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<meta name="DC.Title" content="Outcome Differences between Intra-Arterial Iso- and Low-Osmolality Iodinated Radiographic Contrast Media in the Interventional Management of Stroke III Trial" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4421" />
<meta name="DC.Date" content="2015-07-30" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2015 American Society of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
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<meta name="DC.Description" content="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.

### Abbreviations

EVT
:   endovascular therapy
IA
:   intra-arterial
ICH
:   intracranial hemorrhage
IMS III
:   Interventional Management of Stroke III Trial
IRCM
:   iodinated radiographic contrast media
LOCM
:   low-osmolal contrast media
MCI
:   microcatheter injection
mTICI
:   modified TICI
SICH
:   symptomatic intracranial hemorrhage" />
<meta name="DC.Contributor" content="T.A. Tomsick" />
<meta name="DC.Contributor" content="L.D. Foster" />
<meta name="DC.Contributor" content="D.S. Liebeskind" />
<meta name="DC.Contributor" content="M.D. Hill" />
<meta name="DC.Contributor" content="J. Carrozella" />
<meta name="DC.Contributor" content="M. Goyal" />
<meta name="DC.Contributor" content="R. von Kummer" />
<meta name="DC.Contributor" content="A.M. Demchuk" />
<meta name="DC.Contributor" content="I. Dzialowski" />
<meta name="DC.Contributor" content="V. Puetz" />
<meta name="DC.Contributor" content="T. Jovin" />
<meta name="DC.Contributor" content="H. Morales" />
<meta name="DC.Contributor" content="Y.Y. Palesch" />
<meta name="DC.Contributor" content="J. Broderick" />
<meta name="DC.Contributor" content="P. Khatri" />
<meta name="DC.Contributor" content="S.D. Yeatts" />
<meta name="DC.Contributor" content="IMS III Investigators" />
<meta name="article:published_time" content="2015-07-30" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="Outcome Differences between Intra-Arterial Iso- and Low-Osmolality Iodinated Radiographic Contrast Media in the Interventional Management of Stroke III Trial" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;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 H&lt;sub&gt;2&lt;/sub&gt;O) 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).&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;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 (&lt;i&gt;n&lt;/i&gt; = 31) or low-osmolal contrast media (&lt;i&gt;n&lt;/i&gt; = 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.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_issn" content="1936-959X" />
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<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="INTERVENTIONAL" />
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<meta name="citation_author" content="T.A. Tomsick" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="L.D. Foster" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="D.S. Liebeskind" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="M.D. Hill" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-6269-1543" />
<meta name="citation_author" content="J. Carrozella" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="M. Goyal" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="R. von Kummer" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="A.M. Demchuk" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="I. Dzialowski" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="V. Puetz" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="T. Jovin" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="H. Morales" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="Y.Y. Palesch" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="J. Broderick" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="P. Khatri" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="S.D. Yeatts" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_author" content="IMS III Investigators" />
<meta name="citation_author_institution" content="From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania." />
<meta name="citation_fulltext_world_readable" content="" />
<meta name="twitter:title" content="Outcome Differences between Intra-Arterial Iso- and Low-Osmolality Iodinated Radiographic Contrast Media in the Interventional Management of Stroke III Trial" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="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.

### Abbreviations

EVT
:   endovascular therapy
IA
:   intra-arterial
ICH
:   intracranial hemorrhage
IMS III
:   Interventional Management of Stroke III Trial
IRCM
:   iodinated radiographic contrast media
LOCM
:   low-osmolal contrast media
MCI
:   microcatheter injection
mTICI
:   modified TICI
SICH
:   symptomatic intracranial hemorrhage" />
<meta name="og-title" property="og:title" content="Outcome Differences between Intra-Arterial Iso- and Low-Osmolality Iodinated Radiographic Contrast Media in the Interventional Management of Stroke III Trial" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2015/07/30/ajnr.A4421" />
<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: 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.

### Abbreviations

EVT
:   endovascular therapy
IA
:   intra-arterial
ICH
:   intracranial hemorrhage
IMS III
:   Interventional Management of Stroke III Trial
IRCM
:   iodinated radiographic contrast media
LOCM
:   low-osmolal contrast media
MCI
:   microcatheter injection
mTICI
:   modified TICI
SICH
:   symptomatic intracranial hemorrhage" />
<meta name="og-type" property="og:type" content="article" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node51329--5" data-node-nid="51329" id="top-node-51329--61914270146" data-pisa="ajnr;ajnr.A4421v1" data-pisa-master="ajnr;ajnr.A4421" data-apath="/ajnr/early/2015/07/30/ajnr.A4421.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">INTERVENTIONAL</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Outcome Differences between Intra-Arterial Iso- and Low-Osmolality Iodinated Radiographic Contrast Media in the Interventional Management of Stroke III Trial</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">T.A. Tomsick</span>, <span class="highwire-citation-author" data-delta="1">L.D. Foster</span>, <span class="highwire-citation-author" data-delta="2">D.S. Liebeskind</span>, <span class="highwire-citation-author" data-delta="3">M.D. Hill</span>, <span class="highwire-citation-author" data-delta="4">J. Carrozella</span>, <span class="highwire-citation-author" data-delta="5">M. Goyal</span>, <span class="highwire-citation-author" data-delta="6">R. von Kummer</span>, <span class="highwire-citation-author" data-delta="7">A.M. Demchuk</span>, <span class="highwire-citation-author" data-delta="8">I. Dzialowski</span>, <span class="highwire-citation-author" data-delta="9">V. Puetz</span>, <span class="highwire-citation-author" data-delta="10">T. Jovin</span>, <span class="highwire-citation-author" data-delta="11">H. Morales</span>, <span class="highwire-citation-author" data-delta="12">Y.Y. Palesch</span>, <span class="highwire-citation-author" data-delta="13">J. Broderick</span>, <span class="highwire-citation-author" data-delta="14">P. Khatri</span>, <span class="highwire-citation-author" data-delta="15">S.D. Yeatts</span> and <span class="highwire-citation-author" data-delta="16"><span class="nlm-collab" data-hwp-id="collab-1">IMS III Investigators</span></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">July 2015,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4421 </span></div>
  
  
  
</div>
<div id="hw-article-author-popups-top-node-51329--61914270146" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">T.A. Tomsick </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania.</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=T.A.%2BTomsick%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=Tomsick%20T&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 last"><a href="/search/author1%3AT.A.%2BTomsick%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">L.D. Foster </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania.</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=L.D.%2BFoster%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=Foster%20L&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 last"><a href="/search/author1%3AL.D.%2BFoster%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">D.S. Liebeskind </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania.</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=D.S.%2BLiebeskind%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=Liebeskind%20D&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 last"><a href="/search/author1%3AD.S.%2BLiebeskind%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">M.D. Hill </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania.</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=M.D.%2BHill%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=Hill%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%3AM.D.%2BHill%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 href="http://orcid.org/0000-0002-6269-1543" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.D. Hill</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">J. Carrozella </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania.</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=J.%2BCarrozella%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=Carrozella%20J&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 last"><a href="/search/author1%3AJ.%2BCarrozella%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">M. Goyal </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania.</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=M.%2BGoyal%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=Goyal%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 last"><a href="/search/author1%3AM.%2BGoyal%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">R. von Kummer </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania.</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=R.%2Bvon%2BKummer%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=von%20Kummer%20R&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 last"><a href="/search/author1%3AR.%2Bvon%2BKummer%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">A.M. Demchuk </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania.</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=A.M.%2BDemchuk%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=Demchuk%20A&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 last"><a href="/search/author1%3AA.M.%2BDemchuk%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">I. Dzialowski </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania.</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=I.%2BDzialowski%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=Dzialowski%20I&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 last"><a href="/search/author1%3AI.%2BDzialowski%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">V. Puetz </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. 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Yeatts </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (T.A.T., J.C., H.M.), University of Cincinnati Academic Health Center, University Hospital, Cincinnati, Ohio; Department of Public Health Sciences (L.D.F., Y.Y.P., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina; University of California, Los Angeles Stroke Center (D.S.L.), Los Angeles, California; Department of Radiology and Clinical Neurosciences (M.D.H., M.G.) and Calgary Stroke Program (A.M.D.), Department of Clinical Neurosciences/Medicine/Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Departments of Neuroradiology (R.v.K.) and Neurology (V.P.), Dresden University Stroke Center, Universitädatsklinikum Carl Gustav Carus Technischen Universitädat Dresden, Dresden, Germany; Department of Neurology (I.D.), Elblandklinikum Meissen, Academic Teaching Hospital of Universitädatsklinikum, Carl Gustav Carus Technische Universitädat Dresden, MeißSen, Germany; Department of Neurology (J.B., P.K.), University of Cincinnati Academic Health Center, Cincinnati, Ohio; and The Stroke Institute (T.J.), University of Pittsburgh Medical Center, Pittsburgh. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> 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 H<sub>2</sub>O) 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).</p></div><div id="sec-2" class="subsection"><p id="p-3"><strong>MATERIALS AND METHODS:</strong> 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 (<em>n</em> = 31) or low-osmolal contrast media (<em>n</em> = 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.</p></div><div id="sec-3" class="subsection"><p id="p-4"><strong>RESULTS:</strong> 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.</p></div><div id="sec-4" class="subsection"><p id="p-5"><strong>CONCLUSIONS:</strong> 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.</p></div></div><div class="section glossary" id="glossary-1"><h3>Abbreviations</h3><dl id="def-list-1"><dt id="def-item-1">EVT<span class="def-item-dt-sep"></span></dt><dd>endovascular therapy<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">IA<span class="def-item-dt-sep"></span></dt><dd>intra-arterial<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">ICH<span class="def-item-dt-sep"></span></dt><dd>intracranial hemorrhage<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">IMS III<span class="def-item-dt-sep"></span></dt><dd>Interventional Management of Stroke III Trial<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">IRCM<span class="def-item-dt-sep"></span></dt><dd>iodinated radiographic contrast media<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">LOCM<span class="def-item-dt-sep"></span></dt><dd>low-osmolal contrast media<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">MCI<span class="def-item-dt-sep"></span></dt><dd>microcatheter injection<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">mTICI<span class="def-item-dt-sep"></span></dt><dd>modified TICI<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">SICH<span class="def-item-dt-sep"></span></dt><dd>symptomatic intracranial hemorrhage</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2015 American Society of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-1">Indicates open access to non-subscribers at <a href="http://www.ajnr.org" rel="license">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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      <div class="highwire-cite-title">Outcome Differences between Intra-Arterial Iso- and Low-Osmolality Iodinated Radiographic Contrast Media in the Interventional Management of Stroke III Trial</div>  
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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">Jul 2015, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4421 </span></div>
  
  
  
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      <div class="highwire-cite-title">Outcome Differences between Intra-Arterial Iso- and Low-Osmolality Iodinated Radiographic Contrast Media in the Interventional Management of Stroke III Trial</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">T.A.</span> <span class="nlm-surname">Tomsick</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">L.D.</span> <span class="nlm-surname">Foster</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">D.S.</span> <span class="nlm-surname">Liebeskind</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">M.D.</span> <span class="nlm-surname">Hill</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Carrozella</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Goyal</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">R.</span> <span class="nlm-surname">von Kummer</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">A.M.</span> <span class="nlm-surname">Demchuk</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">I.</span> <span class="nlm-surname">Dzialowski</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Puetz</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Jovin</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Morales</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">Y.Y.</span> <span class="nlm-surname">Palesch</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Broderick</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Khatri</span></span>, <span class="highwire-citation-author" data-delta="15"><span class="nlm-given-names">S.D.</span> <span class="nlm-surname">Yeatts</span></span>, <span class="highwire-citation-author" data-delta="16"><span class="nlm-collab" data-hwp-id="collab-1">IMS III Investigators</span></span></span></div>
  
    	<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">Jul 2015, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4421 </span></div>
  
  
  
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