RESUMO
BACKGROUND: Contrast-induced nephropathy (CIN) is a major complication of percutaneous coronary interventions with currently limited preventive measures. OBJECTIVES: To prevent CIN, we assessed the safety and feasibility of contrast removal from the coronary sinus (CS) during coronary angiography. METHODS: We attempted contrast removal on seven patients undergoing coronary angiography with preexisting renal insufficiency (mean serum creatinine=262+/-56 mg%). RESULTS: In four patients, a balloon catheter could not be successfully deployed in the CS. In three patients, a balloon catheter with distal side holes was positioned in the CS orifice. The balloon was inflated to occlude the CS concurrent with coronary injections, and 12-16 ml of blood was aspirated after each injection. The procedure appeared to be safe, without adverse events and elevations of serum creatinine levels. Contrast media were effectively withdrawn (44%+/-8%) as assessed by fluoroscopy and dilution of blood. The increased venous pressure at the time of injection reduced coronary flow, allowing for small volumes of administered contrast. CONCLUSIONS: Occlusion of the CS during coronary angiography with aspiration of contrast media is safe and effective in reducing contrast load during coronary interventions. This procedure may reduce the risk for CIN in prone patients.
Assuntos
Oclusão com Balão , Meios de Contraste/efeitos adversos , Angiografia Coronária/efeitos adversos , Seio Coronário/diagnóstico por imagem , Ácido Ioxáglico/efeitos adversos , Nefropatias/prevenção & controle , Insuficiência Renal/complicações , Sucção , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Estudos de Viabilidade , Humanos , Injeções , Ácido Ioxáglico/administração & dosagem , Ácido Ioxáglico/sangue , Nefropatias/sangue , Nefropatias/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/sangueRESUMO
Determination of changes in plasma concentration of ioxaglate in patients with renal failure made it possible to demonstrate that distribution and clearance of this contrast medium, as in the case of classic uroangiographic products, conform to an open two-compartment model with clearance from the central compartment. Various pharmacokinetic parameters were calculated. The metabolic clearance of ioxaglate was lower for all 6 patients studied, as compared with results for 3 normal subjects tested, but less marked than with iodamide, a contrast medium involving tubular secretion.
