PT  - JOURNAL ARTICLE
AU  - T.A. Tomsick
AU  - L.D. Foster
AU  - D.S. Liebeskind
AU  - M.D. Hill
AU  - J. Carrozella
AU  - M. Goyal
AU  - R. von Kummer
AU  - A.M. Demchuk
AU  - I. Dzialowski
AU  - V. Puetz
AU  - T. Jovin
AU  - H. Morales
AU  - Y.Y. Palesch
AU  - J. Broderick
AU  - P. Khatri
AU  - S.D. Yeatts
AU  - for the IMS III Investigators
TI  - Outcome Differences between Intra-Arterial Iso- and Low-Osmolality Iodinated Radiographic Contrast Media in the Interventional Management of Stroke III Trial
AID  - 10.3174/ajnr.A4421
DP  - 2015 Nov 01
TA  - American Journal of Neuroradiology
PG  - 2074--2081
VI  - 36
IP  - 11
4099  - http://www.ajnr.org/content/36/11/2074.short
4100  - http://www.ajnr.org/content/36/11/2074.full
SO  - Am. J. Neuroradiol.2015 Nov 01; 36
AB  - BACKGROUND AND PURPOSE: 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).MATERIALS AND 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.EVTendovascular therapyIAintra-arterialICHintracranial hemorrhageIMS IIIInterventional Management of Stroke III TrialIRCMiodinated radiographic contrast mediaLOCMlow-osmolal contrast mediaMCImicrocatheter injectionmTICImodified TICISICHsymptomatic intracranial hemorrhage