title: Outcome Differences between Intra-Arterial Iso- and Low-Osmolality Iodinated Radiographic Contrast Media in the Interventional Management of Stroke III Trial.
abstract: OBJECTIVE
  Intracarotid arterial infusion of nonionic, low-osmolal iohexol contrast medium has been associated with increased intracranial hemorrhage in a rat middle cerebral artery occlusion model compared with saline infusion. Iso-osmolal iodixanol (290 mOsm/kg H2O) infusion demonstrated smaller infarcts and less intracranial hemorrhage compared with low-osmolal iopamidol and saline. No studies comparing iodinated radiographic contrast media in human stroke have been performed, to our knowledge. We hypothesized that low-osmolal contrast media may be associated with worse outcomes compared with iodixanol in the Interventional Management of Stroke III Trial (IMS III).
  
  
  METHODS
  We reviewed prospective iodinated radiographic contrast media data for 133 M1 occlusions treated with endovascular therapy. We compared 5 prespecified efficacy and safety end points (mRS 0-2 outcome, modified TICI 2b-3 reperfusion, asymptomatic and symptomatic intracranial hemorrhage, and mortality) between those receiving iodixanol (n = 31) or low-osmolal contrast media (n = 102). Variables imbalanced between iodinated radiographic contrast media types or associated with outcome were considered potential covariates for the adjusted models. In addition to the iodinated radiographic contrast media type, final covariates were those selected by using the stepwise method in a logistic regression model. Adjusted relative risks were then estimated by using a log-link regression model.
  
  
  RESULTS
  Of baseline or endovascular therapy variables potentially linked to outcome, prior antiplatelet agent use was more common and microcatheter iodinated radiographic contrast media injections were fewer with iodixanol. Relative risk point estimates are in favor of iodixanol for the 5 prespecified end points with M1 occlusion. The percentage of risk differences are numerically greater for microcatheter injections with iodixanol.
  
  
  CONCLUSIONS
  While data favoring the use of iso-osmolal iodixanol for reperfusion of M1 occlusion following IV rtPA are inconclusive, potential pathophysiologic mechanisms suggesting clinical benefit warrant further investigation.
authors.affiliation: From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio thomas.tomsick@uchealth.com.
authors.forename: T A
authors.initials: TA
authors.lastname: Tomsick
authors.affiliation: Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina.
authors.forename: L D
authors.initials: LD
authors.lastname: Foster
authors.affiliation: University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California.
authors.forename: D S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: Department of Radiology and Clinical Neurosciences (M.D.H., M.G.).
authors.forename: M D
authors.identifier: http://orcid.org/0000-0002-6269-1543
authors.initials: MD
authors.lastname: Hill
authors.affiliation: From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio.
authors.forename: J
authors.initials: J
authors.lastname: Carrozella
authors.affiliation: Department of Radiology and Clinical Neurosciences (M.D.H., M.G.).
authors.forename: M
authors.initials: M
authors.lastname: Goyal
authors.affiliation: Departments of Neuroradiology (R.v.K.).
authors.forename: R
authors.initials: R
authors.lastname: von Kummer
authors.affiliation: Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitätsklinikum, Carl Gustav Carus Technische Universität Dresden, Meißen, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Dzialowski
authors.affiliation: Neurology (V.P.), Dresden University Stroke Center, Universitätsklinikum Carl Gustav Carus Technischen Universität Dresden, Dresden, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Puetz
authors.affiliation: The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania.
authors.forename: T
authors.initials: T
authors.lastname: Jovin
authors.affiliation: From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio.
authors.forename: H
authors.initials: H
authors.lastname: Morales
authors.affiliation: Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Y Y
authors.initials: YY
authors.lastname: Palesch
authors.affiliation: Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio.
authors.forename: J
authors.initials: J
authors.lastname: Broderick
authors.affiliation: Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio.
authors.forename: P
authors.initials: P
authors.lastname: Khatri
authors.affiliation: Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina.
authors.forename: S D
authors.initials: SD
authors.lastname: Yeatts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007472:Iohexol / Q000009:adverse effects*; D007479:Iopamidol / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery; D014283:Triiodobenzoic Acids / Q000009:adverse effects*
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C044834:iodixanol; D007479:Iopamidol