A novel technique for ultra‐low contrast administration during angiography or intervention

Nayak, Keshav R.; Mehta, Hirsch; Price, Matthew J.; Russo, Robert J.; Stinis, Curtiss T.; Moses, Jeffrey W.; Mehran, Roxana; Leon, Martin B.; Kandzari, David E.; Teirstein, Paul S.

doi:10.1002/ccd.22414

Cited by 66 publications

(60 citation statements)

References 19 publications

(27 reference statements)

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“…27 The use of a total CV not higher twice and a half the CV/eGFR ratio may serve as a general and simple protective measure for CI-AKI after primary PCI: for instance, biplane angiography and intravascular ultrasound guidance together with careful procedural planning are crucial steps to CV restriction. 28 In addition, because nonevent NRI was in any case larger than event NRI, the addition of CV/eGFR to the AGEF score helps decrease predicted risk for those without CI-AKI (catch nonevents) to a larger degree than it does increase predicted risk for those who experienced CI-AKI (catch events). In simpler and practical words, to maintain CV as low as reasonably possible has a positive effect in reducing the occurrence of CI-AKI on top of the baseline risk assessed with AGEF score and might be a clue to avoid postprocedural overtreatment in those patients with moderate to high risk.…”

Section: Discussionmentioning

confidence: 99%

Renal Function–Adjusted Contrast Volume Redefines the Baseline Estimation of Contrast-Induced Acute Kidney Injury Risk in Patients Undergoing Primary Percutaneous Coronary Intervention

Andò

Gregorio

Morabito

et al. 2014

Circ: Cardiovascular Interventions

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Background-Age, estimated glomerular renal function (eGFR), and ejection fraction are preprocedural predictors of contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention. The effect of renal function-adjusted contrast volume (CV) remains not totally explored, and a threshold has not yet been established. Methods and Results-Logistic regression and receiver-operating characteristic curve analyses were used to assess whether CV/eGFR was an independent predictor of CI-AKI. The increased discriminative value of CV/eGFR over the preprocedural model based on age, eGFR, and ejection fraction was examined using the net reclassification improvement analysis. Of 470 patients enrolled, we observed 25 (5.3%) cases of CI-AKI. Patients with CI-AKI had received a higher renal function-adjusted CV (CV/eGFR 3.62 versus 1.96; P<0.001), and CI-AKI incidence was higher (15%; P<0.001) in patients in the highest quartile of CV/eGFR, corresponding to the cutoff indicated by the receiver-operating characteristic curve (>2.5; area under the curve, 0.77). At multivariable analysis, CV/eGFR above the cutoff (odds ratio, 5.57; P=0.002) remained an independent predictor of CI-AKI. The model with CV/eGFR demonstrated a statistically significantly net reclassification improvement of 0.23 (P=0.021) over the baseline preprocedural model, largely driven by a correct decrease in risk estimates for patients not experiencing CI-AKI, with a likelihood ratio χ 2 of 5.973 (P=0.029). Conclusions-CV remains a key risk factor for CI-AKI after primary percutaneous coronary intervention and our study supports the need for minimizing CV, independently from baseline preprocedural risk. A CV restricted to no more than twice and a half the baseline eGFR might be valuable in reducing the risk of CI-AKI. (Circ Cardiovasc Interv. 2014;7:465-472.)Key Words: acute kidney injury ◼ balloon coronary angioplasty ◼ contrast media adverse effects ◼ myocardial infarction

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Section: Discussionmentioning

confidence: 99%

Renal Function–Adjusted Contrast Volume Redefines the Baseline Estimation of Contrast-Induced Acute Kidney Injury Risk in Patients Undergoing Primary Percutaneous Coronary Intervention

Andò

Gregorio

Morabito

et al. 2014

Circ: Cardiovascular Interventions

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“…11) On the other hand, we presented a successful case of complete revascularization with 3 PCI procedures using a super-low volume of contrast medium, in which a total of 31 mL of contrast medium was administered: 9 mL, 6 mL, and 16 mL, respectively, in a patient with 3VD, including 2 CTOs and severe renal dysfunction. To the best of our knowledge, this is the first report of PCI to complex lesions, including CTOs, with a very small amount of contrast medium.…”

Section: Discussionmentioning

confidence: 99%

“…Although a few PCI cases using a very small amount of contrast medium have been reported, 11) the target lesions of all those cases were not complex lesions, such as chronic total occlusion (CTO), but simple and focal stenotic lesions. Herein, we present a successful case of complete revascularization with 3 separate PCI procedures using super-low volume of contrast medium in a patient with 3-vessel disease (3VD) who had 2 CTOs and severe renal dysfunction.…”

mentioning

confidence: 99%

Successful Complete Revascularization With PCI Using Super-Low Volume of Contrast Medium in a Patient With Three-Vessel Disease Including 2 Chronic Total Occlusions With Severe Renal Dysfunction

Koide

Kato²,

Usui³

et al. 2017

Int. Heart J.

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SummaryThe most important factor for preventing contrast-induced nephropathy (CIN) during percutaneous coronary intervention (PCI) in patients with severe renal dysfunction is to minimize the contrast volume. Herein, we report a successful case of complete revascularization after 3 separate PCI procedures using a super-low volume of contrast medium in a patient with 3-vessel disease, including two chronic total occlusions (CTOs). A 70-year-old man having exertional angina despite maximal medical therapy was referred to our hospital. He had severe renal dysfunction (estimated glomerular filtration rate 19 mL/minute/1.73 m 2 ). Coronary angiography, in which a total volume of 15 mL (over 3 injections) of contrast medium was used after hydration with normal saline, demonstrated 2 CTOs in the proximal left circumflex artery (LCX) and the proximal right coronary artery (RCA) as well as focal stenosis in the mid left descending artery (LAD). Because the patient refused coronary artery bypass grafting, we opted for revascularization with PCI, divided into 3 procedures. We made full use of microcatheter tip injection and evaluation with intravascular ultrasound and achieved complete revascularization with a total of 31 mL of contrast medium: 9 mL for RCA, 6 mL for LAD, and 16 mL for LCX, without the occurrence of CIN. Additionally, we present tips for performing PCI using super-low contrast medium. (Int Heart J 2017; 58: 624-628) Key words: Low-dose contrast medium, Contrast-induced nephropathy C ontrast-induced nephropathy (CIN) is a serious complication caused by administration of iodinated contrast during percutaneous coronary intervention (PCI), and is associated with increased morbidity and mortality. 1,2) CIN was defined as an increase in serum creatinine of either 0.5 mg/dL or 25% from baseline within 72 hours of exposure. 3)Risk factors associated with increased occurrence of CIN are reported to be chronic kidney disease, hemodynamic instability, use of intra-aortic balloon pumping, heart failure, advanced age, anemia, and volume of contrast medium. 4) However, except for contrast volume, it is difficult to modify these risk factors immediately before PCI. The efficacy of preventive strategies for CIN, including N-acetylcysteine, atrial natriuretic peptide infusion, ascorbic acid, statins, and prophylactic hemodialysis, has not been sufficiently established.5-8) Therefore, the established prophylactic approach is to administer adequate hydration and to minimize the volume of contrast medium for prevention of CIN in patients with severe renal dysfunction. However, the safe dose of contrast in patients with severe renal dysfunction remains unclear. Even when contrast volume (CV) used during PCI was less than twice the calculated creatinine clearance (CCC), which is a CV/CCC ratio < 2, CIN occurred in more than 6% of patients with a glomerular filtration rate (GFR) < 30 mL/minute. 9) Furthermore, Nyman, et al also reported an association between the contrast dose (grams iodine)/GFR ratio and the risk of CIN after P...

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“…A recent publication described manual injections of ultra-low contrast volumes for coronary procedures [6]. We have been applying some of the techniques described in this report; however, we do not use intravascular ultrasound routinely, as a contrast saving tool.…”

Section: Discussionmentioning

confidence: 99%

A novel method of ultra-low contrast administration for coronarography and percutaneous coronary intervention using the automatic injector. The need to focus on contrast preservation techniques

Styś¹,

Styŝ²,

Recki³

2011

pwki

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A b s t r a c tBackground: Contrast-induced nephropathy (CIN) is becoming a more pertinent issue in coronary percutaneous procedures, as the population at risk grows. Contrast preservation is the first and probably most important step in prevention of CIN, and yet the research focus seems to be on CIN preventing drugs.Aim: We describe a novel method of contrast preservation for coronarography and percutaneous coronary intervention (PCI) based on use of the automatic contrast injector (ACI). The method also uses a standardized approach to catheterization aimed at minimizing contrast load; however, it is the programming of the ACI that allows for the ultralow contrast dose. We present two cases to illustrate the technique.Material and methods: We have used this standardized protocol successfully for the last 4 years in our cath lab in patients with increased risk of CIN, consistently achieving 10 ml or less of contrast load per coronary case. Our ACI programming protocol is relatively easy to follow.Results and conclusions: We think that use of ACI with appropriate programming should become a preferred, if not standard approach in patients at increased CIN risk. We believe that refocusing on contrast preservation techniques and their distribution throughout the interventional community is of utmost importance for public health.Key words: contrast-induced nephropathy, automatic contrast injector S t r e s z c z e n i e Wstęp: Liczba pacjentów ze zwiększonym ryzykiem nefropatii kontrastowej (CIN) po zabiegach przezskórnych na sercu wzrasta. Pomimo że zmniejszenie ilości podanego środka kontrastowego jest najważniejszym ogniwem w profilaktyce tego powikłania, to literatura na ten temat wydaje się nieproporcjonalnie skąpa.Cel: Opis nowej metody minimalizacji ilości podanego środka kontrastowego w koronarografii i angioplastyce naczyń wieńcowych, opartej głównie na użyciu automatycznego podajnika kontrastu (ACI). Ustandaryzowane podejście do gospodarki kontrastem w czasie zabiegu pozwala na stosowanie minimalnych dawek. W celu pełniejszego zaprezentowania metody opisano 2 typowe przypadki z jej zastosowaniem.

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A novel technique for ultra‐low contrast administration during angiography or intervention

Cited by 66 publications

References 19 publications

Renal Function–Adjusted Contrast Volume Redefines the Baseline Estimation of Contrast-Induced Acute Kidney Injury Risk in Patients Undergoing Primary Percutaneous Coronary Intervention

Renal Function–Adjusted Contrast Volume Redefines the Baseline Estimation of Contrast-Induced Acute Kidney Injury Risk in Patients Undergoing Primary Percutaneous Coronary Intervention

Successful Complete Revascularization With PCI Using Super-Low Volume of Contrast Medium in a Patient With Three-Vessel Disease Including 2 Chronic Total Occlusions With Severe Renal Dysfunction

A novel method of ultra-low contrast administration for coronarography and percutaneous coronary intervention using the automatic injector. The need to focus on contrast preservation techniques

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