Gadolinium‐based coronarography in a patient with renal failure: First clinical report

Sarkis, Antoine; Badaoui, Georges; Slaba, S.; Moussalli, Aida; Jebara, Victor A.

doi:10.1002/ccd.1240

Cited by 21 publications

(19 citation statements)

References 6 publications

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“…15 The first study of CAG using Gd was in patients with renal insufficiency. [6][7][8] There are several limitations to the use of Gd as an X-ray contrast agent. First, it is inferior to iodinated agents for image contrast, although digital subtraction post-processing can resolve that problem.…”

Section: Discussionmentioning

confidence: 99%

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'Gadolinium' as an Alternative to Iodinated Contrast Media for X-Ray Angiography in Patients With Severe Allergy

Ose

Doue

Zen

et al. 2005

Circ J

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-ray coronary angiography (CAG) is an indispensable examination technique for the diagnosis of coronary artery disease and for determination of therapeutic strategies. However, an anaphylactic reaction to the iodinated contrast media can be life-threatening. Gadolinium-based contrast media have been developed to improve the quality of magnetic resonance imaging (MRI) and are considered to be safer and less nephrotoxic than the iodinated agents. It has been recently reported that computed tomography (CT) and digital subtraction angiography (DSA) using gadolinium can provide images of largeand medium-sized vessels of acceptable quality in patients with allergy to iodinated media. 1-5 However, only a few studies of using gadolinium for CAG have been reported and only its safety in patients with renal insufficiency has been discussed. [6][7][8] We report successful CAG using gadodiamide hydrate (Gd DTPA-BMA; Omniscan ® Nycomed, Oslo. Norway) in 3 patients with allergy to iodinated contrast media. Written informed consent for the use of the contrast media was obtained from all patients. Case Reports Case 1A 70-year-old woman (52 kg) with a history of thyroidectomy for thyroid cancer and allergic reaction to iodinated contrast media was admitted to hospital after presenting with chest pain and dyspnea. Electrocardiography showed ST-segment elevation in leads V1-3 leads and T wave inversion in V2-4, and echocardiography showed hypokinesis in the apico-anteroseptal wall of the left ventricle. After sublingual administration of nitroglycerin, her symptoms Circulation Journal Vol. 69, April 2005 and the electrocardiographic findings improved. CAG was performed using 40 ml of undiluted Gd DTPA-BMA in a total of 7 injections because she had a previous, unspecified history of shock as a severe allergic reaction to treatment with an iodinated disinfectant. CAG revealed no significant stenoses in the major coronary arteries (Fig 1) and so we considered her anginal attack might be coronary arterial vasospasm in the left anterior descending artery. Case 2A 71-year-old man (68 kg) with gastric cancer and abdominal aortic aneurysm was admitted to hospital for gastric resection and artificial vessel replacement. He had a history of acute myocardial infarction at 63 years of age and an allergic reaction to an unspecified iodinated contrast media during abdominal CT performed when he was 60 years of age. 99m Tc-tetrofosmin myocardial scintigraphy on admission showed multivessel disease in his coronary arteries, so he underwent preoperative CAG using 40 ml of undiluted Gd DTPA-BMA in a total of 5 injections. Digital subtraction post-processing showed significant stenoses in the mid right coronary artery (segment 2: 75% stenosis), in the circumflex artery (segment 11: 75%, segment 13: 90%), and total occlusions in the distal right coronary artery (segment 4, postero-lateral branch) and the mid left anterior descending artery (segment 7) with contralateral collateral feedings (Fig 2). He underwent coronary artery bypass grafting be...

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Section: Discussionmentioning

confidence: 99%

“…1-5 However, only a few studies of using gadolinium for CAG have been reported and only its safety in patients with renal insufficiency has been discussed. [6][7][8] We report successful CAG using gadodiamide hydrate (Gd DTPA-BMA; Omniscan ® Nycomed, Oslo. Norway) in 3 patients with allergy to iodinated contrast media.…”

mentioning

confidence: 99%

'Gadolinium' as an Alternative to Iodinated Contrast Media for X-Ray Angiography in Patients With Severe Allergy

Ose

Doue

Zen

et al. 2005

Circ J

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“…Its elimination half-life is approximately 90 min (Bokhari et al, 2003). Coronary angiography using gadolinium as a contrast agent has been described (Sarkis et al, 2001;Bokhari et al, 2003;Ose et al, 2005). Patients with iodine-induced hyperthyroidism and unstable angina pectoris would in some cases require an intervention, but the use of iodinated contrast agent imposes a risk for thyrotoxic storm.…”

Section: Discussionmentioning

confidence: 99%

Gadolinium as an Alternative Contrast Agent During Cardiac Catheterization in Patient with Iodine-induced Hyperthyroidism

Matuszczyk

Hahn²,

Böse³

et al. 2006

Exp Clin Endocrinol Diabetes

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We report the first case of a male patient with iodine-induced hyperthyroidism and unstable angina pectoris in whom a diagnostic cardiac catheterization with gadolinium as contrast agent was chosen. The patient was hospitalized with an iodine-induced hyperthyroidism after angioplasty using an iodinated contrast agent. He presented with a continuous arrhythmia and unstable angina pectoris. A repeated cardiac catheterization using iodinated contrast agent was contraindicated. This case report shows that gadolinium is a useful alternative contrast agent for cardiac intervention in patients with iodine-induced hyperthyroidism.

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“…In this issue, Sarkis et al [1] report the performance of coronary angiography utilizing gadodiamide in a patient with renal insufficiency and diabetes presenting with intractable angina. Gadolinium is a lanthanide (rare earth element) that has significant toxicity as a naked metal ion, but is well tolerated when complexed with electron donating ligands.…”

mentioning

confidence: 99%

“…Sarkis et al [1] have shown that it is possible to obtain reasonable imaging using standard angiographic technique. In unique situations this may be of clinical benefit, but the restriction of the amount of contrast coupled with the low concentration of available agents will challenge the ability of the angiographer to obtain adequate diagnostic study, let alone perform intervention, within labeled recommendations in all but the simplest cases.…”

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confidence: 99%

Gadzooks, noniodinated contrast?

Brinker

2001

Cathet Cardio Intervent

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Contrast-enhanced X-ray imaging remains the cornerstone of catheter-based diagnostic and therapeutic approaches to disorders of the cardiovascular system. Central to these procedures are intravascular agents that absorb X-ray within the diagnostic range, thus providing transient opacification of vessels and cardiac chambers. Materials used for this purpose have been derivatives of the tri-iodinated benzene ring and include the traditional (but essentially abandoned) high osmolal ionic, the low osmolal ionic, the low osmolal nonionic, and the isosmotic nonionic contrasts. An ideal intravascular contrast material would absorb X-ray while otherwise remaining physiologically inert. Iodine has a reasonable K-edge of absorption and is in general well tolerated. Iodinated contrasts, however, have been associated with a number of undesirable effects and considerable effort has been directed at the development of better tolerated agents over the last 40 years. Much of the toxicity of the traditional agents has been related to their hyperosmolality. This has been effectively addressed, as noted above, by the introduction of contrasts having progressively lower osmolalities such that agents isosmotic to plasma are now available. This has remarkably reduced the incidence of allergy-like reactions as well as the pain, heat, nausea, and vomiting that accompanied the administration of the traditional high osmolal contrasts. Reduction of contrast osmolality has also significantly reduced extent and frequency of hemodynamic and arrhythomogenic perturbations related to intracoronary and high-volume (e.g., ventricular, aortic, pulmonary arterial) injections. The low osmolal agents (especially the nonionic dimers) are so well tolerated that, when necessary in complex cases, we have administered over a liter of contrast without untoward reaction. This is not to say that even the best of iodinated contrast is risk-free because certainly such is not the case.

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Gadolinium‐based coronarography in a patient with renal failure: First clinical report

Abstract: This article reports the use of gadolinium to perform a coronarography in a patient with renal insufficiency, unstable angina, and peripheral vascular disease. The examination was well tolerated and the images obtained of good quality. Cathet Cardiovasc Intervent 2001;54:68-69.

Cited by 21 publications

References 6 publications

'Gadolinium' as an Alternative to Iodinated Contrast Media for X-Ray Angiography in Patients With Severe Allergy

'Gadolinium' as an Alternative to Iodinated Contrast Media for X-Ray Angiography in Patients With Severe Allergy

Gadolinium as an Alternative Contrast Agent During Cardiac Catheterization in Patient with Iodine-induced Hyperthyroidism

Gadzooks, noniodinated contrast?

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