Contrast-induced Neurotoxicity After Cardiac Catheterization:A Case Report And A Comprehensive Anaysis Of 112 Cases

We report a 72-year-old male developed headache,decreased consciousness,agitation and nocturnal delirium after receiving percutaneous coronary intervention(PCI)on the chronic total occlusion(CTO)lesion of his right coronary artery with administration of nonionic,low-osmolar contrast iopamidol.Brain CT and MRI did not show hemorrhage or infarction.With supportive treatments he recovered soon without any other complications.ObjectiveContrast-induced neurotoxicity(CIN)is an acute but reversible neurological disturbance caused by iodinated contrast agents administration during cardiac catheterization.This research aims to identify risk factors that contribute to the duration of CIN and to describe the epidemiology,pathogenesis,clinical manifestation,treatment and prognosis of CIN following cardiac catheterization.Methods and ResultsThe First Part:The Pubmed,Medline and Web of Science databases were searched and all relevant cases were reviewed.Data was collected and analyzed through Kaplan-Meier and COX regression for survival and hazard curves.Epidemiology,pathogenesis,clinical manifestation,treatment and prognosis of CIN following cardiac catheterization were described by reviewing all relevant articles.The Second Part:73 reports including 112 cases of CIN following cardiac catheterization were found.Male sex consists of 59.82%of cases.Hypertension can be observed in 50.89%of cases.Nonionic and low-osmolar contrasts are applied in more than 50%of cases.Transient cortical blindness(TCB)is the most commonly reported symptom occurring in 58.93%of cases.Symptoms can occur during or 72 hours after the procedure.The average time of clinical resolution is 37.78±44.15 hours ranging from 15 minutes to 6 weeks.The male sex(HR:1.666,95%CI 0.990～2.804,p=0.055),high-osmolality(HR:1.806,95%CI 0.406-8.035,p=0.019)might play protective role in CIN recovery while hypertension(HR:0.221,95%CI 0.085～0.575,p=0.002)might be a hazard factor impeding CIN recovery.ConclusionsCIN is a rare but important complication which should be differentiated from cerebral infarction following cardiac catheterization.Male,high-osmolality may be helpful while hypertension is detrimental to CIN recovery.Since the prognosis is excellent with supportive treatment only,CIN should not be ignored to avoid unnecessary thrombolysis or mistaken stop of antiplatelet drugs.