Reducing the Delay in Thrombolysis: Is It Necessary to Await the Results of Renal Function Tests before Computed Tomography Perfusion and Angiography in Patients with Code Stroke?

Objective: We sought to determine the percentage of patients presenting with code stroke who would be excluded from computed tomography angiography, computed tomography perfusion, or both based on their emergency department laboratory results (creatinine and glomerular filtration rate) and the incidence of contrast-induced nephropathy in patients with code stroke who receive contrast. Design: We conducted a retrospective analysis of our prospective code stroke database. Setting: The study took place in an emergency department at a university medical center. Results: A total of 131 consecutive patients with code stroke were identified. Of these, 11 (8.4%) would not have received contrast based on a creatinine level greater than 1.5 mg/dL on initial evaluation. However, 10 of these 11 patients (91%) had a history of renal disease. A total of 3% of patients who received contrast developed contrast-induced nephropathy. Conclusions: Our findings suggest that the use of contrast agents in patients with code stroke before availability of renal function tests appears safe in patients who do not have a known history of renal disease.