Subarachnoid iodine leakage on dual-energy computed tomography after mechanical thrombectomy is associated with malignant brain edema

Sounds like your competent? doctor needs to create a testing protocol for this and then an intervention to prevent this edema from happening! At least leaders in stroke would do that. IS YOUR DOCTOR A LEADER?  Or a mouse?

Subarachnoid iodine leakage on dual-energy computed tomography after mechanical thrombectomy is associated with malignant brain edema

1. http://orcid.org/0000-0002-4478-0251Atsushi Ogata1,
2. Kuniaki Ogasawara2,
3. Masashi Nishihara3,
4. Ayako Takamori4,
5. Takashi Furukawa1,
6. Toshihiro Ide5,
7. Hiroshi Ito1,
8. Fumitaka Yoshioka1,
9. Yukiko Nakahara1,
10. Jun Masuoka1,
11. Haruki Koike5,
12. Hiroyuki Irie3,
13. Tatsuya Abe1

1. Correspondence to Dr Atsushi Ogata, Department of Neurosurgery, Saga University, Saga, 849-8501, Japan; ogata.a24@gmail.com

Abstract

Background Dual-energy computed tomography (DE-CT) can differentiate between hemorrhage and iodine contrast medium leakage following mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We determined whether subarachnoid hemorrhage (SAH) and subarachnoid iodine leakage (SAIL) on DE-CT following MT were associated with malignant brain edema (MBE).

Methods We analyzed the medical records of 81 consecutive anterior circulation AIS patients who underwent MT. SAH or SAIL was diagnosed via DE-CT performed immediately after MT. We compared the procedural data, infarct volumes, MBE, and modified Rankin scale 0–2 at 90 days between patients with and without SAH and between patients with and without SAIL. Furthermore, we evaluated the association between patient characteristics and MBE.

Results A total of 20 (25%) patients had SAH and 51 (63%) had SAIL. No difference in diffusion-weighted imaging (DWI)-infarct volume before MT was observed between patients with and without SAH or patients with and without SAIL. However, patients with SAIL had larger DWI-infarct volumes 1 day following MT than patients without SAIL (95 mL vs 29 mL; p=0.003). MBE occurred in 12 of 81 patients (15%); more patients with SAIL had MBE than patients without SAIL (22% vs 3%; p=0.027). Severe SAIL was significantly associated with MBE (OR, 12.5; 95% CI, 1.20–131; p=0.006), whereas SAH was not associated with MBE.

Conclusion This study demonstrated that SAIL on DE-CT immediately after MT was associated with infarct volume expansion and MBE.

Data availability statement

Data sharing not applicable as no datasets generated and/or analyzed for this study.

https://doi.org/10.1136/jnis-2023-021413