What are the possible complications and adverse effects of stroke imaging?

Updated: Nov 30, 2018
  • Author: Andrew Danziger; Chief Editor: L Gill Naul, MD  more...
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Answer

The benefits and risks should be fully described and informed consent obtained prior to any diagnostic or interventional procedure or other treatment. This includes risk of radiation exposure for patients undergoing CT scanning or angiography.

Proper screening for implanted metallic devices (eg, pacemakers and defibrillators, cochlear implants) must be obtained prior to MRI.

Prior to administering intravenous contrast for CT, MRI and angiography or any medication, history of allergies should be elicited. Alternative methods for diagnosis, including noncontrast examinations, should be pursued in all patients with history of contrast allergy. If absolutely necessary, a standard premedication regimen should be administered for those who are at risk prior to the contrast examination.

Iodinated contrast agents run the risk of contrast-induced nephropathy. The use of iodinated contrast, especially in a patient population at risk for contrast nephropathy (eg, diabetics and those with compromised renal function) should be viewed with caution and only performed if absolutely necessary. Standard prophylaxis for contrast-induced nephropathy should therefore be strongly considered in patients who are at risk before contrast administration.

Gadolinium-based intravenous contrast agents have been linked to the development of nephrogenic systemic fibrosis or nephrogenic fibrosing dermopathy (NSF/NFD) in patients with moderate to end-stage renal insufficiency. For this reason, the ACR recommends screening at-risk patients' glomerular filtration rates prior to contrast-enhanced MRI. If the MRI examination is absolutely necessary, half (or lower) dose administration of some gadolinium-based agents may be considered in patients with GFR between 30–59 mL/min per 1.73 m2. Renal consultation is recommend for those with GFR below 30 mL/min per 1.73 m2, with the ACR recommending 2 dialysis sessions within 24 hours for hemodialysis patients receiving gadolinium-based MR contrast agents, beginning as soon as the MR examination is completed. [132]

Patients must be carefully selected according to established guidelines prior to administering thrombolytics or mechanical thrombectomy due to the inherent risk of hemorrhagic conversion of a bland ischemic infarct following reperfusion.

Other procedure specific risks for cerebral angiography and neurovascular interventional procedures include embolization of thrombus in ischemic stroke, aneurysm perforation with hemorrhage during coil embolization, and arterial dissection.

Complications from femoral artery puncture include localized hematoma at the groin puncture site, retroperitoneal hematoma, dissection, pseudoaneurysm, and arteriovenous fistula formation.


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