Sage Journals: Discover world-class research

Abstract

Introduction

Mechanical thrombectomy in the setting of acute ischemic stroke (AIS) requires cerebral digital subtraction angiography (DSA), typically performed with iodinated contrast medium. We present a case of emergent cerebral DSA and mechanical thrombectomy using gadolinium-based contrast for cerebral DSA in a patient with a history of anaphylaxis to iodinated contrast agents (ICs).

Case report

A 72-year-old man developed left ventricle assist device thrombus while on anticoagulation. During hospitalization he suffered right middle cerebral artery occlusion with a National Institutes of Health stroke scale score of 10. He had a history of anaphylaxis and the advanced directives revealed do not resuscitate/do not intubate status. We performed an emergent DSA as part of thrombectomy procedure using gadolinium-based contrast mixed in 1:1 proportion with normal saline. The images obtained were of adequate quality and the patient underwent successful thrombectomy with modified thrombolysis in cerebral infarction 2B recanalization.

Conclusion

Gadolinium-based contrast agents could be effective alternatives for cerebral DSA in patients undergoing mechanical thrombectomy for AIS who have a history of anaphylactic reaction to ICs.

Keywords

Gadolinium stroke thrombectomy angiogram contrast allergy

Get full access to this article

View all access options for this article.

References

Thomsen

Bush

Jr . Adverse effects of contrast media: incidence, prevention and management. Drug Saf 1998; 19: 313–324.

Namasivayam

Kalra

Torres

et al.

Adverse reactions to intravenous iodinated contrast media: a primer for radiologists. Emerg Radiol 2006; 12: 210–215.

ACR Committee on Drugs and Contrast Media. ACR manual on contrast media. Version 10.3, 2017.

Beckett

Moriarity

Langer

. Safe use of contrast media: what the radiologist needs to know. Radiographics 2015; 35: 1738–1750.

Wolf

Arenson

Cross

. A prospective trial of ionic vs nonionic contrast agents in routine clinical practice: comparison of adverse effects. AJR Am J Roentgenol 1989; 152: 939–944.

Joint Task Force on Practice Parameters, et al. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol 2005; 115: S483–523.

Saver

Goyal

van der Lugt

et al.

Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA 2016; 316: 1279–1288.

Nogueira

Jadhav

Haussen

et al.

Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018; 378: 11–21.

Albers

Marks

Kemp

et al.

Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018; 378: 708–718.

10.

Hussain

Moussavi

Korya

et al.

Systematic review and pooled analyses of recent neurointerventional randomized controlled trials: setting a new standard of care for acute ischemic stroke treatment after 20 years. Interv Neurol 2016; 5: 39–50.

11.

Hao

Yang

Wang

et al.

Predictors for symptomatic intracranial hemorrhage after endovascular treatment of acute ischemic stroke. Stroke 2017; 48: 1203–1209.

12.

Schonenberger

Uhlmann

Hacke

et al.

Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial. JAMA 2016; 316: 1986–1996.

13.

Campbell

BCV

van Zwam

Goyal

et al.

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018; 17: 47–53.

14.

Bottinor

Polkampally

Jovin

. Adverse reactions to iodinated contrast media. Int J Angiol 2013; 22: 149–154.

15.

Kaufman

Geller

et al.

Selective angiography of the common carotid artery with gadopentetate dimeglumine in a patient with renal insufficiency. AJR Am J Roentgenol 1999; 172: 1613–1614.

16.

Spinosa

Kaufmann

Hartwell

. Gadolinium chelates in angiography and interventional radiology: a useful alternative to iodinated contrast media for angiography. Radiology 2002; 223: 319–325. discussion 326–327.

17.

Nussbaum

Casey

Sebring

et al.

Use of gadolinium as an intraarterial contrast agent in digital subtraction angiography of the cervical carotid arteries and intracranial circulation. Technical note. J Neurosurg 2000; 92: 881–883.

18.

Ose

Doue

Zen

et al.

‘Gadolinium’ as an alternative to iodinated contrast media for x-ray angiography in patients with severe allergy. Circ J 2005; 69: 507–509.

19.

Jacamon

Bonneville

Robert

et al.

Cerebral 3D-gadolinium-DSA in a patient with renal insufficiency presenting a subarachnoid haemorrhage. Interv Neuroradiol 2002; 8: 193–195.

20.

Kalsch

Eggebrecht

et al.

Gadolinium-based coronary angiography in patients with contraindication for iodinated x-ray contrast medium: a word of caution. J Interv Cardiol 2008; 21: 167–174.

21.

Boyden

Gurm

. Does gadolinium-based angiography protect against contrast-induced nephropathy?: a systematic review of the literature. Catheter Cardiovasc Interv 2008; 71: 687–693.

Gadolinium to the rescue for mechanical thrombectomy in acute ischemic stroke

Abstract

Introduction

Case report

Conclusion

Keywords

Get full access to this article

References