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Zebrauskaite A, Tsybulskyi E, Simanauskas I, Zebrauskaite G, Ziubryte G, Ordiene R, Unikas R, Jarusevicius G, Harding SA. Investigations of injection strategies to use heparinized normal saline instead of contrast media for intracoronary optical coherence tomography imaging. Perfusion 2024:2676591241264116. [PMID: 38907368 DOI: 10.1177/02676591241264116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
BACKGROUND The benefits of intravascular imaging-guided percutaneous coronary interventions (PCI) are well established. Intravascular imaging guidance improves short- and long-term outcomes, especially in complex PCI. Optical coherence tomography (OCT) has a higher resolution than intravascular ultrasound. However, the usage of OCT is mainly limited by the need to use contrast for flushing injections, which increases the risk of contrast-induced acute kidney injury, especially in patients with underlying chronic kidney disease. The aim of this study was to prove that flushing techniques with normal saline instead of contrast can be used in OCT imaging and can generate high-quality images. METHODS This prospective single-center observational study included patients with indications for OCT-guided PCI. For OCT pullbacks, heparinized saline was injected by an automatic pump injector at different rates, and additional extension catheters for selective coronary artery engagement were used at the operator's discretion. Recordings were made using the Ilumien Optis OCT system (Abbott) and the Dragonfly (Abbott) catheter and were analyzed at 1-mm intervals by two operators. Pullbacks were categorized as having optimal, acceptable, or unacceptable imaging quality. A clinically usable run was determined if >75% of the region of interest length was described as having optimal or acceptable imaging quality. RESULTS A total of 32 patients were enrolled in the study; 47 different lesions were assessed before and after PCI. In total, 91.5% of runs were described as clinically suitable for use. CONCLUSION Heparinized saline injections for OCT imaging are effective in generating good-quality OCT images suitable for clinical use.
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Affiliation(s)
- Aiste Zebrauskaite
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eduard Tsybulskyi
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ignas Simanauskas
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gabriele Zebrauskaite
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Cardiology, Kaunas Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Greta Ziubryte
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- Department of Cardiology, Kaunas Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
- Institute of Cardiology, Kaunas, Lithuania
| | - Rasa Ordiene
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Ramunas Unikas
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gediminas Jarusevicius
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- Department of Cardiology, Kaunas Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
- Institute of Cardiology, Kaunas, Lithuania
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Somkereki C, Palfi R, Scridon A. Prevention of contrast-associated acute kidney injury in an era of increasingly complex interventional procedures. Front Med (Lausanne) 2024; 10:1180861. [PMID: 38264052 PMCID: PMC10803418 DOI: 10.3389/fmed.2023.1180861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
Radiological and interventional cardiology procedures are in continuous expansion, leading to an important increase in the incidence of contrast-associated acute kidney injury (CA-AKI). Although numerous methods of CA-AKI prevention have been studied, at present, there is no consensus on the definition of this entity or on its prevention. In this paper, we aim to provide a critical analysis of the existing data on the epidemiology, pathophysiology, and clinical significance of CA-AKI. Existing and emergent approaches for CA-AKI prevention are also discussed, with a focus on parenteral fluid administration and on the most recent clinical and experimental data. We also emphasize a number of questions that remain to be answered, and we identify hotspots for future research.
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Affiliation(s)
- Cristina Somkereki
- Cardiology Department, Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureș, Târgu Mureș, Romania
- Physiology Department, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Târgu Mureș, Romania
| | - Renata Palfi
- Cardiology Department, Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureș, Târgu Mureș, Romania
| | - Alina Scridon
- Physiology Department, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Târgu Mureș, Romania
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Exploring the effects of edaravone in rats with contrast-induced acute kidney injury. Life Sci 2022; 309:121006. [PMID: 36174711 DOI: 10.1016/j.lfs.2022.121006] [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: 07/20/2022] [Revised: 09/17/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022]
Abstract
AIMS Oxidative stress and inflammatory response play a vital role in the pathogenesis of contrast-induced acute kidney injury (CI-AKI). This study investigated the effects of edaravone in rats with CI-AKI. MAIN METHODS Male Sprague Dawley rats were randomly assigned into four groups (n = 11-14/group): control, edaravone (30 mg/kg/day intraperitoneally (IP)), CI-AKI, and edaravone with CI-AKI. The induction of CI-AKI was performed by dehydration and the administration of contrast media (iohexol) and inhibitors of prostaglandin (indomethacin) and nitric oxide synthesis (L-NAME: N-nitro L-arginine methyl ester). Edaravone was administered for two weeks before the induction of CI-AKI. Serum creatinine and urea, renal oxidative stress and inflammatory biomarkers, and histopathological alterations were evaluated after 48 h of contrast exposure. KEY FINDINGS Rats with CI-AKI showed a significant increase in serum creatinine and urea. The levels of antioxidant biomarkers including glutathione peroxidase, superoxide dismutase and reduced glutathione were significantly decreased in CI-AKI group versus control. Pre-treatment of rats with edaravone normalized kidney function and protected the kidney from oxidative damage as demonstrated by normalization of previous biomarkers. Furthermore, edaravone partially ameliorated renal histopathological alterations relative to the CI-AKI group, notably in the nephrons. No changes were observed in inflammatory biomarkers including tumour necrosis factor-alpha and interleukin-6 among all groups. SIGNIFICANCE The current findings suggest that edaravone could be a potential strategy to ameliorate developing CI-AKI possibly by improving renal antioxidant capacity. Further studies are warranted to expand the current understanding of the use of edaravone in the various models of AKI.
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Gonzalez EA, Lediju Bell MA. Dual-wavelength photoacoustic atlas method to estimate fractional methylene blue and hemoglobin contents. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-220093GR. [PMID: 36050818 PMCID: PMC9433893 DOI: 10.1117/1.jbo.27.9.096002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
SIGNIFICANCE Methylene blue (MB) is an exogenous contrast agent that has the potential to assist with visualization and penetration challenges in photoacoustic imaging. However, monitoring the local concentration between MB and endogenous chromophores is critical for avoiding unnecessary MB accumulations that could lead to adverse effects such as hemolysis when exposed to increased dose and photodamage when exposed to high laser energies. AIM We developed a modified version of a previously proposed acoustic-based atlas method to estimate concentration levels from a mixture of two photoacoustic-sensitive materials after two laser wavelength emissions. APPROACH Photoacoustic data were acquired from mixtures of 100-μM MB and either human or porcine blood (Hb) injected in a plastisol phantom, using laser wavelengths of 710 and 870 nm. An algorithm to perform linear regression of the acoustic frequency response from an atlas composed of pure concentrations was designed to assess the concentration levels from photoacoustic samples obtained from 11 known MB/Hb volume mixtures. The mean absolute error (MAE), coefficient of determination (i.e., R2), and Spearman's correlation coefficient (i.e., ρ) between the estimated results and ground-truth labels were calculated to assess the algorithm performance, linearity, and monotonicity, respectively. RESULTS The overall MAE, R2, and ρ were 12.68%, 0.80, and 0.89, respectively, for the human Hb dataset and 9.92%, 0.86, and 0.93, respectively, for the porcine Hb dataset. In addition, a similarly linear relationship was observed between the acoustic frequency response at 2.3 MHz and 870-nm laser wavelength and the ground-truth concentrations, with R2 and | ρ | values of 0.76 and 0.88, respectively. CONCLUSIONS Contrast agent concentration monitoring is feasible with the proposed approach. The potential for minimal data acquisition times with only two wavelength emissions is advantageous toward real-time implementation in the operating room.
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Affiliation(s)
- Eduardo A. Gonzalez
- Johns Hopkins University, School of Medicine, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Muyinatu A. Lediju Bell
- Johns Hopkins University, School of Medicine, Department of Biomedical Engineering, Baltimore, Maryland, United States
- Johns Hopkins University, Whiting School of Engineering, Department of Electrical and Computer Engineering, Baltimore, Maryland, United States
- Johns Hopkins University, Whiting School of Engineering, Department of Computer Science, Baltimore, Maryland, United States
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Gao Z, Zhang Z, Gu D, Li Y, Zhang K, Dong X, Liu L, Zhang J, Chen J, Wu D, Zeng M. Hemin mitigates contrast‐induced nephropathy by inhibiting ferroptosis via HO‐1/Nrf2/GPX4 pathway. Clin Exp Pharmacol Physiol 2022; 49:858-870. [PMID: 35598290 DOI: 10.1111/1440-1681.13673] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Zhao Gao
- Medical and Healthcare Center, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Ziyue Zhang
- Department of Cardiology, Daping Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
| | - Daqian Gu
- Department of Cardiology, 900 Hospital of The Joint Logistics Team, Fuzhou, Fujian, China
| | - Yunqian Li
- Medical and Healthcare Center, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Kun Zhang
- Medical and Healthcare Center, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Xiaoli Dong
- Department of Cardiology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Lingli Liu
- Department of Clinical Laboratory, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Jiye Zhang
- Medical Laboratory, Liang Ping People's Hospital of Chongqing, Chongqing, China
| | - Jimin Chen
- Department of Pathology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Duozhi Wu
- Medical and Healthcare Center, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Min Zeng
- Medical and Healthcare Center, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
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Wang J, Zhang C, Liu Z, Bai Y. Risk factors of contrast-induced nephropathy after percutaneous coronary intervention: a retrospective analysis. J Int Med Res 2021; 49:3000605211005972. [PMID: 33878914 PMCID: PMC8072857 DOI: 10.1177/03000605211005972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Contrast-induced nephropathy (CIN) is a serious complication in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). This study aimed to analyze the potential risk factors for CIN in patients undergoing PCI. Methods Patients with ACS who underwent PCI treatment from January 2017 to January 2020 were selected. The patients’ characteristics and medical information were collected and compared. Results A total of 1331 patients undergoing PCI were included. The incidence of CIN was 15.33%. Logistic regression analyses showed that a left ventricular ejection fraction ≤45% (odds ratio [OR] 4.18, 95% confidence interval [CI] 1.10–7.36), serum creatinine levels ≤60 μmol/L (OR 3.03, 95% CI 1.21–5.57), age ≥65 years (OR 2.75, 95% CI 1.32–4.60), log N-terminal pro-B-type natriuretic peptide levels ≥2.5 pg/mL (OR 2.31, 95% CI 1.18–5.13), uric acid levels ≥350 μmol/L (OR 2.29, 95% CI 1.04–5.30), emergency percutaneous intervention (OR 1.35, 95% CI 0.34–3.12), and triglyceride levels ≤1.30 mmol/L (OR 1.10, 95% CI 0.01–2.27) were independent risk factors for CIN in patients who underwent PCI. Conclusions Early prevention is required to reduce the occurrence of CIN in patients who undergo PCI and have risk factors for CIN.
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Affiliation(s)
- Jing Wang
- Department of Cardiology, Yan'an University Affiliated Hospital, Yan'an, China
| | - Chunyu Zhang
- Nursing Teaching and Research Department, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Yan'an, China
| | - Zhina Liu
- Department of Cardiology, Yan'an University Affiliated Hospital, Yan'an, China
| | - Yanping Bai
- Department of Cardiology, Yan'an University Affiliated Hospital, Yan'an, China
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Alshogran OY, Nusair SD, El-Elimat T, Alzoubi KH, Obeidat A, Sweidan M. Evaluation of coenzyme Q10 combined with or without N-acetyl cysteine or atorvastatin for preventing contrast-induced kidney injury in diabetic rats. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:1403-1410. [PMID: 33630121 DOI: 10.1007/s00210-021-02070-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
Combined antioxidants effect for prevention of contrast-induced nephropathy (CIN) remains unclear. This study assessed the potential protective effects of coenzyme Q10 (CoQ10) alone or combined with N-acetyl cysteine (NAC) or atorvastatin against CIN in diabetic rats. Animals were randomly divided into five groups, including control and four disease groups with CIN and diabetes. Group 2 included diabetic rats with CIN. Groups 3-5 included diabetic rats that received CoQ10, CoQ10 and NAC, or CoQ10 and atorvastatin, respectively, before CIN induction. Serum, urine, and tissue were collected to evaluate renal protective effects of tested agents. Renal biomarkers, oxidative stress, and histopathological alterations were investigated. Rats with CIN showed significant renal impairment as revealed by the deleterious effects on kidney function and histology. While induction of CIN did not affect the renal levels of catalase, glutathione peroxidase (GPx), and thiobarbituric acid reactive substances, pretreatment of animals with CoQ10/NAC showed significant increase in GPx and catalase levels versus controls. Lastly, pretreatment with CoQ10/atorvastatin showed regenerative effect on distal tubules with mild kidney histology alterations relative to CIN rats. The combined use of CoQ10/atorvastatin could be a potential strategy to prevent CIN. However, future studies are warranted to test different combinations for longer prophylactic periods.
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Affiliation(s)
- Osama Y Alshogran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Shreen D Nusair
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Tamam El-Elimat
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Abdullah Obeidat
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Maya Sweidan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
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Gupta A, Chhikara S, Vijayvergiya R, Seth A, Mahesh NK, Akasaka T, Singh N. Saline as an alternative to radio-contrast for optical coherence tomography guided percutaneous coronary intervention: A prospective comparison. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 34:86-91. [PMID: 33468422 DOI: 10.1016/j.carrev.2021.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To do a quantitative comparison of saline and contrast Frequency domain optical coherence tomography (FD-OCT) during percutaneous coronary intervention (PCI) optimisation. METHODS 13 pairs of OCT runs were analysed, wherein each pair consisted of a contrast run and a heparinized saline run taken in the same coronary artery at the same position. Quantitative analysis was done comparing minimal lumen area (MLA), proximal reference diameter (PRD), distal reference diameter (DRD) and percentage area stenosis (AS) at the same anatomical location. Lesion morphologies, rendered stent view and 3D reconstruction were compared for image clarity. RESULT The saline OCT runs resulted in comparable MLA (3.88 ± 2.59 mm2 with saline run vs 3.88 ± 2.71 mm2 with contrast run; p = 0.650), PRD (3.66 ± 0.52 mm with saline vs 3.65 ± 0.52 mm with contrast; p = 0.463), DRD (2.97 ± 0.22 mm with saline vs 2.99 ± 0.88 mm with contrast; p = 0.433), and AS (59.60 ± 18.62% with saline vs 59.18 ± 19.11% with contrast; p = 0.753) with respect to the contrast runs. The Bland Altman plots of the measured parameters indicate good agreement between saline and contrast OCT. Linear regression analysis indicated the absence of proportional bias All lesion morphologies (calcified, fibrotic, thin cap fibroatheroma, macrophages, cholesterol crystals and edge dissection), 3D reconstruction and rendered stent view were clearly demonstrable in the saline OCT runs. CONCLUSIONS Using heparinized saline as flushing media in coronary FD-OCT may result in vessel dimensions that are comparable with contrast. Heparinized saline may be used as a contrast saving alternative for FD-OCT during PCI optimization.
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Affiliation(s)
- Ankush Gupta
- Professor of Medicine & Interventional Cardiologist, Head of Department (Cardiology), Military Hospital Jaipur, Rajasthan 302016, India.
| | | | - Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, PGIMER, Chandigarh 160012, India
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi 110025, India.
| | - Nalin K Mahesh
- Department of Cardiology, INHS Asvini, Mumbai, Maharashtra 400005, India
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama 641-8509, Japan.
| | - Navreet Singh
- Department of Cardiology, The Air Force Central Medical Establishment, New Delhi 110010, India
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9
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Mahesh NK, Gupta A, Barward P, Vijayvergiya R, Sharma P, Mahesh A. Study of saline optical coherence tomography-guided percutaneous coronary intervention (SOCT-PCI Study). Indian Heart J 2020; 72:239-243. [PMID: 32861376 PMCID: PMC7474129 DOI: 10.1016/j.ihj.2020.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/01/2020] [Accepted: 03/28/2020] [Indexed: 11/29/2022] Open
Abstract
AIM The aim of this study was to evaluate the feasibility of heparinised saline as flushing media for frequency-domain optical coherence tomography (FD-OCT) image acquisition during percutaneous coronary intervention (PCI) optimisation. METHODS AND RESULTS Twenty-seven patients undergoing FD-OCT-guided PCI were enrolled. Heparinised saline was injected into the coronary during FD-OCT image acquisition. A total of 118 runs were analysed for image quality and diagnostic value. FD-OCT runs were categorised as follows: good runs (GRs), clinically usable runs (CURs) and clinically not usable runs (NURs); GRs and CURs were combined as clinically effective runs (ERs). Saline FD-OCT enabled visualisation of all possible coronary lesions. Of the 118 runs analysed, 61%, 27.1%, 11.9% and 88.1% were GRs, CURs, NURs and ERs, respectively. Sixty-one percent of total runs were left coronary system (LCS) and 39% were right coronary system (RCS) runs. Among LCS runs, 55.6%, 30.6%, 13.8% and 86.2% were GRs, CURs, NURs and ERs, respectively. Among RCS runs, 69.6%, 21.7%, 8.7% and 91.3% were GRs, CURs, NURs and ERs, respectively. CONCLUSION This is the first study to demonstrate the technical feasibility of isolated saline FD-OCT for PCI optimisation.
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Affiliation(s)
- Nalin K Mahesh
- Department of Cardiology, Base Hospital Delhi Cantt, New Delhi, India
| | - Ankush Gupta
- Department of Cardiology, Base Hospital Delhi Cantt, New Delhi, India.
| | | | | | - Prafull Sharma
- Department of Cardiology, Base Hospital Delhi Cantt, New Delhi, India
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10
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Li X, Zhang W, Liu J, Gonzalez L, Liu D, Zhang L, Dardik A, Shu C. Contrast-Induced Kidney Nephropathy in Thoracic Endovascular Aortic Repair: A 2-Year Retrospective Study in 470 Patients. Angiology 2019; 71:242-248. [PMID: 31829038 DOI: 10.1177/0003319719893578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We identified changes in renal function in patients who underwent thoracic endovascular aortic repair (TEVAR) and the factors that may influence renal function. Information on 470 consecutive patients was collected. Kidney function and contrast volume were recorded. Unpaired t test, Spearman correlation, and logistic regression were used for statistical analysis. A Kaplan-Meier curve helped clarify our follow-up findings. Mean contrast volume was 90.5 ± 21.2 mL. The change in serum creatinine was significantly correlated with (1) preexisting renal pathology (P = .033) and (2) aortic dissection (AD) involving the renal arteries (P = .019). The change in serum urea nitrogen (ΔBUN) was only significantly correlated with AD involving the renal arteries (P = .0348). Contrast volume (P = .036, odds ratio = 1.010, 95% confidence interval: 1.001-1.019) was a risk factor for contrast-induced nephropathy (CIN) after TEVAR. Survival rates and renal failure rates among no CIN, CIN, and CIN-acute kidney injury groups at longest 27 months follow-up were significantly different. Creatinine and BUN were generally elevated post-TEVAR. Contrast-induced nephropathy post-TEVAR may correlate with renal comorbidities and renal artery involvement. Contrast volume is risk factor for CIN after TEVAR. More attention needs to be paid to patient renal function during follow-up.
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Affiliation(s)
- Xin Li
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Weichang Zhang
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Jia Liu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China.,Department of Surgery and the Interdepartmental Program in Vascular Biology & Therapeutics, Yale University School of Medicine, New Haven, CT, USA
| | - Luis Gonzalez
- Department of Surgery and the Interdepartmental Program in Vascular Biology & Therapeutics, Yale University School of Medicine, New Haven, CT, USA
| | - Dingxiao Liu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Lei Zhang
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Alan Dardik
- Department of Surgery and the Interdepartmental Program in Vascular Biology & Therapeutics, Yale University School of Medicine, New Haven, CT, USA
| | - Chang Shu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China.,State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Morcos R, Kucharik M, Bansal P, Al Taii H, Manam R, Casale J, Khalili H, Maini B. Contrast-Induced Acute Kidney Injury: Review and Practical Update. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819878680. [PMID: 31700251 PMCID: PMC6826945 DOI: 10.1177/1179546819878680] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is an important consideration in patients undergoing cardiac catheterization. There has been a continuous strive to decrease morbidity and improve procedural safety. This review will address the pathophysiology, predictors, and clinical management of CI-AKI with a concise overview of the pathophysiology and a suggested association with left atrial appendage closure. Minimizing contrast administration and intravenous fluid hydration are the cornerstones of an effective preventive strategy. A few adjunctive pharmacotherapies hold promise, but there are no consensus recommendations on prophylactic therapies.
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Affiliation(s)
- Ramez Morcos
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Michael Kucharik
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Pirya Bansal
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, FL, USA
| | - Haider Al Taii
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, FL, USA
| | - Rupesh Manam
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Joel Casale
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Houman Khalili
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, FL, USA.,Tenet Healthcare Corporation, Boca Raton, FL, USA
| | - Brijeshwar Maini
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, FL, USA.,Tenet Healthcare Corporation, Boca Raton, FL, USA
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12
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Qiao L, Wang S, Jia Q, Bian J, Fan Y, Xu X. Clinical efficacy and safety of statin treatment after carotid artery stenting. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:3110-3115. [PMID: 31352800 DOI: 10.1080/21691401.2019.1645149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective: The randomized controlled trail was carried out to investigate the influence of statin pre-treatment on clinical efficacy of carotid artery stenting (CAS). Methods: 160 eligible patients were randomly divided into statin group (n = 82) and control group (n = 78). The patients in statin group received 40 mg atorvastatin daily 7 days before operation. Major endpoints included transient ischemic attack (TIA), stroke, death, myocardial infarction (MI), and other cardiac adverse events within 30 days after CAS. Results: Preoperative baseline information was similar between the statin and control groups (p > 0.05 for all). Within 48 h after operation, the occurrence rate of CIN (3.66% vs 8.97%, p = .019) and new infarction (4.88% vs. 14.10%, p = .045) were significantly lower in statin group than in control group. 30 days after CAS, the incidences of TIA (12.20% vs. 26.92%, p = .018), ischemic stroke (6.10% vs. 16.67%, p = .034), and other cardiac complications (7.32% vs. 19.23%, p = .026) were also significantly lower in statin group, than in the control group. Multiple analysis demonstrated that statin use exerted protective effect against ischemic stroke (OR = 0.038, 95% CI = 0.003-0.543, p = .016) and other cardiac complications (OR = 0.208, 95%CI = 0.063-0.694, p = .011). Conclusion: Pre-treatment with statin is an effective and safe strategy to prevent from perioperative complications and to improve postoperative outcomes in patients undergoing CAS.
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Affiliation(s)
- Lingya Qiao
- a Department of Neurology, Tianjin Huanhu Hospital , Tianjin , China
| | - Shibo Wang
- b Department of Neurosurgery, Tianjin Huanhu Hospital , Tianjin , China
| | - Qiang Jia
- b Department of Neurosurgery, Tianjin Huanhu Hospital , Tianjin , China
| | - Ji Bian
- a Department of Neurology, Tianjin Huanhu Hospital , Tianjin , China
| | - Yimu Fan
- b Department of Neurosurgery, Tianjin Huanhu Hospital , Tianjin , China
| | - Xiaolin Xu
- a Department of Neurology, Tianjin Huanhu Hospital , Tianjin , China
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Firouzi A, Kazem Moussavi A, Mohebbi A, Alemzadeh-Ansari MJ, Kiani R, Sanati HR, Mohebbi B, Shakerian F, Zahedmehr A, Ansari-Ramandi MM, Oni Heris S, Ghaleshi B, Ghorbani F. Comparison between rosuvastatin and atorvastatin for the prevention of contrast-induced nephropathy in patients with STEMI undergoing primary percutaneous coronary intervention. J Cardiovasc Thorac Res 2018; 10:149-152. [PMID: 30386535 PMCID: PMC6203872 DOI: 10.15171/jcvtr.2018.24] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/31/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction: There is some controversy over the efficacy of statins for the prevention of contrastinduced
nephropathy (CIN). There have also been reports on varying efficacies of different
statins. Hence, in this study the efficacy of atorvastatin and rosuvastatin for the prevention of
CIN was assessed.
Methods: This single-blind randomized clinical trial was performed on 495 random patients with
myocardial infarction with ST-segment elevation undergoing primary percutaneous coronary
intervention (PCI) in a training referral hospital in 2015. Patients were randomly assigned to
receive either atorvastatin 80 mg at admission and daily or rosuvastatin 40 mg at admission and
daily. CIN was defined based on serum creatinine elevation after 48 hours from the PCI.
Results: The incidence of CIN was observed in 63 patients (21.4%) After 48 hours from primary
PCI. Of those, 17% (n = 50) were grade 1 CIN, while 4.4% (n = 13) were grade 2 CIN. There
was no significant difference between rosuvastatin group compared with atorvastatin group,
regarding the CIN grading (P = 0.14).
Conclusion: Our results indicate that atorvastatin and rosuvastatin have similar efficacy for the
prevention of CIN.
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Affiliation(s)
- Ata Firouzi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Kazem Moussavi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Mohebbi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Reza Kiani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Sanati
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Shakerian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Zahedmehr
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Saeed Oni Heris
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahar Ghaleshi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ghorbani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Fergus KB, Baradaran N, Tresh A, Conrad MB, Breyer BN. Use of angioembolization in urology: a review. Transl Androl Urol 2018; 7:535-544. [PMID: 30211044 PMCID: PMC6127546 DOI: 10.21037/tau.2018.05.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/14/2018] [Indexed: 01/10/2023] Open
Abstract
This review discusses current and developing indications for angioembolization (AE) techniques in urology cases, including trauma and non-trauma uses for kidney, prostate, and bladder conditions. AE methods, complications and technical and clinical outcomes are outlined for each indication for the purpose of aiding urologists in selecting ideal candidates for this procedure.
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Affiliation(s)
- Kirkpatrick B. Fergus
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Nima Baradaran
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Anas Tresh
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Miles B. Conrad
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Benjamin N. Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
- Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA, USA
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15
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Urinary cGMP predicts major adverse renal events in patients with mild renal impairment and/or diabetes mellitus before exposure to contrast medium. PLoS One 2018; 13:e0195828. [PMID: 29649334 PMCID: PMC5896998 DOI: 10.1371/journal.pone.0195828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 04/01/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The use of iodine-based contrast agents entails the risk of contrast induced nephropathy (CIN). Radiocontrast agents elicit the third most common cause of nephropathy among hospitalized patients, accounting for 11-12% of cases. CIN is connected with clinically significant consequences, including increased morbidity, prolonged hospitalization, increased risk of complications, potential need for dialysis, and increased mortality rate. The number of in-hospital examinations using iodine-based contrast media has been significantly increasing over the last decade. In order to protect patients from possible complications of such examinations, new biomarkers are needed that are able to predict a risk of contrast-induced nephropathy. Urinary and plasma cyclic guanosine monophosphate (cGMP) concentrations are influenced by renal function. Urinary cGMP is primarily of renal cellular origin. Therefore, we assessed if urinary cGMP concentration may predict major adverse renal events (MARE) after contrast media exposure during coronary angiography. METHODS Urine samples were prospectively collected from non-randomized consecutive patients with either diabetes or preexisting impaired kidney function receiving intra-arterial contrast medium (CM) for emergent or elective coronary angiography at the Charité Campus Mitte, University Hospital Berlin. Urinary cGMP concentration in spot urine was analyzed 24 hours after CM exposure. Patients were followed up over 90 days for occurrence of death, initiation of dialysis, doubling of plasma creatinine concentration or MARE. RESULTS In total, 289 consecutive patients were included into the study. Urine cGMP/creatinine ratio 24 hours before CM exposure expressed as mean±SD was predictive for the need of dialysis (no dialysis: 89.77±92.85 μM/mM, n = 277; need for dialysis: 140.3±82.90 μM/mM, n = 12, p = 0.008), death (no death during follow-up: 90.60±92.50 μM/mM, n = 280; death during follow-up: 169.88±81.52 μM/mM, n = 9; p = 0.002), and the composite endpoint MARE (no MARE: 86.02±93.17 μM/mM, n = 271; MARE: 146.64±74.68 μM/mM, n = 18, p<0.001) during the follow-up of 90 days after contrast media application. cGMP/creatinine ratio stayed significantly increased at values exceeding 120 μM/mM in patients who developed MARE, required dialysis or died. CONCLUSIONS Urinary cGMP/creatinine ratio ≥ 120 μM/mM before CM exposure is a promising biomarker for the need of dialysis and all-cause mortality 90 days after CM exposure in patients with preexisting renal impairment or diabetes.
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16
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Diagnosis and Exclusion of Pulmonary Embolism. Thromb Res 2018; 163:207-220. [DOI: 10.1016/j.thromres.2017.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/30/2017] [Accepted: 06/05/2017] [Indexed: 12/21/2022]
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Sites of Action of Subtoxic Doses of the Iodine-Containing X-Ray Contrast Medium Iopromide on the Kidney and the Search for Means of Preventing the Development of Nephropathy. Pharm Chem J 2017. [DOI: 10.1007/s11094-017-1699-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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The Assessment of the Risk of Acute Kidney Injury in Patients Undergoing an Urgent Endovascular Treatment Due to Severe Renal Bleeding. Cardiovasc Intervent Radiol 2017; 41:398-405. [DOI: 10.1007/s00270-017-1800-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/21/2017] [Indexed: 12/20/2022]
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19
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Bethea A, Keslar L, Silhy R, Samanta D, Chumbe JT. An evaluation of the relationship between traumatic injuries and the development of contrast-associated acute kidney injury. TRAUMA-ENGLAND 2017. [DOI: 10.1177/1460408617714820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Audis Bethea
- Center for Health Services and Outcomes Research, Charleston Area Medical Center, Charleston, USA
- West Virginia Clinical and Translational Science Institute, Charleston, USA
- Charleston Area Medical Center, Charleston, USA
| | - Lauren Keslar
- Select Specialty Hospital—Laurel Highlands, Latrobe, USA
| | | | - Damayanti Samanta
- Center for Health Services and Outcomes Research, Charleston Area Medical Center, Charleston, USA
| | - Julton T Chumbe
- Center for Health Services and Outcomes Research, Charleston Area Medical Center, Charleston, USA
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20
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Adams SK, Sinyangwe I. Acute iliofemoral DVT in the presence of May-Thurner syndrome. Nursing 2017; 47:32-38. [PMID: 28181918 DOI: 10.1097/01.nurse.0000512873.60892.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Susan K Adams
- At Christiana Hospital of Christiana Care Health System in Newark, Del., Susan K. Adams is a staff RN in Heart and Vascular Intervention and also a resource instructor in the Simulation Resource Center at the University of Delaware. Inga Y. Sinyangwe is Staff Development Specialist-Perioperative Services at Christiana Care Health System in Newark, Del
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21
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Xu Q, Wang NN, Duan SB, Liu N, Lei R, Cheng W, Zhou SK. Serum cystatin c is not superior to serum creatinine for early diagnosis of contrast-induced nephropathy in patients who underwent angiography. J Clin Lab Anal 2016; 31. [PMID: 27897324 DOI: 10.1002/jcla.22096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 10/18/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Iodiated contrast-induced nephropathy (CIN) is a serious complication of contrast-enhanced imaging. The aim of this study was to evaluate the diagnostic sensitivities and specificities of serum cystatin C (sCys C) and serum creatinine (sCr) for CIN and to further investigate difference of the incidence, risk factors, and in-hospital and 3-month prognosis of CIN according to sCys C criteria and sCr criteria. METHODS We prospectively evaluated 213 patients who underwent angiography. The sCr and sCys C concentrations were detected before and at 48 hours, 72 hours after the procedure. The incidence, risk factors, and in-hospital and 3-month prognosis of CIN were analyzed. Receiver operating characteristic curve (ROC) analysis was performed for sCr and sCys C 48 hours after procedure. RESULTS The incidence of CIN was 24.4% (sCys C criteria) and 8% (sCr criteria). Diabetes mellitus, dehydration, and hypoalbuminemia were independent risk factors for CIN. Area under the ROC of sCys C 48 hours after procedure was not superior to sCr (0.715 vs 0.790, P=.178). The mortality of patients with CIN in sCr criteria increased significantly (P<.05). CONCLUSION In this study, the incidence and risk factors of CIN were related to diagnostic criteria. The sCys C was not superior to sCr for predicting CIN in the patients who underwent angiography.
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Affiliation(s)
- Qian Xu
- Department of Nephrology, Second Xiangya Hospital, Nephrology Institute, Central South University, Changsha, China
| | - Na-Na Wang
- Department of Nephrology, Second Xiangya Hospital, Nephrology Institute, Central South University, Changsha, China
| | - Shao-Bin Duan
- Department of Nephrology, Second Xiangya Hospital, Nephrology Institute, Central South University, Changsha, China
| | - Na Liu
- Department of Nephrology, Second Xiangya Hospital, Nephrology Institute, Central South University, Changsha, China
| | - Rong Lei
- Department of Nephrology, Second Xiangya Hospital, Nephrology Institute, Central South University, Changsha, China
| | - Wei Cheng
- Department of Nephrology, Second Xiangya Hospital, Nephrology Institute, Central South University, Changsha, China
| | - Shun-Ke Zhou
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, China
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22
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Histopathological Evaluation of Contrast-Induced Acute Kidney Injury Rodent Models. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3763250. [PMID: 27975052 PMCID: PMC5128699 DOI: 10.1155/2016/3763250] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/06/2016] [Accepted: 10/19/2016] [Indexed: 12/20/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) can occur in 3–25% of patients receiving radiocontrast material (RCM) despite appropriate preventive measures. Often patients with an atherosclerotic vasculature have to receive large doses of RCM. Thus, animal studies to uncover the exact pathomechanism of CI-AKI are needed. Sensitive and specific histologic end-points are lacking; thus in the present review we summarize the histologic appearance of different rodent models of CI-AKI. Single injection of RCM causes overt renal damage only in rabbits. Rats and mice need an additional insult to the kidney to establish a clinically manifest CI-AKI. In this review we demonstrate that the concentrating ability of the kidney may be responsible for species differences in sensitivity to CI-AKI. The most commonly held theory about the pathomechanism of CI-AKI is tubular cell injury due to medullary hypoxia. Thus, the most common additional insult in rats and mice is some kind of ischemia. The histologic appearance is tubular epithelial cell (TEC) damage; however severe TEC damage is only seen if RCM is combined by additional ischemia. TEC vacuolization is the first sign of CI-AKI, as it is a consequence of RCM pinocytosis and lysosomal fusion; however it is not sensitive as it does not correlate with renal function and is not specific as other forms of TEC damage also cause vacuolization. In conclusion, histopathology alone is insufficient and functional parameters and molecular biomarkers are needed to closely monitor CI-AKI in rodent experiments.
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Almeida LSD, Barboza JR, Freitas FPS, Porto ML, Vasquez EC, Meyrelles SS, Gava AL, Pereira TMC. Sildenafil prevents renal dysfunction in contrast media-induced nephropathy in Wistar rats. Hum Exp Toxicol 2016; 35:1194-1202. [DOI: 10.1177/0960327115626582] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Contrast-induced nephropathy (CIN) is an iatrogenic medical event in stable cardiology patients that may lead to acute renal failure. There is no current successful therapy to manage CIN. Increasing evidence in experimental models and humans has suggested that this disease is associated with renal tubular and vascular injury triggered by oxidative stress. Considering the importance of reactive oxygen species (ROS) generation in the pathogenesis of CIN, the goal of the present study was to evaluate the effects of sildenafil on CIN development. Male Wistar rats were divided into control, CIN, and CIN pretreated with sildenafil (50 mg/kg/day). CIN was induced by water deprivation, NG-nitro-L-arginine methyl ester + indomethacin injections (10 mg/kg, intraperitoneally) and intravenous iohexol administration (3 g/kg). Renal function was evaluated through glomerular filtration rate (GFR), renal blood flow (RBF), plasma creatinine, uremia, and proteinuria. Oxidative stress was assessed by flow cytometry for intracellular ROS. Treatment with sildenafil attenuated the marked reduction of GFR and RBF in the CIN group. Moreover, sildenafil treatment in CIN rats reduced plasma creatinine, uremia, and proteinuria. Flow cytometry demonstrated that sildenafil attenuated the ROS production in the CIN group. These data suggest that sildenafil may be a new therapeutic agent to prevent CIN through its ability to preserve renal function and attenuate oxidative stress.
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Affiliation(s)
- Lais Salles de Almeida
- Physiological Sciences Graduate Program, Health Sciences Center, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Jamila Rodrigues Barboza
- Physiological Sciences Graduate Program, Health Sciences Center, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Flávia Priscila Santos Freitas
- Physiological Sciences Graduate Program, Health Sciences Center, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Marcella Leite Porto
- Physiological Sciences Graduate Program, Health Sciences Center, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Elisardo Corral Vasquez
- Physiological Sciences Graduate Program, Health Sciences Center, Federal University of Espirito Santo, Vitoria, ES, Brazil
- Pharmaceutical Sciences Graduate Program, University of Vila Velha, Vila Velha, ES, Brazil
| | - Silvana Santos Meyrelles
- Physiological Sciences Graduate Program, Health Sciences Center, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Agata Lages Gava
- Physiological Sciences Graduate Program, Health Sciences Center, Federal University of Espirito Santo, Vitoria, ES, Brazil
- Division of Nephrology, McMaster University, Hamilton, ON, Canada
| | - Thiago Melo Costa Pereira
- Pharmaceutical Sciences Graduate Program, University of Vila Velha, Vila Velha, ES, Brazil
- Federal Institute of Education, Science and Technology, Vila Velha, ES, Brazil
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Mathur M, Weinreb JC. Imaging patients with renal impairment. Abdom Radiol (NY) 2016; 41:1108-21. [PMID: 27015867 DOI: 10.1007/s00261-016-0709-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Imaging with intravascular contrast media is generally considered safe, particularly in patients without renal failure. However, as renal function deteriorates, the potential risk of nonallergic-type adverse events increases. This presents a unique challenge, particularly when the use of intravenous contrast media is deemed essential for diagnostic purposes. Following a discussion regarding the definition and epidemiology of kidney injury, this review focuses on the evolving understanding of both contrast-induced nephropathy and nephrogenic systemic fibrosis and discusses preventative strategies aimed at minimizing the risk of developing these entities. Alternative non-contrast imaging techniques are also discussed.
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Affiliation(s)
- Mahan Mathur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA.
| | - Jeffrey C Weinreb
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
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25
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Özgen A, Sanioğlu S, Bingöl UA. Intra-arterial Ultra-low-Dose CT Angiography of Lower Extremity in Diabetic Patients. Cardiovasc Intervent Radiol 2016; 39:1165-9. [PMID: 27150802 DOI: 10.1007/s00270-016-1358-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/18/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE To image lower extremity arteries by CT angiography using a very low-dose intra-arterial contrast medium in patients with high risk of developing contrast-induced nephropathy (CIN). MATERIALS AND METHODS Three cases with long-standing diabetes mellitus and signs of lower extremity atherosclerotic disease were evaluated by CT angiography using 0.1 ml/kg of the body weight of contrast medium given via 10-cm-long 4F introducer by puncturing the CFA. Images were evaluated by an interventional radiologist and a cardiovascular surgeon. Density values of the lower extremity arteries were also calculated. Findings in two cases were compared with digital subtraction angiography images performed for percutaneous revascularization. Blood creatinine levels were followed for possible CIN. RESULTS Intra-arterial CT angiography images were considered diagnostic in all patients and optimal in one patient. No patient developed CIN after intra-arterial CT angiography, while one patient developed CIN after percutaneous intervention. CONCLUSION Intra-arterial CT angiography of lower extremity might be performed in selected patients with high risk of developing CIN. Our limited experience suggests that as low as of 0.1 ml/kg of the body weight of contrast medium may result in adequate diagnostic imaging.
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Affiliation(s)
- Ali Özgen
- Department of Radiology, Yeditepe University Hospital, İçerenköy mahallesi, Hastane yolu sokak, No: 102-104, 34752, Ataşehir, İstanbul, Turkey.
| | - Soner Sanioğlu
- Department of Cardiovascular Surgery, Yeditepe University Hospital, İçerenköy mahallesi, Hastane yolu sokak, No: 102-104, 34752, Ataşehir, İstanbul, Turkey
| | - Uğur Anıl Bingöl
- Department of Plastic Surgery, Yeditepe University Hospital, İçerenköy mahallesi, Hastane yolu sokak, No: 102-104, 34752, Ataşehir, İstanbul, Turkey
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da Silva PSL, Kubo EY, Fonseca MCM. Severe liver and renal injuries following cerebral angiography: late life-threatening complications of non-ionic contrast medium administration. Childs Nerv Syst 2016; 32:733-7. [PMID: 26285763 DOI: 10.1007/s00381-015-2889-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/11/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Contrast-induced nephropathy requiring dialysis support is rarely reported, whereas severe liver injury after contrast agent administration has not been described in children yet. CLINICAL CASE A previously healthy 10-year-old boy with diagnosis of cerebral arteriovenous malformation underwent a cerebral angiogram study with iohexol (3 mL/kg). After 4 days, he developed vomiting and abdominal pain. Laboratory results showed abnormal liver function tests, including marked elevation of transaminases. In the next day, he evolved with oliguria and blood arterial hypertension. At this time, he presented with worsening renal function tests. Peritoneal dialysis was required for 13 days. The patient had a self-limiting course and received only supportive treatment. CLINICAL PRESENTATION This report highlights delayed complications related to low non-ionic contrast media with a rare presentation that can be neglected or unrecognized by pediatric specialties.
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Affiliation(s)
- Paulo Sergio Lucas da Silva
- Pediatric Intensive Care Unit, Hospital Estadual de Diadema, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
- Pediatric Intensive Care Unit, Rua José Bonifácio 1641, Diadema, São Paulo, Brazil, 099800-150.
| | - Emerson Yukio Kubo
- Pediatric Intensive Care Unit, Hospital Estadual de Diadema, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Liu Y, Liu Y, Li H, Zhou Y, Guo W, Duan C, Chen S, Chen P, Tan N, Chen J. Percutaneous coronary intervention for chronic total occlusion improved prognosis in patients with renal insufficiency at high risk of contrast-induced nephropathy. Sci Rep 2016; 6:21426. [PMID: 26899017 PMCID: PMC4761881 DOI: 10.1038/srep21426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/25/2016] [Indexed: 01/06/2023] Open
Abstract
We investigated whether attempted percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) would improve the prognosis in patients with renal insufficiency at high risk of contrast-induced nephropathy (CIN). We analyzed 2,330 consecutive patients with renal insufficiency with or without CTOs who underwent coronary angiography or PCI from prospectively collected data. The long-term death and risk of CIN were evaluated among three groups: patients without CTOs (group A, n = 1,829), patients with un-attempted PCI for CTOs (group B, n = 142), and patients who underwent attempted PCI for CTOs (group C, n = 359). Overall, group B and group C (successful rate, 89%) patients had similar renal function and were not significantly associated with an increased risk of CIN (adjusted odds ratio [OR] = 0.88, 95% confidence interval [CI]: 0.41–1.93, P = 0.758). During a 2.33-year period (median), multivariate analysis demonstrated that attempted PCI for CTOs was independently associated with lower mortality (adjusted hazard ratio for death: 0.38, 95% CI: 0.18–0.83; P = 0.015). Attempted PCI for CTOs improved the long-term prognosis in patients with high-risk renal insufficiency and did not increase the risk of CIN.
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Affiliation(s)
- Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Hualong Li
- Department of Cardiology, Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Wei Guo
- Department of Cardiology, Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Chongyang Duan
- National Clinical Research Centre for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China.,National Clinical Research Centre for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China.,Department of Biostatistics, South China College of Cardiovascular Research, Guangdong Society of Interventional Cardiology, Guangzhou, China
| | - Pingyan Chen
- National Clinical Research Centre for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
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28
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Lo J, Hill C. Intensive care unit management of transcatheter aortic valve recipients. Semin Cardiothorac Vasc Anesth 2016; 19:95-105. [PMID: 25975594 DOI: 10.1177/1089253215575183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Severe aortic stenosis is an increasingly prevalent disease that continues to be associated with significant mortality. Transcatheter aortic valve replacements have been used as an alternative to surgical aortic valve replacement in high-risk patients with multiple comorbidities. In this review, we discuss postoperative considerations pertinent to the successful management of these complicated patients in the intensive care unit.
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Affiliation(s)
- Joyce Lo
- Stanford University, Stanford, CA, USA
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29
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Abstract
All components of the endothelin (ET) system are present in renal tubular cells. In this review, we summarize current knowledge about ET and the most common tubular diseases: acute kidney injury (AKI) and polycystic kidney disease. AKI originally was called acute tubular necrosis, pointing to the most prominent morphologic findings. Similarly, cysts in polycystic kidney disease, and especially in autosomal-dominant polycystic kidney disease, are of tubular origin. Preclinical studies have indicated that the ET system and particularly ETA receptors are involved in the pathogenesis of ischemia-reperfusion injury, although these findings have not been translated to clinical studies. The ET system also has been implicated in radiocontrast-dye-induced AKI, however, ET-receptor blockade in a large human study was not successful. The ET system is activated in sepsis models of AKI; the effectiveness of ET blocking agents in preclinical studies is variable depending on the model and the ET-receptor antagonist used. Numerous studies have shown that the ET system plays an important role in the complex pathophysiology associated with cyst formation and disease progression in polycystic kidney disease. However, results from selective targeting of ET-receptor subtypes in animal models of polycystic kidney disease have proved disappointing and do not support clinical trials. These studies have shown that a critical balance between ETA and ETB receptor action is necessary to maintain structure and function in the cystic kidney. In summary, ETs have been implicated in the pathogenesis of several renal tubulointerstitial diseases, however, experimental animal findings have not yet led to use of ET blockers in human beings.
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Affiliation(s)
- Albert C M Ong
- Kidney Genetics Group, Academic Nephrology Unit, Department of Infection and Immunity, University of Sheffield Medical School, Sheffield, UK
| | | | - Berthold Hocher
- Institute for Nutritional Science, University of Potsdam, Potsdam, Germany.
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30
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Whayne TF. Renal Iodine Dye Risk, Age, and the Acute Coronary Syndrome. Angiology 2016; 67:107-12. [DOI: 10.1177/0003319715581750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas F. Whayne
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
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31
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Lefel N, Janssen L, le Noble J, Foudraine N. Sodium bicarbonate prophylactic therapy in the prevention of contrast-induced nephropathy in patients admitted to the intensive care unit of a teaching hospital: a retrospective cohort study. J Intensive Care 2016; 4:5. [PMID: 26759720 PMCID: PMC4710042 DOI: 10.1186/s40560-016-0127-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/06/2016] [Indexed: 12/03/2022] Open
Abstract
Background Intravenously administered iodine-containing contrast medium (CM) is associated with the development of contrast-induced nephropathy (CIN). Data on the effectiveness of sodium bicarbonate therapy in the prevention of CIN are controversial. Furthermore, the incidence of and risk factors for CIN in intensive care unit (ICU) patients are poorly defined. We investigated the effectiveness of sodium bicarbonate prophylaxis and the incidence of and risk factors for CIN in a heterogeneous ICU population. Methods This retrospective cohort study included patients admitted to the ICU in 2009–2011 who received CM for computed tomography (CT). Results Two hundred eleven CT scans with CM, performed in 170 patients, were included in the study. Contrast prophylaxis with sodium bicarbonate was administered in 48 of the 211 cases. CIN developed in 19 of the 48 cases receiving prophylaxis and in 39 of 163 cases not receiving prophylaxis (p = 0.03). In 115 CTs performed in patients with a glomerular filtration rate (GFR) >60 mL/min, prophylaxis was administered 15 times (13 %) and no prophylaxis was administered 100 times (87 %). CIN developed in 12 and 13 % of these cases, respectively (NS). In 96 CTs in patients with a GFR <60 mL/min, 17 of 33 (51.5 %) cases receiving prophylaxis developed CIN and 27 of 63 (42.9 %) cases not receiving prophylaxis developed CIN (NS). Prophylactic sodium bicarbonate therapy did not prevent CIN in our patients, irrespective of pre-existing renal failure. Pre-existing renal impairment (odds ratio 4.41), an elevated Acute Physiology and Chronic Health Evaluation (APACHE) IV score (odds ratio 1.02), and higher haemoglobin levels (odds ratio 0.64) were significant and independent risk factors associated with the development of CIN. Conclusions Prophylactic isotonic sodium bicarbonate was not associated with a decreased incidence of CIN in ICU patients. Current sodium bicarbonate prophylaxis guidelines cannot be generalized to a heterogeneous ICU population. Pre-existing renal impairment was associated with the highest CIN risk.
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Affiliation(s)
- Nicole Lefel
- Department of Critical Care, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands
| | - Loes Janssen
- Department of Epidemiology, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands
| | - Jos le Noble
- Department of Critical Care, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands
| | - Norbert Foudraine
- Department of Critical Care, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands
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32
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Antonelli Incalzi R, Aucella F, Leosco D, Brunori G, Dalmartello M, Paolisso G. Assessing Nephrological Competence among Geriatricians: A Proof of Concept Internet Survey. PLoS One 2015; 10:e0141388. [PMID: 26528530 PMCID: PMC4631491 DOI: 10.1371/journal.pone.0141388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/06/2015] [Indexed: 11/21/2022] Open
Abstract
Chronic kidney disease (CKD) is highly prevalent in the elderly and negatively impacts survival and health status. Thus, nephrological competence is mandatory for a skilled geriatrician. The present study aimed to assess nephrological competence in a sample of geriatricians recruited through a web survey. To this aim, a 12-items questionnaire was produced by an expert panel of nephrologists and geriatricians and was available online for members of the Italian Society of Gerontology and Geriatrics (SIGG). Two-hundred-eighty-seven geriatricians volunteered to fill in the questionnaire. The majority of them indirectly estimated the glomerular filtration rate (GFR) using mainly the Cockroft-Gault (C-G) formula. Selected nephrological exams, such as urinary Na and serum D-vitamin measurements, did not qualify as routine exams although the majority of geriatricians supplemented their patients with fat-soluble secosteroids. Ten percent of geriatricians asked for nephrological consultation only for stage 5 CKD patients and 30,9% only for stage 4 or 5. Erythropoietin supplementation was common practice for the majority of geriatricians, while only one third of them systematically used a procedure intended to prevent the contrast induced nephropathy (CIN). Finally, an alleged 50% adherence to the international guidelines for the management of CKD patients emerged from the questionnaire. Overall, results from this survey strongly recommend promoting nephrological education among geriatricians. Didactic standards for in training geriatricians need to be updated and the cooperation between geriatrics and nephrological societies promoted.
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Affiliation(s)
| | - Filippo Aucella
- Dept of Nephrology and Dialysis, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Dario Leosco
- Dept of Translational Medical Science, University of Naples Federico II, Napoli, Italy
- * E-mail:
| | - Giuliano Brunori
- Dept of Nephrology and Dialysis, S. Chiara Hospital, Trento, Italy
| | | | - Giuseppe Paolisso
- Department of Medical, Surgical, Neurological, Aging and Metabolic Sciences, Second University of Naples, Napoli, Italy
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33
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Jin B, Wu BW, Zhang JJ, Luo XP, Shi HM. Preventive effect of reduced glutathione on contrast-induced nephropathy in elderly patients undergoing coronary angiography or intervention: a randomized, controlled trial. Braz J Med Biol Res 2015; 48:839-42. [PMID: 26176313 PMCID: PMC4568812 DOI: 10.1590/1414-431x20154676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/28/2014] [Indexed: 11/21/2022] Open
Abstract
Coronary angiography can be a high-risk condition for the incidence of contrast-induced nephropathy (CIN) in elderly patients. Reduced glutathione, under a variety of mechanisms, may prevent CIN in this procedure. We prospectively examined whether hydration with reduced glutathione is superior to hydration alone for prevention of CIN in an elderly Han Chinese population. A total of 505 patients (271 males and 234 females) aged 75 years or older who underwent non-emergency coronary angiography or an intervention were randomly divided into two groups. The treatment group received hydration with reduced glutathione (n=262) and the control group received hydration alone (n=243). Serum creatinine and blood urea nitrogen levels were measured prior to coronary angiography and 48 h after this procedure. The primary endpoint was occurrence of CIN, which was defined as 25% or 44.2 µmol/L above baseline serum creatinine levels 48 h after the procedure. The overall incidence of CIN was 6.49% in the treatment group and 7.41% in the control group, with no significant difference between the groups (P=0.68). In subgroup analysis by percutaneous coronary intervention, no significant differences were found between the two groups. In summary, reduced glutathione added to optimal hydration does not further decrease the risk of CIN in elderly patients undergoing coronary angiography or an intervention.
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Affiliation(s)
- B Jin
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, CN
| | - B W Wu
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, CN
| | - J J Zhang
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, CN
| | - X P Luo
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, CN
| | - H M Shi
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, CN
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34
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Emergency Evaluation for Pulmonary Embolism, Part 2: Diagnostic Approach. J Emerg Med 2015; 49:104-17. [DOI: 10.1016/j.jemermed.2014.12.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/17/2014] [Accepted: 12/21/2014] [Indexed: 12/14/2022]
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35
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36
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Joung KW, Yang KH, Shin WJ, Song MH, Ham K, Jung SC, Lee DH, Suh DC. Anesthetic consideration for neurointerventional procedures. Neurointervention 2014; 9:72-7. [PMID: 25426301 PMCID: PMC4239411 DOI: 10.5469/neuroint.2014.9.2.72] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 08/23/2014] [Indexed: 01/25/2023] Open
Abstract
Interventional neuroradiology (INR) has been a rapidly expanding and advancing clinical area during the past few decades. As the complexity and diversity of INR procedures increases, the demand for anesthesia also increases. Anesthesia for interventional neuroradiology is a challenge for the anesthesiologist due to the unfamiliar working environment which the anesthesiologist must consider, as well as the unique neuro-interventional components. This review provides an overview of the anesthetic options and specific consideration of the anesthesia requirements for each procedure. We also introduce the anesthetic management for interventional neuroradiology performed in our medical institution.
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Affiliation(s)
- Kyung Woon Joung
- Department of Anesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ku Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Jung Shin
- Department of Anesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Myung Hee Song
- Department of Anesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyungdon Ham
- Department of Anesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Chul Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae Chul Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Kurtul A, Murat SN, Yarlioglues M, Duran M, Celik IE, Kilic A. Mild to Moderate Renal Impairment Is Associated With No-Reflow Phenomenon After Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction. Angiology 2014; 66:644-51. [DOI: 10.1177/0003319714546738] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated whether admission estimated glomerular filtration rate (eGFR) values are associated with no-reflow phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Patients (n = 673; 59 ± 13 years; 77.1% men) were stratified into 3 groups according to eGFR at admission: normal renal function (eGFR ≥ 90 mL/min/1.73 m2), mild renal impairment (eGFR 60-89 mL/min/1.73 m2), and moderate renal impairment (eGFR 30-59 mL/min/1.73 m2). No-reflow phenomenon was defined as thrombolysis in myocardial infarction flow grade <3 after pPCI. The rate of no-reflow gradually increased from the normal renal function group to the moderate impaired renal function group ( P < .001). Multivariate analysis showed that eGFR (odds ratio [OR] 0.942, P < .001), Killip ≥2 class (OR 3.968, P = .008), left ventricular ejection fraction (OR 0.959, P = .034), and early patency of infarct vessel (OR 0.186, P < .001) were independent predictors of no-reflow phenomenon. Mild to moderate renal impairment at admission is independently associated with no-reflow phenomenon after pPCI.
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Affiliation(s)
- Alparslan Kurtul
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Sani Namik Murat
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mikail Yarlioglues
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mustafa Duran
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Ibrahim Etem Celik
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Alparslan Kilic
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
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38
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Abaci O, Harmankaya O, Kocas B, Kocas C, Bostan C, Coskun U, Yildiz A, Ersanli M. Long-Term Follow-Up of Patients at High Risk for Nephropathy After Contrast Exposure. Angiology 2014; 66:514-8. [PMID: 25115554 DOI: 10.1177/0003319714546527] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Contrast medium-induced acute kidney injury (CI-AKI) is associated with morbidity and mortality, but the long-term outcomes of patients who do not develop CI-AKI remain unknown. We assessed clinical end points during long-term follow-up in patients at high risk for nephropathy who did not develop CI-AKI. Patients (n = 135) with impaired renal function (estimated glomerular filtration rate: 30-60 mL/min/1.73 m(2)) were divided into 2 groups according to contrast media (CM) exposure. The primary end point of this study was a composite outcome measure of death or renal failure requiring dialysis. Multivariate analyses identified CM exposure to be independently associated with major adverse long-term outcomes (hazard ratio: 2.3; 95% confidence interval, 1.34-6.52; P = .018). Even when CM exposure does not cause CI-AKI in patients with impaired renal function, in the long term, primary end points occur more frequently in patients exposed to CM than in those with no CM exposure.
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Affiliation(s)
- Okay Abaci
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Ozlem Harmankaya
- Department of Nephrology, Bakırkoy Sadi Konuk Educational and Research Hospital, Istanbul, Turkey
| | - Betul Kocas
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Cuneyt Kocas
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Cem Bostan
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Ugur Coskun
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Ahmet Yildiz
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Murat Ersanli
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
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