Use of gadolinium as an intraarterial contrast agent in digital subtraction angiography of the cervical carotid arteries and intracranial circulation

Abstract

Patients with renal insufficiency or other contraindications to iodine-based contrast agents present a significant management dilemma when conventional arteriography is required. The authors describe the use of gadolinium as an alternative contrast agent for arterial digital subtraction (DS) angiography of the cervical carotid arteries (CAs) and intracranial circulation. Three patients with renal insufficiency presented with symptoms of ischemic cerebrovascular disease and inconclusive noninvasive imaging studies, which necessitated conventional angiography. Traditional transfemoral catheterization of the cervical CAs was performed and DS angiographic studies were obtained using gadolinium as an intraarterial contrast agent. In one case, selective arteriographic examination of the internal carotid arteries and vertebrobasilar system was performed as well. High-quality, diagnostic images essentially indistinguishable from routine angiographic studies were obtained in all cases. No patient suffered a complication related to the use of gadolinium, and no patient demonstrated worsened renal function after the procedure. In the setting of a contraindication to iodine-based contrast agents, gadolinium represents an important alternative contrast material that allows for excellent visualization of the cervical CAs and intracranial circulation.

'Gadolinium' as an Alternative to Iodinated Contrast Media for X-Ray Angiography in Patients With Severe Allergy

“…The incidence of all side effects has been reported as 1-2% for gadolinium-based contrast media (Gd) and 3.0% for iodinated contrast media, and the incidence of critical life-threatening side effects with Gd was one-tenth that for iodinated contrast media. 9,[11][12][13] Gd has been advocated as an alternative to iodinated contrast media for DSA or CT. [1][2][3][4][5] Although Gd-based contrast media are obviously safer than the iodinated ones, there are 2 major side effects that must be considered in relation to angiography. 14 One is a hemodynamic or arrhythmic effect resulting from ionicity when the agent is directly injected into the coronary artery.…”

“…First, it is inferior to iodinated agents for image contrast, although digital subtraction post-processing can resolve that problem. [3][4][5] The technique requires the same silhouette without dye injection for making a masking image, and accurate framing and fixation of the patient is essential. However, detection of life-threatening ischemia such as stenoses of the main coronary artery is important and the contrast of Gd may still be sufficient.…”

Gadolinium‐based coronarography in a patient with renal failure: First clinical report

“…Gadolinium is a well-known contrast agent used to enhance MRI vascular imaging [1,3,4]. This drug is well tolerated and, when used at the recommended dose, has no nephrotoxicity [1][2][3][4][5].…”

“…Moreover, this agent is used in renal transplant recipients requiring diagnostic or interventional procedures on the renal artery of the allograft [1,2,4].…”

Gadzooks, noniodinated contrast?

“…A number of subsequent studies have confirmed that gadolinium can be used to image small-and moderate-sized arteries with digital subtraction techniques. The diagnostic quality of these studies appears in general to be quite good and some find the images to be comparable to those obtained when dilute iodinated contrast is used [3][4][5]. Others, however, find that the latter produce slightly superior angiograms [6,7] and allow better definition of segmental branches of the primary artery [8].…”