Greater intraprocedural systolic blood pressure and blood pressure variability are associated with contrast-induced neurotoxicity after neurointerventional procedures

Cynthia B Zevallos; Biyue Dai; Sudeepta Dandapat; Darko Quispe-Orozco; Andrea Holcombe; Sameer Ansari; Mudassir Farooqui; Colin P Derdeyn; Edgar A Samaniego; Santiago Ortega-Gutierrez

doi:10.1016/j.jns.2020.117209

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Greater intraprocedural systolic blood pressure and blood pressure variability are associated with contrast-induced neurotoxicity after neurointerventional procedures

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Greater intraprocedural systolic blood pressure and blood pressure variability are associated with contrast-induced neurotoxicity after neurointerventional procedures

Cynthia B Zevallos, Biyue Dai, Sudeepta Dandapat, Darko Quispe-Orozco, Andrea Holcombe, Sameer Ansari, Mudassir Farooqui, Colin P Derdeyn, Edgar A Samaniego and Santiago Ortega-Gutierrez

Journal of the neurological sciences, Vol.420, pp.117209-117209

01/15/2021

DOI: 10.1016/j.jns.2020.117209

PMID: 33187680

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Abstract

Contrast-induced neurotoxicity (CIN) is a rare complication of neurointerventional procedures and its understanding remains limited. We evaluated the association of CIN with systemic hemodynamics in patients undergoing neuroendovascular interventions. We conducted a 1:2 matched case-control study from a prospectively collected database of 2510 neurointerventional patients. We defined CIN as new neurological deficits presented ≤24 h post-operation after excluding other possible etiologies. We obtained demographic, clinical and imaging data, and baseline and intraprocedural blood pressures (BP) from medical records. The area between baseline and intraprocedural BP was used to measure sustained variability of BP over time. A generalized linear mixed model and generalized estimating equation were used to analyze the BP difference between groups over time. We evaluated 11 CIN cases and 22 controls. 2746 and 5837 min of continued BP data were analyzed for cases and controls, respectively. CIN cases had higher measurements and greater variability for: Systolic BP (SBP) [median 125 (IQR:121–147) vs. 114 (IQR:107–124) mmHg], median area above baseline [median 350 (IQR:25–1328) vs. 52 (IQR:0–293) mmHg*minutes] and mean arterial pressure (MAP) [median 85 (IQR:79–98) vs. 80 (IQR:74–89) mmHg]. CIN cases demonstrated a significant mean increase in SBP and MAP of 23.41 mmHg (p < 0.01) and 13.79 mmHg (p < 0.01) when compared to controls, respectively, over the perioperative time. Sustained hypertension and high BP variability may contribute to the pathophysiology of CIN. Acute hypertension can increase blood-brain barrier permeability and potentially allow contrast to leak into the brain parenchyma causing direct toxicity and CIN symptoms. •Contrast-induced neurotoxicity is rare, but its awareness and diagnosis are essential in the neurointerventional practice.•Uncontrolled procedural SBP above patient baseline and increased BP variability might contribute to the development of CIN.•These might increase BBB permeability,allow contrast leak into the brain parenchyma, and causee direct toxicity.•CIN includes new, gradual, and focal neurological symptoms that correlate with a pattern of hemispheric edema on head CT.

Contrast agents

Blood pressure

Neurotoxicity syndrome

Blood-brain barrier

Cerebral angiography

Details

Title: Subtitle: Greater intraprocedural systolic blood pressure and blood pressure variability are associated with contrast-induced neurotoxicity after neurointerventional procedures
Creators: Cynthia B Zevallos - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Biyue Dai - Department of Biostatistics, University of Iowa, Iowa City, IA, USA
Sudeepta Dandapat - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Darko Quispe-Orozco - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Andrea Holcombe - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Sameer Ansari - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Mudassir Farooqui - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Colin P Derdeyn - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Edgar A Samaniego - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Santiago Ortega-Gutierrez - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Resource Type: Journal article
Publication Details: Journal of the neurological sciences, Vol.420, pp.117209-117209
DOI: 10.1016/j.jns.2020.117209
PMID: 33187680
NLM abbreviation: J Neurol Sci
ISSN: 0022-510X
eISSN: 1878-5883
Publisher: Elsevier B.V
Language: English
Date published: 01/15/2021
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery; Internal Medicine
Record Identifier: 9984070208402771

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