Comparison of ioversol and iodixanol related adverse drug reactions in cerebrovascular interventional procedures

The incidence of iodinated contrast media (ICM)-related adverse drug reactions (ADRs) varies significantly by procedure type. Compared other procedure types, cerebrovascular interventional procedures substantially increase the incidence of contrast-induced encephalopathy (0.38-2.90%). The associations of ioversol (nonionic low-osmolal ICM) with central nervous system (CNS) ADRs and iodixanol (nonionic ios-osmolal ICM) with cutaneous ADR manifestations have been establishe. This study aimed to compare the incidence of CNS ADRs and evaluate the occurrence, extent, and risk factors for ADRs associated with ioversol and iodixanol use during cerebrovascular interventional procedures. We conducted a prospective study involving 1,015 participants with suspected cerebrovascular diseases from July 2019 to July 2022. Participants underwent cerebrovascular interventional procedures with either iodixanol or ioversol administration. Data on ioversol and iodixanol-related CNS ADRs, data on other ADRs, and participants' baseline information were collected. Out of 848 participants (average age, 61.5 ± 12.6 years; 205 females) who received ICM, 16.7% (142 of 848) experienced CNS ADRs. Compared with iodixanol, ioversol was associated with a greater rate of CNS ADRs (12.6% vs. 21.1%, P = 0.001, RR = 1.666). Iodixanol was associated with higher rates of numbness and blurred vision (29.1% vs. 14.9%, P = 0.042), whereas ioversol was associated with higher incidences of headache and overall ADRs during the procedures (20.0% vs. 46.0%, P = 0.002). Logistic regression analysis revealed that a history of allergic diseases was a risk factor for iodixanol-related ADRs (odds ratio [OR], 2.5; 95% confidence interval [CI]: 1.2-4.9; P = 0.010). Severe cerebral vascular stenosis (OR, 2.8; 95% CI: 1.8-4.4; P < 0.001), female sex (OR, 0.5; 95% CI: 0.3-0.8; P = 0.005) and relatively young age (OR, 0.97; 95% CI: 0.95-0.99; P = 0.004) were risk factors for ioversol-related ADRs. Iodixanol appears to have a lower likelihood of causing ICM-related CNS ADRs than does ioversol during cerebrovascular interventional procedures.