Safety of dipyridamole testing in patients with cerebrovascular disease

Lette, Jean; Carini, G; Tatum, James L.; Paquet, Nancy; Bisson, Guy; Picard, Michel; Bom, Hee Seung; Lusa, Anna Maria; Labanti, Graziana; Teitelbaum, Jeanne; Verreault, Jean; Cerino, Michel; McNamara, Daniel; Eybalin, Marie Claire; Levasseur, Adrien; Langlais, François; Miller, D. Douglas

doi:10.1016/s0002-9149(99)80602-x

Cited by 5 publications

(3 citation statements)

References 17 publications

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“…La seguridad del DIP intravenoso como vasodilatador coronario con SPECT fue demostrada en un importante trabajo multicéntrico de casi 74.000 casos, que presentó riesgo muy bajo de efectos cardiovasculares adversos serios, similar a lo observado en la prueba con ejercicio 28 . Se ha publicado el uso seguro de esta droga en diversos tipos de pacientes frágiles, adultos mayores, diabéticos, hipertensos, obesos, con insuficiencia renal crónica, postinfarto agudo al miocardio reciente 7,[28][29][30][31][32][33][34][35] . Sin embargo, se plantea tener cierta cautela en accidentes vasculares cerebrales recientes; en un trabajo de sobre 400 casos, solo se publicó un episodio de tipo isquémico transitorio 30 .…”

Section: Discussionunclassified

Estratificación de riesgo de muerte a mediano plazo de pacientes evaluados por enfermedad coronaria con SPECT de perfusión miocárdica bajo efecto de dipiridamol

et al. 2018

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Predictive value of dipyridamole myocardial perfusion tomography on survival Background: Dipyridamole (DIP) is the most commonly employed pharmacological stressor for myocardial perfusion tomography (SPECT) in patients unable to reach an adequate work load. Aim: To assess the predictive capacity of DIP SPECT on survival. Material and Methods: We included 985 adults aged 66 ±11 years (45% women) with rest and DIP-SPECT. The main indications for the procedure were coronary artery disease (CAD) screening in 66% and known CAD in 33%. Participants were followed up for a median of 65 months (interquartile range 54 to 86 months). During the follow up, 261 deaths were recorded and 98% had a specified cause in their death certificate. Results: Myocardial SPECT was abnormal in 44% of participants. Transient ischemic defects were observed in 34%, fixed defects concordant with infarction in 27% and post-stress systolic dysfunction in 23%. Twenty five percent of deaths were attributable to cardiac or ischemic cause and 22% to cancer. In a bivariate analysis, the hazard ratio (HR) of death of any cause was lower in females and higher in the presence of CAD. The multivariate analysis showed that being older than 46 years increased the HR of death of any cause. In a bivariate analysis, the HR for cardiac death was higher when the myocardial SPECT showed ischemia, necrosis or left ventricular dilation. In the multivariate analysis, post-stress left ventricular systolic function was associated with a lower risk of cardiac death. Conclusions: An abnormal myocardial SPECT, perfusion abnormalities, left ventricular systolic function or dilation are independent predictors of cardiac death in these participants.

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Section: Discussionunclassified

Estratificación de riesgo de muerte a mediano plazo de pacientes evaluados por enfermedad coronaria con SPECT de perfusión miocárdica bajo efecto de dipiridamol

et al. 2018

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“…Neurological adverse effects of intravenous dipyridamole have seldom been reported in the literature although TIA and cerebrovascular accidents are theoretical complications [1,3]. Previous case reports have hypothesized that an intracerebral steal phenomenon precipitated TIAs by affecting either large proximal or smaller branch vessels [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…Previous case reports have hypothesized that an intracerebral steal phenomenon precipitated TIAs by affecting either large proximal or smaller branch vessels [4][5][6]. One study specifically addressed the safety of dipyridamole in patients with cerebrovascular disease [3]. Only one TIA occurred among 400 patients, and that was noted in a patient with severe hypertension and a normal carotid Doppler.…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular steal phenomenon in a patient undergoing dipyridamole nuclear perfusion cardiac imaging

Raju

Mood

Laird-Fick

et al. 2012

Journal of Cardiology Cases

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Transient ischemic neurological deficits following intravenous dipyridamole administration during pharmacological cardiac stress test are seldom reported, but there can be serious vascular complications. We report a case of a 58-year-old Caucasian male who developed expressive aphasia after dipyridamole infusion during an elective dipyridamole-technetium cardiac stress test performed for chest pain. Computed tomography angiogram of the neck revealed a known total occlusion of the right internal carotid artery and 50% stenosis of the left internal carotid artery. The patient's aphasia spontaneously resolved within 24 h.In this paper, we report a unique case in which the administration of intravenous dipyridamole precipitated transient ischemic attack in a patient with stable asymptomatic bilateral carotid artery disease and prior carotid endarterectomy. We also discuss the intracerebral vascular steal phenomenon as a possible pathophysiological mechanism in this patient.

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