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<meta name="DC.Title" content="Determinants and Clinical Relevance of Iodine Contrast Extravasation after Endovascular Thrombectomy: A Dual-Energy CT Study" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8081" />
<meta name="DC.Date" content="2024-01-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2024 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Iodine contrast extravasation (ICE) is common in patients with acute ischemic stroke (AIS) after endovascular-thrombectomy (EVT). The aim of our study was to evaluate the incidence of ICE assessed by dual-energy CT (DECT), its determinants, and associations with clinical outcome.

MATERIALS AND METHODS: We retrospectively examined imaging parameters and clinical factors from consecutive patients with AIS treated with EVT who had a DECT 24 hours thereafter, identified at a single academic center. Associations between ICE, clinical, imaging, and procedural parameters, as well as clinical outcome were explored by using univariable and multivariable models.

RESULTS: A total of 197 consecutive patients were included (period 2019–2020), of which 53 (27%) demonstrated ICE that was pure ICE in 30/53 (57%) and mixed with intracranial hemorrhage (ICH) in 23/53 (43%). Low initial-ASPECTS, high per-procedural-contrast volume injected, and high admission-glycemia were independently associated with ICE (respectively, OR = 0.43, 95% CI, 0.16–1.13, P = .047; OR = 1.02, 95% CI, 1.00–1.04, P = .003; OR = 8.92, 95% CI, 0.63–125.77, P = .043). ICE was independently associated with ICH ( P = .047), but not with poorer clinical outcome (6-month mRS &gt;2, P = .223). Univariate analysis demonstrated that low ADC, higher ischemic volume, ICA occlusion, mass effect, longer procedure duration, combined thrombectomy technique, higher number of device passes, and lower recanalization rate were associated with ICE (respectively, P = .002; &lt;.001; .002; &lt;.001; .002; 0.011; &lt;0.001; 0.015).

CONCLUSIONS: ICE evaluated with DECT is a relatively frequent finding after EVT, present in almost one-third of patients. Lower admission ASPECTS, higher glycemia, and high contrast volume injected per procedure were associated with ICE. We also found an association between ICE and ICH, confirming blood–brain barrier alteration as a major determinant of ICH.

AIS
:   acute ischemic stroke
BBB
:   blood-brain barrier
DECT
:   dual-energy computed tomography
EVT
:   endovascular thrombectomy
HU
:   Hounsfield units
ICC
:   intraclass correlation coefficient
ICE
:   iodine contrast extravasation
ICH
:   intracranial hemorrhage
IOM
:   iodine overlay map
VNC
:   virtual noncontrast" />
<meta name="DC.Contributor" content="Clémence Hoche" />
<meta name="DC.Contributor" content="Alba Henderson" />
<meta name="DC.Contributor" content="Héloïse Ifergan" />
<meta name="DC.Contributor" content="Marie Gaudron" />
<meta name="DC.Contributor" content="Christophe Magni" />
<meta name="DC.Contributor" content="Igor Maldonado" />
<meta name="DC.Contributor" content="Jean-Philippe Cottier" />
<meta name="DC.Contributor" content="Marco Pasi" />
<meta name="DC.Contributor" content="Grégoire Boulouis" />
<meta name="DC.Contributor" content="Clara Cohen" />
<meta name="article:published_time" content="2024-01-01" />
<meta name="article:section" content="Neurovascular/Stroke Imaging" />
<meta name="citation_title" content="Determinants and Clinical Relevance of Iodine Contrast Extravasation after Endovascular Thrombectomy: A Dual-Energy CT Study" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Iodine contrast extravasation (ICE) is common in patients with acute ischemic stroke (AIS) after endovascular-thrombectomy (EVT). The aim of our study was to evaluate the incidence of ICE assessed by dual-energy CT (DECT), its determinants, and associations with clinical outcome.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively examined imaging parameters and clinical factors from consecutive patients with AIS treated with EVT who had a DECT 24 hours thereafter, identified at a single academic center. Associations between ICE, clinical, imaging, and procedural parameters, as well as clinical outcome were explored by using univariable and multivariable models.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;A total of 197 consecutive patients were included (period 2019–2020), of which 53 (27%) demonstrated ICE that was pure ICE in 30/53 (57%) and mixed with intracranial hemorrhage (ICH) in 23/53 (43%). Low initial-ASPECTS, high per-procedural-contrast volume injected, and high admission-glycemia were independently associated with ICE (respectively, OR = 0.43, 95% CI, 0.16–1.13, &lt;i&gt;P&lt;/i&gt; = .047; OR = 1.02, 95% CI, 1.00–1.04, &lt;i&gt;P&lt;/i&gt; = .003; OR = 8.92, 95% CI, 0.63–125.77, &lt;i&gt;P&lt;/i&gt; = .043). ICE was independently associated with ICH (&lt;i&gt;P&lt;/i&gt; = .047), but not with poorer clinical outcome (6-month mRS &amp;gt;2, &lt;i&gt;P&lt;/i&gt; = .223). Univariate analysis demonstrated that low ADC, higher ischemic volume, ICA occlusion, mass effect, longer procedure duration, combined thrombectomy technique, higher number of device passes, and lower recanalization rate were associated with ICE (respectively, &lt;i&gt;P&lt;/i&gt; = .002; &amp;lt;.001; .002; &amp;lt;.001; .002; 0.011; &amp;lt;0.001; 0.015).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;ICE evaluated with DECT is a relatively frequent finding after EVT, present in almost one-third of patients. Lower admission ASPECTS, higher glycemia, and high contrast volume injected per procedure were associated with ICE. We also found an association between ICE and ICH, confirming blood–brain barrier alteration as a major determinant of ICH.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2024/01/01" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A8081" />
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<meta name="citation_volume" content="45" />
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<meta name="citation_article_type" content="Research Article" />
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<meta name="citation_firstpage" content="30" />
<meta name="citation_lastpage" content="36" />
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<meta name="citation_author" content="Clémence Hoche" />
<meta name="citation_author_institution" content="bNeurology (C.H., M.G., M.P.), University Hospital of Tours, Tours, France" />
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<meta name="citation_author" content="Alba Henderson" />
<meta name="citation_author_institution" content="dDepartment of Diagnostic Neuroradiology (A.H., C.M., C.C.), University Regional Hospital of Orleans, Orléans, France" />
<meta name="citation_author" content="Héloïse Ifergan" />
<meta name="citation_author_institution" content="aFrom the Departments of Diagnostic and Interventional Neuroradiology (H.I., J.-P.C.,G.B.), University Hospital of Tours, Tours, France" />
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<meta name="citation_author_institution" content="dDepartment of Diagnostic Neuroradiology (A.H., C.M., C.C.), University Regional Hospital of Orleans, Orléans, France" />
<meta name="citation_author" content="Igor Maldonado" />
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<meta name="citation_author" content="Marco Pasi" />
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<meta name="citation_author_institution" content="dDepartment of Diagnostic Neuroradiology (A.H., C.M., C.C.), University Regional Hospital of Orleans, Orléans, France" />
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<meta name="twitter:title" content="Determinants and Clinical Relevance of Iodine Contrast Extravasation after Endovascular Thrombectomy: A Dual-Energy CT Study" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Iodine contrast extravasation (ICE) is common in patients with acute ischemic stroke (AIS) after endovascular-thrombectomy (EVT). The aim of our study was to evaluate the incidence of ICE assessed by dual-energy CT (DECT), its determinants, and associations with clinical outcome.

MATERIALS AND METHODS: We retrospectively examined imaging parameters and clinical factors from consecutive patients with AIS treated with EVT who had a DECT 24 hours thereafter, identified at a single academic center. Associations between ICE, clinical, imaging, and procedural parameters, as well as clinical outcome were explored by using univariable and multivariable models.

RESULTS: A total of 197 consecutive patients were included (period 2019–2020), of which 53 (27%) demonstrated ICE that was pure ICE in 30/53 (57%) and mixed with intracranial hemorrhage (ICH) in 23/53 (43%). Low initial-ASPECTS, high per-procedural-contrast volume injected, and high admission-glycemia were independently associated with ICE (respectively, OR = 0.43, 95% CI, 0.16–1.13, P = .047; OR = 1.02, 95% CI, 1.00–1.04, P = .003; OR = 8.92, 95% CI, 0.63–125.77, P = .043). ICE was independently associated with ICH ( P = .047), but not with poorer clinical outcome (6-month mRS &gt;2, P = .223). Univariate analysis demonstrated that low ADC, higher ischemic volume, ICA occlusion, mass effect, longer procedure duration, combined thrombectomy technique, higher number of device passes, and lower recanalization rate were associated with ICE (respectively, P = .002; &lt;.001; .002; &lt;.001; .002; 0.011; &lt;0.001; 0.015).

CONCLUSIONS: ICE evaluated with DECT is a relatively frequent finding after EVT, present in almost one-third of patients. Lower admission ASPECTS, higher glycemia, and high contrast volume injected per procedure were associated with ICE. We also found an association between ICE and ICH, confirming blood–brain barrier alteration as a major determinant of ICH.

AIS
:   acute ischemic stroke
BBB
:   blood-brain barrier
DECT
:   dual-energy computed tomography
EVT
:   endovascular thrombectomy
HU
:   Hounsfield units
ICC
:   intraclass correlation coefficient
ICE
:   iodine contrast extravasation
ICH
:   intracranial hemorrhage
IOM
:   iodine overlay map
VNC
:   virtual noncontrast" />
<meta name="og-title" property="og:title" content="Determinants and Clinical Relevance of Iodine Contrast Extravasation after Endovascular Thrombectomy: A Dual-Energy CT Study" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/45/1/30" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Iodine contrast extravasation (ICE) is common in patients with acute ischemic stroke (AIS) after endovascular-thrombectomy (EVT). The aim of our study was to evaluate the incidence of ICE assessed by dual-energy CT (DECT), its determinants, and associations with clinical outcome.

MATERIALS AND METHODS: We retrospectively examined imaging parameters and clinical factors from consecutive patients with AIS treated with EVT who had a DECT 24 hours thereafter, identified at a single academic center. Associations between ICE, clinical, imaging, and procedural parameters, as well as clinical outcome were explored by using univariable and multivariable models.

RESULTS: A total of 197 consecutive patients were included (period 2019–2020), of which 53 (27%) demonstrated ICE that was pure ICE in 30/53 (57%) and mixed with intracranial hemorrhage (ICH) in 23/53 (43%). Low initial-ASPECTS, high per-procedural-contrast volume injected, and high admission-glycemia were independently associated with ICE (respectively, OR = 0.43, 95% CI, 0.16–1.13, P = .047; OR = 1.02, 95% CI, 1.00–1.04, P = .003; OR = 8.92, 95% CI, 0.63–125.77, P = .043). ICE was independently associated with ICH ( P = .047), but not with poorer clinical outcome (6-month mRS &gt;2, P = .223). Univariate analysis demonstrated that low ADC, higher ischemic volume, ICA occlusion, mass effect, longer procedure duration, combined thrombectomy technique, higher number of device passes, and lower recanalization rate were associated with ICE (respectively, P = .002; &lt;.001; .002; &lt;.001; .002; 0.011; &lt;0.001; 0.015).

CONCLUSIONS: ICE evaluated with DECT is a relatively frequent finding after EVT, present in almost one-third of patients. Lower admission ASPECTS, higher glycemia, and high contrast volume injected per procedure were associated with ICE. We also found an association between ICE and ICH, confirming blood–brain barrier alteration as a major determinant of ICH.

AIS
:   acute ischemic stroke
BBB
:   blood-brain barrier
DECT
:   dual-energy computed tomography
EVT
:   endovascular thrombectomy
HU
:   Hounsfield units
ICC
:   intraclass correlation coefficient
ICE
:   iodine contrast extravasation
ICH
:   intracranial hemorrhage
IOM
:   iodine overlay map
VNC
:   virtual noncontrast" />
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      <h1 class="highwire-cite-title" id="page-title">Determinants and Clinical Relevance of Iodine Contrast Extravasation after Endovascular Thrombectomy: A Dual-Energy CT Study</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Clémence Hoche</span>, <span class="highwire-citation-author" data-delta="1">Alba Henderson</span>, <span class="highwire-citation-author" data-delta="2">Héloïse Ifergan</span>, <span class="highwire-citation-author" data-delta="3">Marie Gaudron</span>, <span class="highwire-citation-author" data-delta="4">Christophe Magni</span>, <span class="highwire-citation-author" data-delta="5">Igor Maldonado</span>, <span class="highwire-citation-author" data-delta="6">Jean-Philippe Cottier</span>, <span class="highwire-citation-author" data-delta="7">Marco Pasi</span>, <span class="highwire-citation-author" data-delta="8">Grégoire Boulouis</span> and <span class="highwire-citation-author" data-delta="9">Clara Cohen</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2024,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">45 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">30-36; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8081 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-105409--6608298496" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Clémence Hoche </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology (C.H., M.G., M.P.), University Hospital of Tours, Tours, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Cl%C3%A9mence%2BHoche%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hoche%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a 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class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology (C.H., M.G., M.P.), University Hospital of Tours, Tours, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Marie%2BGaudron%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gaudron%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AMarie%2BGaudron%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a 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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jan 2024, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">45 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">30-36; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8081 </span></div>
  
  
  
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