臨床與影像特色與動脈取栓後顯影劑引起的腦病風險

Abstract

顯影劑誘發性腦病變(Contrast-Induced Encephalopathy, CIE)是急性缺血性中風接受血管內取栓術後罕見但嚴重的併發症。本研究旨在探討與 CIE 相關的臨床及 影像風險因子。 本研究為前瞻性資料蒐集回顧性分析研究，蒐集 2015 年九月至 2024 年八月間於台大醫院接受血管內取栓術治療患者其臨床資料、實驗室檢驗結果、影像特徵與 顯影劑使用量，並以無母數方法分析。 共 887 位患者納入分析，其中 22 位(2.48%)發生 CIE。CIE 患者年齡較高、體重較輕，具有較高比例的既往中風、心臟疾病及腎功能不全，並接受較高濃度的顯影劑。Firth 校正邏輯回歸分析顯示，較低的 eGFR(OR 0.96; 95% CI, 0.94– 0.98)、既往中風(OR 2.58; 95% CI, 1.02–6.51)、M2 段阻塞(OR 3.53;95% CI, 1.39–8.92)及較高的體重校正顯影劑劑量(OR 3.96; 95% CI, 1.57–10.02)皆為 CIE 的獨立風險因子。CIE 雖未與死亡率增加相關，但與較差的功能預後有關。 結論:腎功能不良、既往中風、大腦中動脈 M2 段阻塞及過量顯影劑使用與 CIE 風險升高相關。術前個體化顯影劑劑量調整與風險評估有助於降低 CIE 風險並改 善血管內取栓術後恢復情形。

Background Contrast-Induced Encephalopathy (CIE) is a rare but serious complication after endovascular thrombectomy (EVT) for acute ischemic stroke. This study aimed to identify clinical and imaging risk factors for CIE. Method We retrospectively reviewed 887 patients who received EVT between September 2015 and August 2024 at National Taiwan University Hospital. Clinical profiles, laboratory data, imaging features, and contrast usage were analyzed by non-parametric statistical methods. Firth’s penalized logistic regression was employed to identify independent risk factor of CIE, accounting for rare event bias. Results There are 887 patients analyzed and CIE occurred in 22 patients (2.48%). These patients were older, had lower body weight, more prior stroke, heart disease, renal impairment, and higher contrast concentration. Firth’s logistic regression showed that lower eGFR (OR 0.96; 95% CI, 0.94–0.98), prior stroke (OR 2.58; 95% CI, 1.02–6.51), M2 occlusion (OR 3.53; 95% CI, 1.39–8.92), and higher contrast concentration (OR 3.96; 95% CI, 1.57–10.02) were independently associated with CIE. CIE was not associated with increased mortality but was linked to poorer functional outcomes. Conclusion Poor renal function, previous stroke, occlusion at M2, and excessive contrast dosing are associated with CIE. Individualized contrast dosing and pre- procedural risk stratification may reduce CIE risk and improve post-EVT recovery.