Comparative Observation Of Adverse Events Of Second And Third Generation Iodinated Contrast Medium In Cerebrovascular Interventional Surgery

[Background] With the widespread use of iodinated contrast medium(ICM),the reports of iodinated contrast medium induced adverse events(AEs)are also increasing.However,most iodinated contrast medium induced adverse events are mild and not life-threatening events,severe iodinated contrast medium induced adverse events have been reported.At present,the difference of adverse events caused by the injection of second and third generation iodinated contrast agents is still controversial,especially in the cerebrovascular interventional surgery.[Aim] We tried to indentify both the occurrence and severity of adverse events and risk factors for second(ioversol)and third(iodixanol)generation iodinated contrast agents in cerebrovascular interventional surgery[Materials and method] This is a prospective,single-center,double-blind,randomized cohort clinical study.This study included 1015 patients with suspicion of cerebrovascular disease who received cerebrovascular intervention surgery between July 2019 and July 2022 at the Department of Neurology of the 940 th Hospital of Joint Logistics Support force of Chinese People’s Liberation Army.The baseline characteristics of patients were recorded,and the symptoms,timing and severity of adverse reactions were prospectively collected.To evaluate both the difference of adverse events and risk factors for second(ioversol)and third(iodixanol)generation iodinated contrast agents in cerebrovascular interventional surgery.[Result] A total of 1015 patients were included during the study,and 99 participants were excluded according to the exclusion criteria.The remaining 916 participants were injected with iodinated contrast agent according to the random distribution table of iodinated contrast agent,and were divided into ioversol group or iodixanol group according to the injected iodinated contrast agent.68 participants were excluded because they did not receive postoperative renal function.Finally,among 848 patients(mean age±standard deviation,61.48 years±12.57,and 24.2% female)who underwent ICM administration,the overall prevalence of ioversol-related AEs was 34.6%(143 of 413),and iodixanol-related AEs occurred in 28.3%(123 of 435).With regard to moderate and sever AEs,proportion of iodixanol and ioversol was 2.4% and 5.7%,respectively.With regard to timing,proportion of iodixanol and ioversol of acute AEs was 29.8% and 20.5%,respectively,whereas that of iodixanol and ioversol of delayed AEs was 7.5% and 11.5% respectively.With regard to symptom,proportion of iodixanol and ioversol of CNS symptom was 12.6% and 21.1%,respectively,whereas that of iodixanol and ioversol of cutaneous symptom was 5.5% and1.7%,respectively.Logistic regression analysis revealed that history of allergic diseases was a risk factor for iodixanol-related AEs(Adjusted OR=2.645;95%CI 1.306-5.357;P=0.007).Severe cerebral vascular stenosis(Adjusted OR=2.916;95%CI 1.858-4.578;P<0.001),and age(Adjusted OR=0.976;95%CI 0.958-0.995;P=0.012)were risk factors for ioversol-related AEs.[Conclusion] Compared with other arterial and venous routes of ICM injection,the risk of central nervous system symptom may be increased by repeated direct injection of ICM in cerebrovascular interventional surgery.Patients receiving iodixanol administration yielded a lower rate of AEs than patients receiving ioversol administration in this prospective randomized study of cerebrovascular interventional surgery.However,in clinical practice,more of patients receiving iodixanol administration need symptomatic treatment.Iodixanolrelated AEs is associated with history of allergic diseases,and ioversol-related AEs is associated with severe cerebral vascular stenosis.