Recent studies have shown the feasibility and safety of the percutaneous approach for the treatment of vertebrobasilar disease using either balloon angioplasty alone, coronary stents, or combined angioplasty followed by stenting. The major concern in performing percutaneous procedures for the treatment of obstructive disease of the vertebrobasilar circulation involves the risk of embolic phenomena. We describe the successful treatment of a symptomatic patient with bilateral vertebrobasilar disease utilizing a distal protection filter during stenting with simultaneous use of transcranial Doppler to measure microembolization and vertebral artery blood flow during the procedure.
Injectable and absorbable contrast media for the use in radiology, all of which contains iodine as an essential component, has been, and continues to be, one of the main sources of agents which cause hospital-acquired renal failure. Although numerous methods have been explored to prevent renal contrast damage, radiocontrast-induced nephropathy continues to be a concern in patients with existing renal insufficiency, who undergo contrast-enhanced radiographic examinations. Patients who develop contrast-induced nephropathy (CIN) have a worse prognosis and an increased risk of complications and mortality. Prevention of CIN during radiocontrast procedures continues to elude clinicians and is a chief concern during percutaneous coronary intervention, as these patients often have multiple comorbidities. A wide variety of animal and clinical investigations, and substances have been tried in order to prevent this complication, including: dialysis, contrast volume and type; adenosine antagonists; acetylcysteine; fenoldopam; and various others. The purpose of this review is to appraise all the past and current strategies employed to prevent CIN, especially during percutaneous coronary intervention.
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