ARRS 2022 Abstracts

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1432. Adverse Events From Intra-Arterial Administration of Gadolinium-Based Contrast Agents: Systematic Review and Meta-Analysis
Authors * Denotes Presenting Author
  1. Chad MacLeod *; The Ottawa Hospital; University of Ottawa
  2. Isabelle Gauthier; The Ottawa Hospital; University of Ottawa
  3. Trevor McGrath; The Ottawa Hospital; University of Ottawa
  4. Nicola Schieda; The Ottawa Hospital; University of Ottawa
  5. Matthew McInnes; The Ottawa Hospital; University of Ottawa
Objective:
Off-label use of gadolinium-based contrast agents (GBCAs) is described for intra-arterial (IA) administrations in patients with contraindication to iodinated contrast, though mainly in case-reports and case series. Immediate and long-term safety of IA GBCA use is unclear. We performed a systematic review and meta-analysis of adverse events related to IA GBCA use, including immediate hypersensitivity reactions (HR), post-contrast acute kidney injury (PC-AKI), nephrogenic systemic fibrosis (NSF), and gadolinium retention.

Materials and Methods:
A search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases for studies evaluating adverse events related to the IA administration of gadolinium was performed. The search included articles posted after GBCA was approved for clinical use (1988). The study protocol was registered to Prospero (CRD42021243323). Meta-analysis of proportions was performed by using random-effects modeling, with 95% confident intervals (CI), for HR and PC-AKI. Risk of bias for the individual studies was evaluated using the ROBINS-I tool.

Results:
From 68 studies reporting 1179 patients who underwent 1368 IA GBCA administrations, HR occurred in 5.7% (6 events out of 1368 administrations; 95% CI: 4.2% - 7.7%) with zero deaths and only 1 severe reaction. From 57 studies reporting 1040 patients who underwent 1207 administrations, PC-AKI occurred in 11.2% (80 out of 1214 administrations; 95% CI: 8.5% - 14.7%). Seven studies reported a total of 7 cases of NSF out of 224 patients who underwent 326 IA GBCA administrations, 5.9% (95% CI, 1.4% - 21.4 %). No studies reported gadolinium retention as an outcome. Overall, 52/75 included studies had moderate to serious risk of bias as they primarily consisted of case reports, case series and retrospective studies.

Conclusion:
Intra-arterial GBCA use is relatively safe, with only one severe reaction reported in 1368 administrations. Post contrast acute kidney injury has generally not been thought to occur with GBCA, however our report indicates a rate of 11.2%. Further research is required to clarify the mechanism and assess the incidence of gadolinium retention. Adverse events should be considered on an individual basis when deciding between IA GBCA versus iodinated contrast.