Contrast Injection from an Intermediate Catheter Placed in an Intradural Artery is Associated with Contrast-Induced Encephalopathy following Neurointervention

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
FIGURE.
A 70-year-old man undergoing hemodialysis due to end-stage renal failure underwent coil embolization for a right MCA aneurysm with a maximum diameter of 9 mm. Right middle cerebral arteriography (A) and fluoroscopic view (B) show contrast of the right MCA aneurysm from the 6F Sofia catheter, an intermediate catheter guided to the right MCA horizontal segment. Right middle cerebral arteriography (C) shows complete embolization of aneurysm achieved by a stent-assisted technique. Half an hour after completion of the treatment, the patient's condition with stupor, disorientation, and severe left upper and lower extremity paralysis progressively deteriorated. No obvious ischemic and hemorrhagic lesions were seen on MR imaging (D, DWI; E, FLAIR sequence). MRA did not detect arterial occlusion, dissection, or vasospasm. Noncontrast CT (F) shows enhancement due to leakage of contrast medium into the right cerebral cortex and subcortex. After hemodialysis, disturbance of consciousness and left hemiparesis gradually improved. Noncontrast CT (G) 5 days after treatment demonstrates that the contrast-induced enhancement in the right cerebral cortex and subcortex had disappeared. The arrowhead indicates the tip of Sofia catheter.

Table 1:

Baseline clinical characteristics in CIE and non-CIE groups^{^a}

Note:—eGFR indicates estimated glomerular filtration rate; NA, not applicable.
↵a Unless otherwise indicated, values represent the number of aneurysms (%) or median [interquartile range]. Not all percentage totals reach 100% because of rounding.
↵b Patients with a history of both ischemic and hemorrhagic stroke were counted in each category.
↵c Renal dysfunction was defined as an eGFR of <45 mL/min/1.73 m².
↵d P < .05.
↵e History of allergy included allergy to any food or drug.

Table 2:

Multivariate logistic regression analysis and stepwise selection of risk factors for CIE

Parameter	OR (95% CI)	P Value
Variables with P < .05 or previously reported as risk factors for CIE
Intradural placement of catheter for angiography	50.2 (7.25–347)	<.001^{^a}
Previously treated aneurysm	7.46 (1.47–37.9)	.015^{^a}
Prior stroke	4.30 (0.756–24.5)	.1
Hemodialysis	7.91 (0.504–124)	.14
Hypertension	0.985 (0.233–4.17)	.98
Diabetes mellitus	1.64 (0.241–11.1)	.62
Posterior circulation aneurysm	7.52 × 10⁻¹⁰ (0–Inf)	.995
Total contrast medium volume (mL)	0.997 (0.988–1.01)	.58
Nonionic contrast medium	7.85 × 10⁷ (0–Inf)	.99
Endovascular technique (flow diversion)	7.15 (0.642–79.7)	.11
After the stepwise selection using the P value (until P < .05)
Intradural placement of catheter for angiography	40.4 (8.63–189)	<.001^{^a}
Previously treated aneurysm	8.20 (2.26–29.6)	.001^{^a}