The role of N-acetylcysteine in the prevention of contrast-induced nephrotoxicity.

PURPOSE: To determine the role of prophylactic N-acetylcysteine in the prevention of contrast-induced nephrotoxicity. METHODS: One hundred and sixteen patients undergoing noncoronary angiography, with or without pre-existing renal impairment, were randomly assigned to receive prophylactic oral N-acetylcysteine or no treatment. Serum creatinine (sCr) was measured prior to angiography and 48 hr after the procedure. Urine samples were collected before and after the examination for measurement of malondialdehyde (MDA) concentration. Contrast-induced nephrotoxicity (CIN) was defined as a rise in serum creatinine of 0.5 mg/dl (44 mmol/l) at 48 hr. RESULTS: Complete data were available on 106 patients, 53 of whom had received N-acetylcysteine. There were no significant differences between the two groups in baseline characteristics, type of angiogram, or volume and concentration of contrast used. Three patients (2.8%), all of whom had received N-acetylcysteine, developed CIN. In the N-acetylcysteine group, the mean serum creatinine in patients with renal impairment was 151.0 +/- 44.2 micromol/l prior to the procedure and 155.6 +/- 48.6 micromol/l (p = 0.49) after the procedure. Respective values for those without renal impairment were 79.6 +/- 15.1 micromol/l and 81.2 +/- 20.0 micromol/l (p = 0.65). In the group that had not received N-acetylcysteine, the mean serum creatinine levels before and after the procedure were 150.0 +/- 58.1 and 141.4 +/- 48.0 micromol/l (p = 0.17) in patients with renal impairment and 79.7 +/- 14.2 and 81.4 +/- 15.4 micromol/l (p = 0.34) in those without renal impairment. In both groups, no significant change in urinary MDA concentration was observed. CONCLUSION: There is no benefit to the prophylactic administration of N-acetylcysteine in patients undergoing peripheral angiography using current contrast media.

Endovascular treatment of giant splenic aneurysm that developed after liver transplantation.

Splenic artery aneurysms (SAAs) are not uncommon in patients with portal hypertension. They are usually diagnosed in preliminary examinations prior to orthotopic liver transplantation (OLT) and are treated surgically at the time of transplantation. In our case, the patient developed a giant SAA after liver transplantation. This was detected incidentally upon routine ultrasound follow-up, and the diagnosis was confirmed on magnetic resonance (MR) angiography. The patient was treated by endovascular embolization because it is believed that this minimally invasive approach is beneficial in an immunocompromised patient following OLT. After coil embolization, to achieve complete and immediate blood flow exclusion of the sac, it was decided to inject some glue ( N-butyl-2-cyanoacrylate) directly into the aneurysm. The aneurysm was successfully obliterated. To the best of our knowledge the use of cyanoacrylate glue in an SSA has never been reported.

Using 6-mm Cutting Balloon angioplasty in patients with resistant peripheral artery stenosis: preliminary results.

OBJECTIVE: The objective of this study was to assess the efficacy of 6-mm Cutting Balloon angioplasty in patients with resistant peripheral stenoses caused by neointimal hyperplasia or irradiation-induced arteriopathy in vascular territories that are not amenable for use of the smaller Cutting Balloons that are used in cardiology. CONCLUSION: Peripheral Cutting Balloon angioplasty with the new 6-mm Cutting Balloon device proved useful in the short term for treatment of peripheral arterial stenoses resistant to conventional angioplasty.

Endovascular repair of thoracic aortic aneurysm and intramural hematoma in giant cell arteritis.

An 80-year-old woman with established giant cell arteritis presented at the authors' institution with a 6.5-cm false aneurysm of the descending thoracic aorta complicated by focal dissection and intramural hematoma after a 1-week history of acute-onset chest pain. The patient underwent uncomplicated endovascular aortic repair with a 32-mm x 15-cm TagExcluder stent-graft. After the procedure, the intramural hematoma resolved and the patient's corticosteroid and immunosuppressive therapy was repeatedly adjusted. However, the giant cell arteritis activity relapsed after 8 months with development of a similar 1.5-cm false aneurysm below the thoracic stent-graft, complicated by focal intramural hematoma. Repeat uncomplicated thoracic stent-graft implantation was performed and CT follow-up displayed resorption of the intramural hematomas with no evidence of endoleak or any new aortic pathology. This report discusses the difficult management of patients with relapsing active aortic giant cell arteritis and the potential role for endovascular thoracic aortic repair.