Objective: Exposure to contrast agents may cause nephrotoxicity. The safety of performing CT-angiography without having knowledge of the baseline creatinine level in stroke patients treated with tissue plasminogen activator (tPA) has not been established.
Methods: This is an observational cohort study, with a historical control group to evaluate the safety of CT-angiography performed before tPA-treatment given within 3 hours of symptom onset. The CT-angiography group represents all patients treated with tPA between September/2003 and November/2007 who had CT-angiography. The control group consists of all patients treated with tPA between January/1999 and August/2003 when CT-angiography was not performed. The primary outcome was a creatinine increase in 24-72 hours compared to baseline; the secondary outcome was a creatinine increase by ≥44 µmol/l in 24-72 hours and the incidence of symptomatic intracerebral hemorrhage (sICH).
Results: Baseline parameters between the CT-angiography group (164 patients, age 70±11; 91 male) and the control group (77 patients, age 67±11; 45 male) were similar. In the CT-angiography group the mean creatinine increase was −0.89 mmol/l and in the control group 2.2 mmol/l (p=0.42). A creatinine increase of ≥44 μmol/l occurred in 5 patients (3%) in the CT angiography group and in 3 patients (4%) in the control group (p=0.50). Also, in the CT-angiography group 8 patients (5%) had sICH as compared to 3 patients (4%) in the control group (p=0.73).
Conclusion: Contrast agents given for CT-angiography, performed in patients with normal and abnormal creatinine level, neither caused renal injury nor interfered with the safety of tPA-treatment.
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