High‐volume nonionic dimeric contrast medium: First experiences during complex coronary interventions

Abstract

Interventional cardiology is a rapidly developing field of medicine with annually increasing numbers of coronary interventions. Especially through the development of alternative techniques for coronary angioplasty, new indications have been found and more difficult lesions are tackled. Inevitably, such complex interventions are time-consuming and require high amounts of contrast medium. Newer, mostly nonionic agents have been developed with improved tolerability as well as fewer cardiac and renal side effects due to their nonionic, hydrophilic structure, and their osmolality isotonic to plasma. This study sought to investigate the effects of high-volume nonionic, dimeric contrast medium during coronary interventions with special emphasis on renal and hemodynamic side effects during routine hospital stays.Retrospectively, 25 consecutive patients (age 56 6 10 yr) with normal renal and cardiac function receiving G500 ml of the nonionic dimeric contrast medium iodixanol during complex coronary interventions were analyzed. The analysis was based on serum creatinine levels 1 day before and 2 days after contrast medium administration for the monitoring of renal function. Additionally, heart rate and left ventricular pressures were evaluated before and after left ventricular angiography. Mean serum creatinine rose from 0.9 6 0.2 mg/dl to 1.1 6 0.2 mg/dl (P F 0.05) after 2 days of coronary intervention. Heart rate, left ventricular systolic pressure, and left ventricular end-diastolic pressure did not change significantly. No major side effects were encountered in the short follow-up period of 2 days.Based on this retrospective analysis, high-volume nonionic, dimeric contrast medium administration in patients without preexisting renal insufficiency is associated with little impairment of renal function, and has only minor hemodynamic and general side effects. Iodixanol 320 mg I/ml is well-tolerated and effective for the use of cardioangiography. Given the limitations of this retrospective analysis, future prospective studies should systematically address the effects of high-volume contrast medium administration in otherwise healthy patients as well as in high-risk patients undergoing coronary interventions. Cathet. Cardiovasc. Diagn. 40:241-246, 1997. r 1997 Wiley-Liss, Inc.

Determinants of amount of contrast utilized in patients undergoing percutaneous coronary procedures

“…The risk of CIN is particularly high in patients with coexisting medical illnesses; particularly vulnerable are older patients (age > 70 years), women, patients with diabetes mellitus and accompanying renal insufficiency [7,[23][24][25]. The impact of higher volumes of contrast media on kidney function may be less detrimental in low-risk patients [26] and with the use of nonionic contrast media [27]. Nevertheless, contrast volume adjusted for body weight and renal function was the strongest predictor of nephropathy requiring dialysis [odds ratio (OR) = 6.2, P < 0.001 for CIN requiring dialysis in patients receiving more than the adjusted contrast volume] [19].…”

Anästhesiologisches Management bei neuroendovaskulären Eingriffen

“…Die Inzidenz steigt mit zunehmenden Kontrastmittelvolumina [22,28]. In mehreren Studien konnte nachgewiesen werden, dass durch Iodixanol die Serum-Kreatinin-Werte auch bei hohen Kontrastmittelvolumina und bei Patienten mit eingeschränkter Nierenfunktion geringer ansteigen als durch andere nichtionische Kontrastmittel [2,3,13,18].…”

Effects of non-ionic iodinated contrast media on patient heart rate and pressures during intra-cardiac or intra-arterial injection

“…Iodinated contrast media (CM) are known to have transient vasodilatory properties which can influence hemodynamic and International Journal of Cardiology 118 (2007) 389 -396 www.elsevier.com/locate/ijcard electrocardiographic (ECG) parameters immediately after administration [1][2][3][4][5][6][7][8][9][10][11]. While the reported changes in heart rate (HR) and left ventricular (LV) pressure or arterial blood pressure (BP) are generally considered clinically insignificant and do not cause problems in terms of patient safety, variations in HR in particular might conceivably impact on diagnostic image quality of scans that require cardiac gating.…”