Incidence of contrast-associated acute kidney injury differs by procedure type in neuroendovascular surgery

Background Evidence regarding the incidence and risk factors of contrast-associated acute kidney injury (CA-AKI) after neuroendovascular surgery (NES) remains limited. This study aimed to identify risk factors for CA-AKI after NES. Methods We retrospectively analyzed adolescent and adult patients who underwent NES under general anesthesia at our institution between 2014 and 2024. CA-AKI was defined as a serum creatinine increase ≥0.3 mg/dL within 48 h, or ≥1.5 times baseline within 7 days. Risk factors were assessed using logistic regression. Results Among 2412 patients (840 males) aged 10–91 years, NES indications included unruptured cerebral aneurysm (UCA, n = 1808), carotid artery stenosis (CAS, n = 212), dural arteriovenous fistula (DAVF, n = 183), aneurysmal subarachnoid hemorrhage (aSAH, n = 107), and arteriovenous malformation (AVM, n = 102). The overall incidence of CA-AKI was 1.91%. By lesion type, incidences were 9.35% (aSAH), 9.91% (CAS), 2.94% (AVM), 0.55% (DAVF), and 0.61% (UCA). Multivariate analysis identified diabetes mellitus (odds ratio [OR], 2.414; 95% confidence interval [CI], 1.099–5.306; p = .028), lower preoperative total protein (OR, 0.447; 95% CI, 0.265–0.754; p = .003), higher preoperative creatinine (OR, 5.692; 95% CI, 2.962–10.938; p = <0.001), and lesion type (aSAH vs. UCA: OR, 17.672; CAS vs. UCA: OR, 9.551; both p < .001) as significant predictors. Conclusion Patients undergoing NES for aSAH or CAS were associated with an increased risk of CA-AKI, independent of known risk factors. To our knowledge, this is the first study to demonstrate lesion-specific differences in CA-AKI risk after NES.