title: Risk of acute kidney injury associated with neuroimaging obtained during triage and treatment of patients with acute ischemic stroke symptoms.
abstract: BACKGROUND
  Combining non-contrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) imaging (referred to as a CT stroke study, CTSS) provides a rapid evaluation of the cerebrovascular axis during acute ischemic stroke. Iodinated contrast-enhanced CT imaging is not without risk, which includes renal injury. If a patient's CTSS identifies vascular pathology, digital subtraction angiography (DSA) is often performed within 24-48 h. Such patients may receive multiple administrations of iodinated contrast material over a short time period.
  
  
  OBJECTIVE
  We aimed to evaluate the incidence of acute kidney injury (AKI) in patients who underwent a CTSS and DSA for evaluation of acute ischemic symptoms or for stroke intervention within a 48 h period between August 2012 and December 2014.
  
  
  METHODS
  We identified 84 patients for inclusion in the analysis. Patients fell into one of two cohorts: AKI, defined as a rise in the serum creatinine level of ≥0.5 mg/dL from baseline, or non-AKI. Clinical parameters included pre- and post-imaging serum creatinine level, time between CTSS and DSA, and type of angiographic procedure (diagnostic vs intervention) performed.
  
  
  RESULTS
  Four patients (4.7%) experienced AKI, one of whom had baseline renal dysfunction (defined as baseline serum creatinine level ≥1.5 mg/dL). The mean difference between baseline and peak creatinine values was found to be significantly greater in patients with AKI than in non-AKI patients (1.65 vs -0.09, respectively; p=0.0008).
  
  
  CONCLUSIONS
  This study provides preliminary evidence of the safety and feasibility of obtaining CTSS with additional DSA imaging, whether for diagnosis or intervention, to identify possible acute ischemic stroke.
authors: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.|Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
authors: Shelby L
authors: SL
authors: Hall
authors: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.|Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
authors: Stephan A
authors: SA
authors: Munich
authors: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.|Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
authors: Marshall C
authors: MC
authors: Cress
authors: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.|Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
authors: Leonardo
authors: L
authors: Rangel-Castilla
authors: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.|Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.|Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.|Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors: Elad I
authors: EI
authors: Levy
authors: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.|Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.|Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.|Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.|Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors: Kenneth V
authors: KV
authors: Snyder
authors: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.|Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.|Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.|Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.|Jacobs Institute, Buffalo, New York, USA.
authors: Adnan H
authors: AH
authors: Siddiqui
keywords: Angiography; CT; CT Angiography; CT perfusion; Stroke