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Budoff MJ, Lee HS, Roy SK, Shekar C. Efficacy and Safety of Iodixanol in Computed Coronary Tomographic Angiography and Cardiac Catheterization. J Cardiovasc Dev Dis 2023; 10:449. [PMID: 37998507 PMCID: PMC10671983 DOI: 10.3390/jcdd10110449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
Iodixanol is an iso-osmolar non-ionic dimeric hydrophilic contrast agent with a higher viscosity than the monomeric agents. It is the only Food and Drug Administration (FDA)-approved iso-osmolar agent in the United States, and it is the only contrast agent with an FDA-approved indication for use in cardiac computed tomographic angiography (CCTA), to assist in the diagnostic evaluation of patients with suspected coronary artery disease. In clinical studies, it has been noted to have fewer side effects and similar image quality when compared to low-osmolar contrast media. This can be attributed to the pharmacological properties of iodixanol. These contrast agents are used for coronary computed tomography angiography and cardiac catheterization. In this article, the use, tolerability, and efficacy of iodixanol are reviewed, specifically evaluating the use of CCTA and coronary angiography, including outcome studies, randomized trials, and comparisons to other contrast agents.
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Affiliation(s)
- Matthew J. Budoff
- Department of Cardiology, Lundquist Institute, Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA;
| | | | - Sion K. Roy
- Department of Cardiology, Lundquist Institute, Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA;
| | - Chandana Shekar
- Department of Cardiology, College of Medicine, Banner-University of Arizona, 1111 E McDowell Road, Phoenix, AZ 85006, USA;
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Iodinated Contrast Agents Reduce the Efficacy of Intravenous Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients: a Multicenter Cohort Study. Transl Stroke Res 2020; 12:530-539. [PMID: 32895894 DOI: 10.1007/s12975-020-00846-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/23/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
This study aimed to investigate whether the application of iodinated contrast agents before intravenous (IV) recombinant tissue plasminogen activator (rt-PA) reduces the efficacy in acute ischemic stroke (AIS) patients. To determine whether the application of iodinated contrast agents before intravenous rt-PA reduces the efficacy in AIS patients. We analyzed our prospectively collected data of consecutive AIS patients receiving IV rt-PA treatment in the MISSION CHINA study. Clinical outcome at 3 months was assessed with modified Rankin Scale (mRS) score and dichotomized into good outcome (0-2) and poor outcome (3-6). Symptomatic intracerebral hemorrhage (sICH) was defined as cerebral hemorrhagic transformation in combination with clinical deterioration of National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points at 24-h. We performed logistic regression analysis and propensity score matching analysis to investigate the impact of iodinated contrast agents before IV rt-PA on poor outcome and sICH, respectively. A total of 3593 patients were finally included, and iodinated contrast agents were used before IV rt-PA among 859 (23.9%) patients. Patients in the iodinated contrast group were more likely to result in poor outcome (39.9% vs 33.4%, P = 0.001) and sICH (3.4% vs 1.5%, P < 0.001), compared with non-contrast group. Binary logistic regression analysis revealed that the application of iodinated contrast agents was independently associated with poor outcome (OR 1.342; 95% CI 1.103-1.631; P = 0.003) and sICH (OR 1.929; 95% CI 1.153-3.230; P = 0.012), respectively. After propensity score matching, the application of iodinated contrast agents was still independently associated with poor outcome (OR 1.246; 95% CI 1.016-1.531; P = 0.034) and sICH (OR 1.965; 95% CI 1.118-3.456; P = 0.019). Applying iodinated contrast agents before IV rt-PA may reduce the thrombolytic efficacy in AIS patients. Further benefit-risk analysis might be needed when iodinated contrast-used imaging is considered before intravenous thrombolysis.
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Zhang J, Jiang Y, Rui Q, Chen M, Zhang N, Yang H, Zhou Y. Iodixanol versus iopromide in patients with renal insufficiency undergoing coronary angiography with or without PCI. Medicine (Baltimore) 2018; 97:e0617. [PMID: 29718868 PMCID: PMC6393082 DOI: 10.1097/md.0000000000010617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The use of contrast agents during coronary angiography can result in contrast-induced nephropathy (CIN), particularly in patients with renal dysfunction. On the contrary, different contrast agents can induce different degree of changes in cardiac function. The objective of our meta-analysis was to compare the clinical safety of iso-osmolar contrast medium iodixanol to low-osmolar contrast medium iopromide in patients with renal insufficiency undergoing coronary angiography with or without percutaneous coronary intervention (PCI). METHODS We searched Medline, Embase, Cochrane Library, and reference lists to identify randomized controlled trials that compared iodixanol to iopromide with the incidence of CIN as an endpoint in renal impaired patients undergoing coronary angiography. Outcome measures were the incidence of CIN, absolute peak serum creatinine (Scr) increase from baseline and a composite of cardiovascular adverse events. RESULTS A total of 8 trials with 3532 patients were pooled; 1759 patients received iodixanol and 1773 patients received iopromide. There was no significant difference in the incidence of CIN (summary odds ratio [OR] 0.50, 95% confidence interval [CI] 0.19-1.35, P = .17) and peak Scr increase (mean difference -0.01 mg/dL, 95% CI -0.08 to 0.05, P = .69) when iodixanol was compared with iopromide. But iodixanol was associated with a statistically significant reduction in cardiovascular adverse events when compared with iopromide (OR 0.47, 95% CI 0.30-0.73, P = .0009). CONCLUSIONS Analysis of pooled data from 8 randomized controlled trials of iodixanol against iopromide in patients with renal insufficiency undergoing coronary angiography with or without PCI showed that iodixanol nonsignificantly reduced the incidence of CIN, but was associated with a significantly reduced risk of cardiovascular adverse events when compared with iopromide.
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Zhang B, Zhang Y, Liu B, Fang L, Li Y, Meng S. Iso-Osmolar Iodixanol Induces Less Increase in Circulating Endothelial Microparticles In Vivo and Less Endothelial Apoptosis In Vitro Compared with Low-Osmolar Iohexol. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:8303609. [PMID: 29849514 PMCID: PMC5914123 DOI: 10.1155/2018/8303609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/29/2018] [Accepted: 02/19/2018] [Indexed: 01/06/2023]
Abstract
Background and Aims There is no consensus on whether iodixanol is superior to iohexol. This study aimed to compare the effects of iodixanol and iohexol on circulating endothelial microparticles (EMPs) in stable coronary artery disease (CAD) patients with diabetes mellitus (DM), and also their cytotoxic effects on human umbilical vein endothelial cells (HUVECs) in vitro. Methods 100 CAD patients with DM were randomly assigned to receive iso-osmolar contrast medium iodixanol (group I) or low-osmolar iohexol (group II) during coronary angioplasty. An additional 49 CAD patients without DM receiving iohexol were recruited as group III. Circulating CD31+/CD41a- EMPs, CD62E+ EMPs, and CD31+/CD41a+ platelet microparticles (PMPs) were determined by flow cytometry. In vitro, the cytotoxic effects of iodixanol and iohexol on HUVECs were determined. Results Circulating CD31+/CD41a- EMPs and PMPs were significantly increased after angioplasty in all 3 groups, while CD62E+ EMPs significantly decreased in group I. CD31+/CD41a- EMPs and PMPs were significantly higher in group II than group I or III. In vitro, both contrast media induced EMP release and inhibited the viability and induced apoptosis of HUVECs, as well as increasing Bax and cleaved caspase-3 and decreasing Bcl-2. The above effects were less evident in iodixanol than in iohexol. Conclusions Compared with iohexol, iodixanol induces less release of EMPs in both CAD patients with DM during angioplasty and in vitro HUVEC culture, which is associated with less pronounced proapoptotic effects of iodixanol on HUVECs. Clinical Study Registration Number This study is registered with ChiCTR-TRC-14005183.
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Affiliation(s)
- Beijian Zhang
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi Zhang
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bo Liu
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lu Fang
- Haematopoiesis and Leukocyte Biology Laboratory, Baker Heart and Diabetes Research Institute, Melbourne, VIC, Australia
| | - Yigang Li
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shu Meng
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Shah B, Berger JS, Allen N, Guo Y, Sedlis SP, Xu J, Perez A, Attubato M, Slater J, Feit F. The assessment of thrombotic markers utilizing ionic versus non-ionic contrast during coronary angiography and intervention trial. Catheter Cardiovasc Interv 2016; 88:727-737. [PMID: 26773574 DOI: 10.1002/ccd.26353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/09/2015] [Accepted: 11/15/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine how two different types of iodinated contrast media (CM), low-osmolar ionic dimer ioxaglate (Hexabrix) and iso-osmolar non-ionic dimer iodixanol (Visipaque), affect multiple indices of hemostasis. BACKGROUND In vitro models demonstrate differential effects of ionic and non-ionic CM on markers of hemostasis. METHODS This blinded endpoint trial randomized 100 patients to ioxaglate or iodixanol. The primary endpoint was change in endogenous thrombin potential (ETP) following diagnostic angiography. Secondary endpoints included change in markers of fibrinolysis [tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1)] and platelet aggregation following diagnostic angiography and percutaneous coronary intervention (PCI) with bivalirudin. Data are presented as median [interquartile range]. RESULTS ETP significantly decreased after diagnostic angiography in both ioxaglate (baseline 1810 nM*minute [1540-2089] to post-angiography 649 nM*minute [314-1347], p < 0.001) and iodixanol groups (baseline 1682 nM*minute [1534-2147] to post-angiography 681 nM*minute [229-1237], p < 0.001), but the decrease was not different between CM (p = 0.70). There was a significant increase in ETP during PCI (n = 45), despite the use of bivalirudin, suggesting a prothrombotic effect of PCI (post-angiography 764 nM*minute [286-1283] to post-PCI 1081 nM*minute [668-1552], p = 0.02). There were no significant differential effects on tPA, PAI-1, and markers of platelet activity. CONCLUSION There were no significant differential effects between ioxaglate and iodixanol. Both CM led to significant reductions in thrombin generation and no significant effects on fibrinolytic activity or platelet activity, thereby contributing to a favorable antithrombotic milieu. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Binita Shah
- Department of Medicine (Cardiology), NYU School of Medicine, New York, New York
| | - Jeffrey S Berger
- Department of Medicine (Cardiology and Hematology), NYU School of Medicine, New York, New York
| | - Nicole Allen
- Department of Medicine (Cardiology), NYU School of Medicine, New York, New York
| | - Yu Guo
- Department of Population Health (Biostatistics), NYU School of Medicine, New York, New York
| | - Steven P Sedlis
- Department of Medicine (Cardiology), VA New York Harbor Health Care System, New York, New York
| | - Jinfeng Xu
- Department of Population Health (Biostatistics), NYU School of Medicine, New York, New York
| | - Adriana Perez
- Department of Medicine (Cardiology), NYU School of Medicine, New York, New York
| | - Michael Attubato
- Department of Medicine (Cardiology), NYU School of Medicine, New York, New York
| | - James Slater
- Department of Medicine (Cardiology), NYU School of Medicine, New York, New York
| | - Frederick Feit
- Department of Medicine (Cardiology), NYU School of Medicine, New York, New York
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A meta-analysis of the risk of total cardiovascular events of isosmolar iodixanol compared with low-osmolar contrast media. J Cardiol 2014; 63:260-8. [DOI: 10.1016/j.jjcc.2013.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 10/18/2013] [Accepted: 11/27/2013] [Indexed: 11/17/2022]
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Narula A, Mehran R, Weisz G, Dangas GD, Yu J, Genereux P, Nikolsky E, Brener SJ, Witzenbichler B, Guagliumi G, Clark AE, Fahy M, Xu K, Brodie BR, Stone GW. Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy. Eur Heart J 2014; 35:1533-40. [DOI: 10.1093/eurheartj/ehu063] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Solomon R. Contrast media: are there differences in nephrotoxicity among contrast media? BIOMED RESEARCH INTERNATIONAL 2014; 2014:934947. [PMID: 24587997 PMCID: PMC3919099 DOI: 10.1155/2014/934947] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/04/2013] [Indexed: 01/04/2023]
Abstract
Iodinated contrast agents are usually classified based upon their osmolality--high, low, and isosmolar. Iodinated contrast agents are also nephrotoxic in some but not all patients resulting in loss of glomerular filtration rate. Over the past 30 years, nephrotoxicity has been linked to osmolality although the precise mechanism underlying such a link has been elusive. Improvements in our understanding of the pathogenesis of nephrotoxicity and prospective randomized clinical trials have attempted to further explore the relationship between osmolality and nephrotoxicity. In this review, the basis for our current understanding that there are little if any differences in nephrotoxic potential between low and isosmolar contrast media will be detailed using data from clinical studies.
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Affiliation(s)
- Richard Solomon
- University of Vermont College of Medicine, Burlington, VT 05401, USA
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García-García HM, Kukreja N, Daemen J, Tanimoto S, van Mieghem C, Gonzalo N, van Weenen S, van der Ent M, Sianos G, de Feyter P, Serruys PW. Contemporary treatment of patients with chronic total occlusion: critical appraisal of different state-of-the-art techniques and devices. EUROINTERVENTION 2012; 3:188-96. [PMID: 19758937 DOI: 10.4244/eijv3i2a34] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To describe the contemporary approach of chronic total occlusion (CTO) treatment of patients at the Thoraxcenter, Rotterdam, The Netherlands. Additionally, to make a critical appraisal of the performance of state-of-the-art CTO dedicated guidewires and devices in a prospective registry of patients. METHODS AND RESULTS During 20 months, a total of 160 consecutive patients (165 CTOs) were enrolled. The mean age was 61.5+/-11.1 years and 83.6% were male. In 91.5% of the patients this was the first attempt to open the CTO and 93.8% were de novo. The overall success rate was 60.6%. A median of 1 guiding catheter was used per case (Range: 1 to 9) and a median of 4 guidewires (Range: 1 to 11; 13 different types). 74.5% patients required more than one guidewire/device for the treatment of the CTO. The guidewires that most frequently crossed the CTO were the following: PT Graphix intermediate 33.0%, Miracle 3 g 27.4% and Crosswire NT 25.5%. The only device tested as a first option for the treatment of the CTOs was the CROSSER. Overall, the CROSSER system was used in 23 (13.9%) patients with a success rate of 60.9%. The Point 9(R) X-80 Laser catheter was used in 10 (6.1%) patients with a success rate of 60%. Another 3 patients were treated with the Point 7(R) laser catheter. Both were used either to facilitate the crossing of the balloon, or to treat primarily in-stent restenosis occlusions. The SafeCross(R) System was used in 15 (9.1%) patients and the success rate in these patients was 46.7%. The most common strategy used in this registry was the use of an over-the-wire balloon in 81.5% of the cases. The parallel wire technique was used in 27.3% of the cases and in 12.7% was converted into a "see-saw" technique. When a large false lumen was created, re-entry into the true lumen was attempted in 21.2% of the cases, by means of IVUS guided approach and/or the use of stiffer guidewires, such as a Confianza guidewire. Retrograde recanalisation was attempted in 10 cases (6.1%), in three cases a graft was used; the remaining cases were treated either via collaterals or the septal branches. CONCLUSIONS The treatment of CTOs requires the use of a high number of guiding catheters and guidewires, as well as the use of sophisticated devices. The procedure must be carefully planned in advance as far as possible, as well as considering a prompt change in approach during the performance of the procedure to prevent complications derived from long procedures by using specific techniques such as parallel wire, see-saw, anchoring balloon, etc.
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Bellemain-Appaix A, Beygui F, Lesty C, Gupta S, Silvain J, Le Feuvre C, Cayla G, Allali Y, Montalescot G, Collet JP. Impact of anticoagulation on ionic and nonionic contrast media effect on thrombogenesis and fibrinolysis: The PEPCIT study. Catheter Cardiovasc Interv 2011; 79:823-33. [DOI: 10.1002/ccd.23080] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 02/19/2011] [Indexed: 11/10/2022]
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Abstract
The rapid development of percutaneous coronary and peripheral vascular interventional technologies and also noninvasive imaging systems has led to a dramatic increase in the number of patients receiving contrast media (CM). Although relatively uncommon, adverse events can occur following administration of contrast, including nuisance reactions (e.g., nausea and urticaria) and potentially severe complications, such as contrast-induced nephropathy and thrombotic events. In this report, we review the evidence regarding the occurrence of thrombotic effects following iodinated CM administration during percutaneous coronary intervention.
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Affiliation(s)
- Jonathan S Reiner
- Cardiac Catheterization Laboratories, George Washington University Medical Center, Washington, District of Columbia, USA.
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Klein LW, Sheldon MW, Brinker J, Mixon TA, Skelding K, Strunk AO, Tommaso CL, Weiner B, Bailey SR, Uretsky B, Kern M, Laskey W. The use of radiographic contrast media during PCI: a focused review: a position statement of the Society of Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2010; 74:728-46. [PMID: 19830793 DOI: 10.1002/ccd.22113] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Lloyd W Klein
- Rush Medical College & Department of Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois 60657, USA.
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Garcia-Garcia H, van Mieghem C, Gonzalo N, Meijboom W, Weustink A, Onuma Y, Mollet N, Schultz C, Meliga E, van der Ent M, Sianos G, Goedhart D, den Boer A, de Feyter P, Serruys P. Computed Tomography in Total coronary Occlusions (CTTO Registry): radiation exposure and predictors of successful percutaneous intervention. EUROINTERVENTION 2009; 4:607-16. [DOI: 10.4244/eijv4i5a102] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Collet JP, Beygui F, Barthélemy O, Livarek B, Montalescot G. [Treatment of intracoronary thrombus in the catheterisation laboratory in acute coronary syndrome patients]. Ann Cardiol Angeiol (Paris) 2007; 56:250-6. [PMID: 17963716 DOI: 10.1016/j.ancard.2007.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Treatment of intracoronary thrombus is well documented. Three situations should be differentiated Primary percutaneous coronary intervention for early STEMI presenters is the most frequent one. Glycoprotein IIb/IIIa inhibitors are the gold standard antithrombotic treatment with a clear mortality benefit with abciximab. Thrombectomy with simple to use devices is another attractive option for interventionalists, although there is no clear established clinical benefit. Rescue PCI following failed thrombolysis is a more complicated situation given the underlying bleeding risk that is difficult to evaluate. The second situation is when a thrombus appears during an elective PCI. Although much less frequent than primary PCI, it is more often related to a lack of identification of the risk, to an inappropriate choice of the materials or to a non-optimal upstream antithrombotic treatment. A careful identification of all potential relevant causes is the key point of the management strategy. Post-PCI rethrombosis is the third situation and probably the less frequent. However, it is the most difficult to deal with.
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Affiliation(s)
- J-P Collet
- Institut de cardiologie, centre hospitalier universitaire de la Pitié-Salpêtrière, APHP, 47, boulevard de l'Hôpital, 75013 Paris, France.
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Brunette J, Mongrain R, Rodés-Cabau J, Larose É, Leask R, Bertrand OF. Comparative rheology of low- and iso-osmolarity contrast agents at different temperatures. Catheter Cardiovasc Interv 2007; 71:78-83. [DOI: 10.1002/ccd.21400] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Aubry P, Halna du Fretay X, Tchetche D. [Contrast media and percutaneous coronary interventions]. Ann Cardiol Angeiol (Paris) 2007; 56:2-9. [PMID: 17343032 DOI: 10.1016/j.ancard.2006.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Contrast media are widely used for percutaneous coronary interventions. Currently, about a dozen types of contrast media are available in France. On account of their overall safety, only low osmolar and isosmolar contrast media are used in practice. However, the appropriate use of contrast media remains difficult as accurate recommendations are lacking. Several doubts are still present regarding potential adverse effects of contrast media. Our review summarizes contrast media-related risks (hypersensitivity, arrhythmic risk, effects on coagulation and platelets, contrast media-induced nephrotoxicity) underlying mechanisms, prophylaxis strategies, and differences among contrast media. Many questions remain in this area and we need further prospective randomised trials.
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Affiliation(s)
- P Aubry
- Departement de cardiologie, centre hospitalier Bichat-Claude Bernard, 46, Rue Henri-Huchard, 75018 Paris, France.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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