Background

Contrast-induced neurotoxicity (CIN) is an increasingly recognised complication following endovascular procedures utilising contrast. It remains poorly understood with heterogenous clinical management strategies. The aim of this review was to identify commonly employed treatments for CIN to enhance clinical decision making.

Methods

A systematic search of Embase (1947–2022) and Medline (1946–2022) was conducted. Articles describing (i) patients with a clinical diagnosis of CIN, (ii) with radiological exclusion of other pathologies, (iii) detailed report of treatments, and (iv) discharge outcomes, were included. Data relating to demographics, procedure, symptoms, treatment and outcomes were extracted.

Results

A total of 73 patients were included, with a median age of 64 years. The most common procedures were cerebral angiography (42.5%) and coronary angiography (42.5%), and the median volume of contrast administered was 150 ml. The most common symptoms were cortical blindness (38.4%) and reduced consciousness (28.8%), and 84.9% of patients experienced complete resolution at the time of discharge. Management included intravenous fluids to dilute contrast in the cerebrovasculature (54.8%), corticosteroids to reduce blood–brain barrier damage (47.9%), antiseizure (16.4%) and sedative (16.4%) medications. Mannitol (13.7%) was also utilised to reduce cerebral oedema. Intensive care admission was required for 19.2% of patients. No statistically significant differences were observed between treatment and discharge outcomes.

Conclusions

The clinical management of CIN should be considered on a patient-by-patient basis, but may consist of aggressive fluid therapy alongside corticosteroids, as well as other supportive therapy as required. Further examination of CIN management is required to define best practice.

中文翻译：

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对比剂引起的神经毒性的临床管理：系统评价

背景

造影剂引起的神经毒性（CIN）是使用造影剂的血管内手术后越来越多的人认识到的并发症。对于异质临床管理策略仍然知之甚少。本次综述的目的是确定 CIN 的常用治疗方法，以增强临床决策。

方法

对 Embase (1947-2022) 和 Medline (1946-2022) 进行了系统检索。文章描述了 (i) 临床诊断为 CIN 的患者，(ii) 放射学排除其他病理，(iii) 详细的治疗报告，以及 (iv) 出院结果。提取了与人口统计、手术、症状、治疗和结果相关的数据。

结果

共有 73 名患者纳入研究，中位年龄为 64 岁。最常见的手术是脑血管造影（42.5%）和冠状动脉造影（42.5%），造影剂的中位剂量为 150 ml。最常见的症状是皮质失明（38.4%）和意识下降（28.8%），84.9%的患者在出院时完全缓解。治疗方法包括静脉输液以稀释脑血管造影剂（54.8%）、皮质类固醇以减少血脑屏障损伤（47.9%）、抗癫痫药物（16.4%）和镇静药物（16.4%）。甘露醇（13.7%）也被用来减少脑水肿。 19.2%的患者需要接受重症监护。治疗和出院结果之间没有观察到统计学上的显着差异。

结论

CIN 的临床治疗应根据患者情况进行考虑，但可能包括积极的液体治疗和皮质类固醇治疗，以及其他所需的支持治疗。需要进一步检查 CIN 管理以确定最佳实践。