Abstract TMP66: Safety of Urgent Computed Tomographic Angiography in the Evaluation of Patients with Acute Stroke

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Abstract

Objective: Computed Tomography Angiography ( CTA) is the standard of care test for ischemic stroke patients with suspected large vessel occlusion. When establishing emergency room stroke pathways, concerns for contrast induced nephropathy (CIN), which occurs in 11% of the general population could influence the time efficiency for CTA. Our aim is to report the incidence of CIN in our suspected severe stroke population.

Method: With Institutional Review board approval, we maintained a prospective database on patients who were identified to have a high pre-hospital Rapid Arterial occlusion Evaluation ( RACE) between July 2015 and June of 2016. Per protocol, RACE alert patients go directly to the CT scanner to obtain a CT head and a CTA unless the test is cancelled by the stroke team. Labs are typically not available when CTA is performed. Our data included patient demographics, pre-morbid risk factors, baseline serum Creatinine level (Cr), peak Cr level during admission and at discharge. Incidence of renal consults and need for Hemodialysis was also monitored.

Results: A total of 150 RACE alert patients were included in the analysis. Median age of patients was 73 and 12 patients had pre-morbid chronic renal failure. CTA was not performed in 21 of patients, due to low probabability of stroke determined by stroke team onsite.. Transient CIN occurred in 9(6%) of patients, renal consult was obtained in 4(3%) patients and 2(1) patients had a diagnosis of acute kidney injury on discharge.

Conclusion: Emergent CTA resulted in a low number of transient CIN in our RACE alert patients. No cases of chronic renal Failure or need for HD were reported in our prospective cohort. A larger prospective registry may be needed to confirm the safety of this approach.

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