Safety following mechanical thrombectomy for acute ischemic stroke using iso-osmolar contrast media

Purpose Mechanical thrombectomy (MT) in the treatment of acute ischemic stroke (AIS) is already recommended as the standard care according to international guidelines. However, symptomatic intracranial hemorrhage (SICH) is a major complication of MT. Several studies reported that use of iso-osmolar contrast media (IOCM) was associated with a lower incidence of cerebral hemorrhage than low-osmolar contrast media (LOCM) after MT. The objective of this study was to evaluate the safety of MT using IOCM compared with using LOCM. Material and Methods One hundred and thirty-nine consecutive patients (56 men, mean age 79.9 years) who underwent MT within 24 hours from onset of AIS between April 2020 and October 2024 (LOCM; n = 38, IOCM; n = 101) were retrospectively reviewed. The procedural success rate, incidence of SICH, proportion of patients with good prognosis, acute and delayed adverse reactions, and contrast-induced acute kidney injury (CI-AKI) were analyzed according to contrast media type. Results Successful recanalization was observed in 103 patients (74.1%). Overall, 5 patients (3.6%) developed SICH: 1 patient (1.0%) in the IOCM group and 4 patients (10.5%) in the LOCM group showing significant difference (p = 0.007). Overall, 53 patients (38.1%) had a good prognosis, and 5 patients (3.6%) had delayed adverse reactions from the contrast agent without differences. No acute adverse reactions or CI-AKI occurred in either group. Conclusions The incidence of SICH after MT was 1.0% using IOCM lower than using LOCM. The use of an IOCM may be a safe option in MT for AIS.