and angiography procedures. Patients suffering from chronic kidney disease (CKD) or end-stage kidney disease (ESKD) are considered to be at a higher risk of contrast medium neurotoxicity, due to the delayed elimination of the contrast medium. However, the occurrence and characteristics of CIE in CKD/ESKD patients have not been extensively investigated. Methods: We conducted a comprehensive literature search, utilizing databases such as MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, up to September 2022. The purpose was to identify documented cases of CIE among patients with CKD or ESKD. Employing a random-effects model, we calculated the pooled incidence and odds ratio (OR) of CIE in CKD/ESKD patients. Results: Our search yielded a total of eleven articles, comprising nine case reports and two observational studies. Among these studies, 2 CKD patients and 12 ESKD patients with CIE were identified. The majority of the CKD/ESKD patients with CIE (93%) had undergone intra-arterial contrast media and/or endovascular procedures to diagnose acute cerebrovascular disease, coronary artery disease, and peripheral artery disease. The male-to-female ratio was 64%, and the median age was 63 years (with an interquartile range of 55 to 68 years). In the two observational studies, the incidence of CIE was found to be 6.8% in CKD patients and 37.5% in ESKD patients, resulting in a pooled incidence of 16.4% (95% CI, 2.4%-60.7%) among the CKD/ESKD patients. Notably, CKD and ESKD were significantly associated with an increased risk of CIE, with ORs of 5.77 (95% CI, 1.37-24.3) and 223.5 (95% CI, 30.44-1641.01), respectively. The overall pooled OR for CIE in CKD/ESKD patients was 32.9 (95% CI, 0.89-1226.44). Although dialysis prior to contrast exposure did not prevent CIE, approximately 92% of CIE cases experienced recovery after undergoing dialysis following contrast exposure. However, the effectiveness of dialysis on CIE recovery remained uncertain, as there was no control group for comparison. Conclusions: In summary, our study indicates an association between CIE and CKD/ESKD. While patients with CIE showed signs of recovery after dialysis, further investigations are necessary, especially considering the lack of a control group, which made the effects of dialysis on CIE recovery uncertain.