Cerebral thromboembolic complications associated with the use of a nonionic contrast medium in coronary angiography.

Cerebrovascular complications were registered in 11 patients (0.21%) of 5,339, consecutively submitted to coronary angiography with the nonionic contrast medium iohexol (Omnipaque). Six of the patients had diseases predisposing them to thromboembolic complications, 3 of whom earlier had symptoms of cerebral stroke. Excluding these 6, the incidence of cerebral thromboembolic events was 0.10% in patients with no predisposing diseases. Precise catheterization technique and some anticoagulation and antiplatelet activity therapy are definite precautions against these complications, while the role of the contrast medium is still debated.

Abnormalities of left ventricular filling in patients with coronary artery disease: assessment by colour M-mode Doppler technique.

In 54 healthy individuals and 107 patients with coronary artery disease, intraventricular early filling velocities were recorded by colour M-mode Doppler. The time difference between the occurrence of peak velocity in the apical region and at the mitral tip was calculated, and normalized by dividing it by the mitral to apical distance. Transmitral velocities were determined by the single pulsed Doppler technique. The patients were divided into groups according to systolic function as assessed by left ventriculography. The normalized time difference was similar in the reference group (12 +/- 8 ms.cm-1) and the patient group with no electrocardiographical signs of previous infarction and normal ventriculography (16 +/- 16 ms.cm-1). It increased significantly in the group with infarction and/or regional systolic dysfunction (43 +/- 21 ms.cm-1), and a further increase was present in the group with severely impaired ventricles (53 +/- 14 ms.cm-1). The ratio between peak early and late transmitral velocity fell significantly in the group with infarction and/or regional systolic dysfunction, but was normalized in the group with severely impaired ventricles. Colour M-mode Doppler shows that apical filling is delayed in patients with injured left ventricles due to coronary artery disease. This delay increases with progression of ventricular injury. The technique may be an important addition to transmitral pulsed Doppler in assessing left ventricular filling.

Renal effects of nonionic contrast media after cardioangiography.

A prospective double-blind randomized cardioangiographic study with iopentol and iohexol was performed in 60 patients. Glomerular filtration rate (GFR) was assessed by serum values of creatinine and beta 2-microglobulin (beta 2-MG), estimated creatinine clearance (CCr) according to Cockroft & Gault's formula, and 24 hour CCr. The urinary excretion of albumin, beta 2-MG, and of the renal tubular enzymes alkaline phosphatase (ALP) and N-acetyl-beta-glucosaminidase (NAG) was also measured. Contrary to what has been found after i.v. injections, GFR was reduced by both nonionic contrast media. Serum creatinine (S-Cr) was increased by more than 25% in 6 patients, 3 in each group. CCr was more sensitive than S-Cr and S-beta 2-MG, but this method is less precise because of risk of urine sampling errors. Estimated CCr gave no additional information to S-Cr. The urinary excretion of NAG and ALP was increased. No clinically significant differences between iopentol and iohexol were detected. No correlation was found between the changes in tubular function parameters and changes in GFR. Twenty patients were on calcium channel blockers before the investigation, but this had no protective effect on the renal function parameters.

Iodixanol in cardioangiography in patients with coronary artery disease. Tolerability, cardiac and renal effects.

Iodixanol is a new nonionic, dimeric contrast medium. With the addition of 18 mmol/l Na+ and 0.3 mmol/l Ca++ to iodixanol 320 mg I/ml a plasma-isotonic solution was obtained. The purpose was to evaluate the suitability of iodixanol for use in cardioangiography by determining the diagnostic efficacy, patient tolerability, and cardiac and renal side-effects. Initially, 14 patients with coronary artery disease were examined using iodixanol. A double-blind, randomized study was then performed in 72 patients, comparing iodixanol and iohexol. Serum and urine were sampled before the examination, and one and 2 days after. The diagnostic information was good and the number of adverse events low with iodixanol. The patients reported significantly less of a sensation of warmth following injection of iodixanol than iohexol. Our results also indicate that iodixanol 320 mg I/ml influences renal function to a lesser degree than does iohexol 350 mg I/ml. We therefore conclude that isotonic iodixanol is a safe contrast medium for use in cardioangiography.

Long-term clinical results of percutaneous transluminal angioplasty in transplant renal artery stenosis.

Twenty-five patients with transplant artery stenosis were identified among 1141 renal graft recipients. Impaired graft function (9 patients), hypertension (4 patients) or both (12 patients) were the indications for arteriography. All were treated by percutaneous angioplasty (PTA). The immediate technical success rate was 88% and actuarial graft survival was 88% and 80% at 2 and 5 years respectively. The long-term success rate on graft function was 67% (median observation time 24 months) and on hypertension 63% (median observation time 23 months). Six patients needed rePTA (8 procedures) and in only one patient was surgical repair performed. No case of graft loss due to PTA was recorded and in only one case did occlusion of a segmental artery lead to impairment of graft function. Minor complications were recorded in four other cases and in no case was surgical intervention necessary. Based on these results we favour PTA as a first-line interventional procedure in transplant renal artery stenosis, and the need for surgical repair has been low.

Percutaneous transluminal coronary angioplasty. Six years experience.

In a six-year period (1982-1987), 248 patients were treated with 297 procedures (percutaneous transluminal coronary angioplasty, PTCA) on 282 vessels. Two hundred and fifty-nine (87.2%) of the procedures in 210 (76.7%) of the patients appeared successful angiographically. Thirty-eight procedures were unsuccessful due to failure to pass the stenosis in 18 patients, dissection or occlusion of the treated vessel in 11, and significant residual stenosis in 9 patients. Emergency operations were performed after 11 (3.7%) of the procedures. Two patients died postoperatively. Myocardial infarction was seen in 13 patients, of whom 4 developed pathologic Q-waves in their ECG. Restenosis occurred in 60 (28.6%) of the patients. In the last year of the study, the patients selected for PTCA were in a poorer state angiographically, but the results of PTCA were better, without any increase of the complication rate. Our results, which are in accordance with others, support the concept that PTCA is a relatively safe procedure with a primary success rate of almost 90 percent. However, approximately one third of the patients developed restenosis, which in most cases occurred within 3 months.

Safety of the nonionic contrast medium omnipaque in coronary angiography.

The low osmolar nonionic contrast medium Omnipaque was used in 5,339 consecutive coronary angiographies and serious complications were registered. Myocardial infarction occurred in 4 patients, of whom 2 died, and ventricular fibrillation in 1. Cerebral embolism occurred in 11 patients, all of whom survived. The results are compared with those of previous series of coronary angiography with high osmolar ionic media. It is concluded that use of the nonionic medium Omnipaque resulted in a significant reduction of the frequency of serious complications.

Pulmonary changes at computed tomography in patients with testicular carcinoma treated with cis-platinum, vinblastine and bleomycin.

Computed tomography was performed before and after CVB therapy (cis-platinum, vinblastine, bleomycin) in 42 patients with metastatic testicular carcinoma. Twenty-one of these (3 symptomatic, 18 asymptomatic) developed subpleural pulmonary abnormalities which were streaky or reticular in 7, homogeneous with a broad base against pleura in 3 and had a mixed pattern in 11 patients. Histologic examination was obtained in 3 patients and showed fibrosis with no tumor tissue. Twelve patients with marked CVB induced abnormalities underwent repeat CT within 6 to 24 weeks. Changes disappeared spontaneously in 7, diminished in 3 and increased in 2 of these. Further conventional chest radiography of the latter two revealed complete regression of changes. Pulmonary lesions induced by CVB therapy should be kept in mind at follow-up so that an erroneous diagnosis of tumor progression is not made.