Safety and Efficacy of Carbon Dioxide and Intravascular Ultrasound-Guided Stenting for Renal Artery Stenosis in Patients With Chronic Renal Insufficiency

Kawasaki, Daizo; Fujii, Kenichi; Fukunaga, Masao; Fukuda, N; Masuyama, Tohru; Ohkubo, Nobukazu; Kato, Masaaki

doi:10.1177/0003319714524297

Cited by 14 publications

(9 citation statements)

References 25 publications

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“…The serious complications that may occur due to CO2 angiography include death, nonfatal myocardial infarction, respiratory arrest and renal failure. Although serious complications are extremely rare, transient complications occur in 7.3% of patients (9); in particular, transient mesenteric ischemia has been shown to occur in 1.3% of patients (7). The use of higher CO2 volumes is associated with an increased incidence of major complications (6).…”

Section: Discussionmentioning

confidence: 99%

Renal Artery Stenting Using CO<sub>2</sub> Gas Angiography in Combination with Iodinated Contrast Angiography

et al. 2016

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A 76-year-old woman was hospitalized repeatedly due to unexplained heart failure. On admission, she had hypertensive acute heart failure. Her symptoms disappeared promptly after the initial treatment; however, her systolic blood pressure remained at over 160 mmHg despite her taking three antihypertensive drugs. Closer examination revealed hemodynamically significant right renal artery stenosis and a lack of left kidney function. We performed percutaneous transluminal renal angioplasty using CO2 angiography in combination with iodinated contrast agents. The patient's renal function and blood pressure improved, however, CO2 gasinduced mild ischemic colitis occurred. We discuss the possibility of the use of combined iodinated contrast angiography and CO2 angiography to avoid contrast-induced nephropathy and the complications peculiar to CO2 angiography.

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Section: Discussionmentioning

confidence: 99%

Renal Artery Stenting Using CO<sub>2</sub> Gas Angiography in Combination with Iodinated Contrast Angiography

et al. 2016

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“…61 IVUS has the potential to reduce radiation dose and increase procedure safety as previously discussed. As with any vessel instrumentation, IVUS carries the risk of vessel dissection, injury, perforation or total occlusion, air embolism, unstable angina, MI, haemodynamic instability, arrhythmias, limb ischaemia and death.…”

Section: Safety and Complicationsmentioning

confidence: 95%

“…Contrast minimising strategies like the use of carbon dioxide digital subtraction and IVUS to guide interventions have been described for renal artery interventions, 61 and for iliac artery CTO interventions. 62 In addition to providing measurements and precisely locate key landmarks and venous branches, IVUS can identify important abnormalities (e.g.…”

Section: Ivus and Endovascular Interventionsmentioning

confidence: 99%

Impact of Intravascular Ultrasound in Clinical Practice

Vásquez

Mistry

Singh

2014

Interventional Cardiology Review

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Intravascular ultrasound (IVUS) has expanded our understanding of atherosclerotic plaque morphology, and provides an opportunity to guide cardiovascular interventions and evaluate results. Use of this technique requires understanding of ultrasound physics, catheter differences, skills in vessel, plaque and stent quantification and knowledge of artifacts and various physiologic and pathologic findings. Optimal cardiovascular interventions should result in absence of inflow or outflow obstruction, precise geographic landing, while attaining the largest feasible luminal gain without plaque protrusion, vessel dissection or perforation and, if deployed, with complete stent expansion and apposition to the vessel wall. IVUS is safe, cost efficient and effectively optimises cardiovascular interventions. In addition, IVUS improves outcomes when used to guide coronary interventions using bare metal stents (BMS) and drug eluting stents (DES). The role of IVUS in endovascular therapy is rapidly expanding. This review will focus on the impact of IVUS in clinical practice.

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“…4,5 Owing to its low atomic number, CO 2 acts by displacing blood to provide a negative contrast image with digital subtraction angiography. The use of CO 2 as a contrast agent has potential serious complications such as neurotoxicity and arrhythmias and its use is therefore contraindicated above the diaphragm, in patients with an arteriovenous malformation, fistula or atrial septal defects.…”

Section: Introductionmentioning

confidence: 99%

“…Our RDN technique is based on that described in the Symplicity hypertension (HTN)-2 trial and previous publications. 2,4,7 Each patient consented for the procedure and potential complications including abdominal pain, bleeding from puncture site, pseudoaneurysm, renal artery dissection, renal artery thrombosis and failure of procedure. The following procedures were conducted in accordance with the ethical standards of the responsible committee.…”

Section: Introductionmentioning

confidence: 99%

The use of carbon dioxide angiography for renal sympathetic denervation: a technical report

Renton¹,

Hameed²,

Dasgupta³

et al. 2016

The British Journal of Radiology

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Objective: Hypertension is the leading attributable cause of cardiovascular mortality worldwide. Patients with hypertension have multiple comorbidities including high rates of concomitant renal disease. Current pharmacological approaches are inadequate in the treatment of resistant hypertension. Renal sympathetic denervation (RDN) has been shown to effectively treat resistant hypertension. The traditional use of iodinated contrast in RDN is contraindicated in patients with significant renal insufficiency. In patients with renal impairment, carbon dioxide (CO2) can be used as an alternative contrast material for RDN. This article describes the technical aspects of RDN using CO2 angiography. Methods: Our centre is experienced in the innovative RDN procedure using CO2 angiography. We describe the protocol for CO2 angiography for RDN using a home-made CO2 delivery system and the Symplicity™ (Minneapolis MN 55432 USA) catheter (Medtronic) device. Results: CO2 angiography is an excellent alternative to iodinated contrast for RDN procedures. Conclusion: CO2 angiography for RDN is a safe and effective alternative to iodinated contrast. RDN using CO2 angiography is an easy and feasible procedure that can be used in patients with renal insufficiency or iodinated contrast allergies. Advances in knowledge: There is a paucity of descriptive reports for CO2 angiography for RDN and we provide details of the optimal protocol for the procedure. In particular, we describe the use of a Symplicity Spyral™ catheter (Medtronic), which has not been reported to date for use in this procedure.

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Safety and Efficacy of Carbon Dioxide and Intravascular Ultrasound-Guided Stenting for Renal Artery Stenosis in Patients With Chronic Renal Insufficiency

Cited by 14 publications

References 25 publications

Renal Artery Stenting Using CO<sub>2</sub> Gas Angiography in Combination with Iodinated Contrast Angiography

Renal Artery Stenting Using CO<sub>2</sub> Gas Angiography in Combination with Iodinated Contrast Angiography

Impact of Intravascular Ultrasound in Clinical Practice

The use of carbon dioxide angiography for renal sympathetic denervation: a technical report

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