Contrast-induced encephalopathy following intra- arterial iodinated contrast media injection in patients with atherosclerotic cardiovascular disease: A retrospective analysis

Abstract

Background & Objective: This study examined the current status of contrast-induced encephalopathy (CIE) following intra-arterial iodinated contrast media injection in patients with atherosclerotic cardiovascular disease (ASCVD). Specifically, we aimed to examine the clinical, epidemiological characteristics, pathogenic mechanisms, and clinical symptoms of CIE in patients with ASCVD in order to promote its prompt diagnosis and treatment.

Methods: Chinese and English scientific databases were searched using the following search terms: atherosclerotic cardiovascular disease, contrast- induced encephalopathy, neurotoxicity, encephalopathy, brain injury, cortical blindness, cerebral/carotid arteriography, cardiac catheterization, coronary angiography, percutaneous coronary intervention, and peripheral arteriography. The retrieved articles and references of the primary articles were used to collect the basic information. SPSS 20.0 and Excel statistic software were used to conduct this retrospective analysis.

Results: A total of 89 cases consisting of 87 patients were identified. Of all the patients, 59 (67.05%) were male. Patients had an average age of 67.12 + 10.51 years. In addition, 64 (73.56%) had hypertension, 26 (29.89) had diabetes mellitus, 14 (16.09%) had renal impairment, and 5 (5.75%) had old cerebral infarction or transient cerebral ischemia. The mean and median volumes of administered iodinated contrast media were 228.41 and 190 ml, respectively (range: 25–1500 ml). The symptoms included cortical blindness (24.72%), delirium (13.48%), hemiplegia (10.11%), seizure (8.99%), and ophthalmoplegia (5.62%). The symptoms typically appeared within minutes to hours following the contrast administration and always resolved entirely within 24–72 hours. Only 4 patients suffered irreversible damage; 1 of these patients died after 56 days of treatment.

Conclusions: CIE is a rare complication during the intervention procedure. It has variable presentations with an excellent prognosis. Nevertheless, it can result in clinical complications, such as neurological sequelae or even death on rare occasions. Therefore, physicians should pay close attention to implementing appropriate measures.