Clinical management of contrast-induced neurotoxicity: a systematic review.
Adverse event
Complication
Contrast
Encephalopathy
Endovascular
Management
Neurotoxicity
Treatment
Journal
Acta neurologica Belgica
ISSN: 2240-2993
Titre abrégé: Acta Neurol Belg
Pays: Italy
ID NLM: 0247035
Informations de publication
Date de publication:
08 Feb 2024
08 Feb 2024
Historique:
received:
13
09
2023
accepted:
04
01
2024
medline:
8
2
2024
pubmed:
8
2
2024
entrez:
8
2
2024
Statut:
aheadofprint
Résumé
Contrast-induced neurotoxicity (CIN) is an increasingly recognised complication following endovascular procedures utilising contrast. It remains poorly understood with heterogenous clinical management strategies. The aim of this review was to identify commonly employed treatments for CIN to enhance clinical decision making. A systematic search of Embase (1947-2022) and Medline (1946-2022) was conducted. Articles describing (i) patients with a clinical diagnosis of CIN, (ii) with radiological exclusion of other pathologies, (iii) detailed report of treatments, and (iv) discharge outcomes, were included. Data relating to demographics, procedure, symptoms, treatment and outcomes were extracted. A total of 73 patients were included, with a median age of 64 years. The most common procedures were cerebral angiography (42.5%) and coronary angiography (42.5%), and the median volume of contrast administered was 150 ml. The most common symptoms were cortical blindness (38.4%) and reduced consciousness (28.8%), and 84.9% of patients experienced complete resolution at the time of discharge. Management included intravenous fluids to dilute contrast in the cerebrovasculature (54.8%), corticosteroids to reduce blood-brain barrier damage (47.9%), antiseizure (16.4%) and sedative (16.4%) medications. Mannitol (13.7%) was also utilised to reduce cerebral oedema. Intensive care admission was required for 19.2% of patients. No statistically significant differences were observed between treatment and discharge outcomes. The clinical management of CIN should be considered on a patient-by-patient basis, but may consist of aggressive fluid therapy alongside corticosteroids, as well as other supportive therapy as required. Further examination of CIN management is required to define best practice.
Sections du résumé
BACKGROUND
BACKGROUND
Contrast-induced neurotoxicity (CIN) is an increasingly recognised complication following endovascular procedures utilising contrast. It remains poorly understood with heterogenous clinical management strategies. The aim of this review was to identify commonly employed treatments for CIN to enhance clinical decision making.
METHODS
METHODS
A systematic search of Embase (1947-2022) and Medline (1946-2022) was conducted. Articles describing (i) patients with a clinical diagnosis of CIN, (ii) with radiological exclusion of other pathologies, (iii) detailed report of treatments, and (iv) discharge outcomes, were included. Data relating to demographics, procedure, symptoms, treatment and outcomes were extracted.
RESULTS
RESULTS
A total of 73 patients were included, with a median age of 64 years. The most common procedures were cerebral angiography (42.5%) and coronary angiography (42.5%), and the median volume of contrast administered was 150 ml. The most common symptoms were cortical blindness (38.4%) and reduced consciousness (28.8%), and 84.9% of patients experienced complete resolution at the time of discharge. Management included intravenous fluids to dilute contrast in the cerebrovasculature (54.8%), corticosteroids to reduce blood-brain barrier damage (47.9%), antiseizure (16.4%) and sedative (16.4%) medications. Mannitol (13.7%) was also utilised to reduce cerebral oedema. Intensive care admission was required for 19.2% of patients. No statistically significant differences were observed between treatment and discharge outcomes.
CONCLUSIONS
CONCLUSIONS
The clinical management of CIN should be considered on a patient-by-patient basis, but may consist of aggressive fluid therapy alongside corticosteroids, as well as other supportive therapy as required. Further examination of CIN management is required to define best practice.
Identifiants
pubmed: 38329641
doi: 10.1007/s13760-024-02474-4
pii: 10.1007/s13760-024-02474-4
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Andaluz N, Zuccarello M (2008) Recent trends in the treatment of cerebral aneurysms: analysis of a nationwide inpatient database. J Neurosurg 108(6):1163–1169
doi: 10.3171/JNS/2008/108/6/1163
pubmed: 18518722
Salem MM, Maragkos GA, Gomez-Paz S, Ascanio LC, Ngo LH, Ogilvy CS et al (2021) Trends of ruptured and unruptured aneurysms treatment in the United States in post-ISAT era: a national inpatient sample analysis. J Am Heart Assoc 10(4):e016998
doi: 10.1161/JAHA.120.016998
pubmed: 33559478
pmcid: 7955327
Vazquez S, Graifman G, Spirollari E, Ng C, Uddin A, Feldstein E et al (2022) Incidence and risk factors for acute transient contrast-induced neurologic deficit: a systematic review with meta-analysis. Stroke 2(1):e000142
Quintas-Neves M, Araújo JM, Xavier SA, Amorim JM, Silva VCE, Pinho J (2020) Contrast-induced neurotoxicity related to neurological endovascular procedures: a systematic review. Acta Neurol Belg 120:1419–1424
doi: 10.1007/s13760-020-01508-x
pubmed: 32997325
Meijer FJ, Steens SC, Tuladhar AM, van Dijk ED, Boogaarts HD (2022) Contrast-induced encephalopathy—neuroimaging findings and clinical relevance. Neuroradiology 64(6):1265–1268
doi: 10.1007/s00234-022-02930-z
pubmed: 35290482
pmcid: 9117370
Mariajoseph FP, Lai LT, Moore J, Chandra RV, Goldschlager T, Praeger A et al (2023) Current knowledge and perspectives of contrast-induced neurotoxicity: a survey of Australian clinicians. J Clin Neurosci 116:8–12
doi: 10.1016/j.jocn.2023.08.014
pubmed: 37597332
Moher D, Liberati A, Tetzlaff J, Altman DG, Group* P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269
Murad MH, Sultan S, Haffar S, Bazerbachi F (2018) Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 23(2):60–63
doi: 10.1136/bmjebm-2017-110853
pubmed: 29420178
pmcid: 6234235
Liao M-T, Lin T-T, Lin L-Y, Hwang J-J, Tseng C-D (2013) Contrast-induced encephalopathy after percutaneous coronary intervention. Acta Cardiol Sin 29(3):277
pubmed: 27122717
pmcid: 4804840
Muruve D, Steinman T (1996) Contrast-induced encephalopathy and seizures in a patient with chronic renal insufficiency. Clin Nephrol 45(6):406–409
pubmed: 8793235
Waldron RL, Bridenbaugh RB, Dempsey EW (1974) Effect of angiographic contrast media at the cellular level in the brain: hypertonic vs chemical action. Am J Roentgenol 122(3):469–476
doi: 10.2214/ajr.122.3.469
Rapoport S (1973) Reversible opening of the blood-brain barrier by osmotic shrinkage of the cerebrovascular endothelium: opening of the tight junctions as related to carotid arteriography. Small vessel angiography. Mosby, St. Louis, pp 137–151
Harnish PP, Hagberg DJ (1988) Contrast media-induced blood-brain barrier damage potentiation by hypertension. Invest Radiol 23(6):463–465
doi: 10.1097/00004424-198806000-00009
pubmed: 3403206
Junck L, Marshall WH (1983) Neurotoxicity of radiological contrast agents. Ann Neurol 13(5):469–484
doi: 10.1002/ana.410130502
pubmed: 6347033
Rapoport S, Thompson H, Bidinger JM (1974) Equi-osmolal opening of the blood-brain barrier in the rabbit by different contrast media. Acta Radiol Diagn 15(1):21–32
doi: 10.1177/028418517401500103
De Gans J, Van de Beek D (2002) Dexamethasone in adults with bacterial meningitis. N Engl J Med 347(20):1549–1556
doi: 10.1056/NEJMoa021334
pubmed: 12432041
Hodzic E, Hasbun R, Granillo A, Tröscher AR, Wagner H, von Oertzen TJ et al (2023) Steroids for the treatment of viral encephalitis: a systematic literature review and meta-analysis. J Neurol 270:3603–3615
doi: 10.1007/s00415-023-11715-0
pubmed: 37060361
pmcid: 10105360
Beck RW, Cleary PA, Trobe JD, Kaufman DI, Kupersmith MJ, Paty DW et al (1993) The effect of corticosteroids for acute optic neuritis on the subsequent development of multiple sclerosis. N Engl J Med 329(24):1764–1769
doi: 10.1056/NEJM199312093292403
pubmed: 8232485
Rudick RA, Cohen JA, Weinstock-Guttman B, Kinkel RP, Ransohoff RM (1997) Management of multiple sclerosis. N Engl J Med 337(22):1604–1611
doi: 10.1056/NEJM199711273372207
pubmed: 9371858
McMahon D, Oakden W, Hynynen K (2020) Investigating the effects of dexamethasone on blood-brain barrier permeability and inflammatory response following focused ultrasound and microbubble exposure. Theranostics 10(4):1604
doi: 10.7150/thno.40908
pubmed: 32042325
pmcid: 6993222
Hue CD, Cho FS, Cao S, Bass CRD, Meaney DF, Morrison B III (2015) Dexamethasone potentiates in vitro blood-brain barrier recovery after primary blast injury by glucocorticoid receptor-mediated upregulation of ZO-1 tight junction protein. J Cereb Blood Flow Metab 35(7):1191–1198
doi: 10.1038/jcbfm.2015.38
pubmed: 25757751
pmcid: 4640274
Zevallos CB, Dandapat S, Ansari S, Farooqui M, Quispe-Orozco D, Mendez-Ruiz A et al (2020) Clinical and imaging features of contrast-induced neurotoxicity after neurointerventional surgery. World Neurosurg 142:e316–e324
doi: 10.1016/j.wneu.2020.06.218
pubmed: 32634632
Li J, Qi G, Zhang H, Chen G, Wang S, Yan M et al (2021) Contrast-induced encephalopathy mimicking stroke after a second cerebral DSA: an unusual case report. BMC Neurol 21(1):430
doi: 10.1186/s12883-021-02457-5
pubmed: 34740313
pmcid: 8570035
Chu Y-T, Lee K-P, Chen C-H, Sung P-S, Lin Y-H, Lee C-W et al (2020) Contrast-induced encephalopathy after endovascular thrombectomy for acute ischemic stroke. Stroke 51(12):3756–3759
doi: 10.1161/STROKEAHA.120.031518
pubmed: 33121385
Shawkat H, Westwood M-M, Mortimer A (2012) Mannitol: a review of its clinical uses. Contin Educ Anaesth Crit Care Pain 12(2):82–85
doi: 10.1093/bjaceaccp/mkr063
Schwarz S, Schwab S, Bertram M, Aschoff A, Hacke W (1998) Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke 29(8):1550–1555
doi: 10.1161/01.STR.29.8.1550
pubmed: 9707191
Charpentier C, Audibert G, Guillemin F, Civit T, Ducrocq X, Bracard S et al (1999) Multivariate analysis of predictors of cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage. Stroke 30(7):1402–1408
doi: 10.1161/01.STR.30.7.1402
pubmed: 10390314
Bauer AM, Rasmussen PA (2014) Treatment of intracranial vasospasm following subarachnoid hemorrhage. Front Neurol 5:72
doi: 10.3389/fneur.2014.00072
pubmed: 24904517
pmcid: 4032992
Komotar RJ, Zacharia BE, Valhora R, Mocco J, Connolly ES Jr (2007) Advances in vasospasm treatment and prevention. J Neurol Sci 261(1–2):134–142
doi: 10.1016/j.jns.2007.04.046
pubmed: 17570400
Newell DW, Eskridge JM, Mayberg MR, Grady MS, Winn HR (1989) Angioplasty for the treatment of symptomatic vasospasm following subarachnoid hemorrhage. J Neurosurg 71(5):654–660
doi: 10.3171/jns.1989.71.5.0654
pubmed: 2530321
Schierhout G, Roberts I (1998) Prophylactic antiepileptic agents after head injury: a systematic review. J Neurol Neurosurg Psychiatry 64(1):108–112
doi: 10.1136/jnnp.64.1.108
pubmed: 9436738
pmcid: 2169898
Iuchi T, Kuwabara K, Matsumoto M, Kawasaki K, Hasegawa Y, Sakaida T (2015) Levetiracetam versus phenytoin for seizure prophylaxis during and early after craniotomy for brain tumours: a phase II prospective, randomised study. J Neurol Neurosurg Psychiatry 86(10):1158–1162
doi: 10.1136/jnnp-2014-308584
pubmed: 25511789
Temkin NR (2002) Prophylactic anticonvulsants after neurosurgery. Epilepsy Currents 2(4):105–107
doi: 10.1111/j.1535-7597.2002.00038.x
pubmed: 15309132
pmcid: 321029
Zafar SN, Khan AA, Ghauri AA, Shamim MS (2012) Phenytoin versus leviteracetam for seizure prophylaxis after brain injury–a meta analysis. BMC Neurol 12:1–8
doi: 10.1186/1471-2377-12-30