Abstract T P12: Intraarterial (IA) Iodinated Radiographic Contrast Media (IRCM) Effect in the Interventional Management of Stroke (IMS) III Trial
Background: IRCM have variable anti-thrombotic, fibrinolytic, cytotoxic, hydrostatic, and vasoactive effects. IA low-osmolar iohexol (~700 mOsm/L) was associated with increased ICH in a rat MCA occlusion model compared to saline infusion. IA isosmolar iodixanol (280 mOsm/L) was associated with smaller infarcts and less ICH versus low-osmolar iopamidol and saline. Reduced odds of favorable outcome in patients receiving IV IRCM prior to IV rtPA has been suggested. No human stroke study has compared outcomes according to IA IRCM use.
Methods: 133 IMS III subjects underwent endovascular therapy (EVT) for M1 occlusion. mTICI 2B-3 reperfusion, 90-day mRS 0-2, asymptomatic ICH, symptomatic ICH, and 90-day mortality were analyzed according to use of either iso-osmolar iodixanol (n=31) or low-osmolar IRCM (n=102). Separate adjusted models were fit for each outcome. Variables imbalanced between IRCM types or associated with outcome (p<0.1) were considered potential covariates for adjusted models, including antiplatelet medication (67.7% iodixanol vs. 44.1%, p=0.021), coronary artery disease history (35.5% iodixanol vs. 19.6%, p=0.067) and age (iodixanol median 73 vs. 68.5 yrs, p=0.070). Adjusted relative risks were estimated using a log-link regression model following stepwise selection of covariates.
Results: % Differences for all specified outcomes in favor of the iodixanol group were identified. None of 11 baseline or EVT variables linked to outcome was in favor of the iodixanol group (p < 0.3). Unadjusted and adjusted relative risk point estimates were in favor of the iodixanol group for all specified outcomes (Table).
Conclusion: While there were no significant differences, relative risk point estimates for relevant specified endpoints for M1 occlusion are in favor of iodixanol use. Small sample size limits ability to show significant differences. Data remains hypothesis-generating. Potential mechanisms warrant further investigation.
Author Disclosures: T. Tomsick: Research Grant; Significant; Research Grant; Significant; NINDS- Interventional Co-PI, IMS III trial. L.D. Foster: Research Grant; Significant; unblinded statistician for IMS III Trial. S.D. Yeatts: Research Grant; Significant; NINDS- unblinded statistician IMS III Trial. Consultant/Advisory Board; Significant; Genentech - PRISMS trial Steering Committee member. M.D. Hill: Research Grant; Significant; Hoffmann-La Roche Canada- grant with drug supplied for clinical trial, Covidien- Grant for clinical trial. J. Carrozzella: None. D.S. Liebeskind: Consultant/Advisory Board; Modest; Stryker, Covidien. Research Grant; Significant; NIH-NINDS. P. Khatri: Research Grant; Modest; Dr. Khatri’s Dept of Neurology receives support for her role DSMB member from Biogen, Inc.. Research Grant; Significant; Dr. Khatri’s Dept of Neurology receives support for her roles as: (1) Lead PI of the PRISMS trial from Genentech, Inc and (2) Neurology PI of the THERAPY trial from Penumbra, Inc. M. Goyal: Research Grant; Significant; Institutional Grant by Covidien to partially fund ESCAPE trial. Consultant/Advisory Board; Significant; Covidien (for conduct and design of SWIFT PRIME trial; for education). V. Puetz: None. I. Dzialowski: None. H. Morales: None. A.M. Demchuk: Honoraria; Modest; Covidien honoraria for CME. Research Grant; Significant; Unrestricted grant for ESCAPE trial: Covidien. Y.Y. Palesch: None. J.P. Broderick: Research Grant; Significant; NINDS- PI IMS III trial. Other Research Support; Modest; Genentech - Drug supplied to IMS III trial. Consultant/Advisory Board; Modest; Genentech - Steering Committee member PRISMS trial.
- © 2015 by American Heart Association, Inc.