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Cardiology
Advances and Challenges in Iodinated Contrast Media
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
9 sections · 99 slides
Overview
- Scope of this presentation
Evolution and classification of iodinated contrast media
- Role of iodinated contrast media in imaging
- Osmolality as the defining parameter
- Evolution of contrast agents
- Ionic high-osmolality contrast media
- Low-osmolality contrast media
- Iso-osmolar contrast media
- Viscosity of contrast agents
- Dosing limits and hydration
- Iohexol, a nonionic low-osmolar agent
- Iodixanol, an iso-osmolar agent
- Selective coronary angiogram
- Contrast-enhanced cardiac computed tomography, short axis
- Volume-rendered cardiac computed tomography
- Nephrotoxicity across agent classes
- Iodixanol versus iohexol in diabetic renal impairment
- Haemodynamic and electrophysiologic effects
- Contribution of contrast to catheterisation complications
- Current utilisation and the cost debate
Hypersensitivity reactions to iodinated contrast media
- Mechanism of anaphylactoid reactions
- The shellfish and iodine allergy misconception
- Incidence of acute allergy-like reactions
- Multicentre study of 196,081 patients
- Recurrence risk after a previous reaction
- Urticarial wheals
- Severity-tailored premedication
- Premedication regimen before elective procedures
- Changing the agent after a reaction
- Intradermal skin testing to select an alternative
- Prevention strategy for a patient with prior reaction
- Risk of severe reaction with asthma and beta-blockade
- Delayed hypersensitivity reactions
- Iotrolan and delayed reactions
Contrast-induced thyroid dysfunction
- The acute Wolff–Chaikoff effect
- Escape from the acute Wolff–Chaikoff effect
- Two outcomes of iodine excess
- Jöd–Basedow phenomenon
- Incidence and risk of contrast-induced hyperthyroidism
- Diagnosis and management of contrast-induced hyperthyroidism
- Contrast-induced hypothyroidism
- Management and monitoring of thyroid dysfunction
Thrombogenic effects of iodinated contrast media
- Contrast media and haemostasis
- Platelet effects of ionic versus nonionic agents
- Effects on coagulation and fibrinolysis
- Endothelial injury from contrast media
- Contrast type and thrombus during angioplasty
- Ionic contrast and stent occlusion
- Contradictory prospective data on thrombotic events
- Limitations of the early comparative trials
- Ionic versus nonionic contrast: the balance
Contrast-induced nephropathy
- Definition of contrast-induced nephropathy
- Clinical course of contrast-induced nephropathy
- Incidence of contrast-induced nephropathy
- Nonmodifiable risk factors
- Modifiable risk factors
- Contrast volume and anaemia as predictors
- Risk factors for contrast-induced nephropathy
- Assessing renal function before contrast
- Contrast nephropathy in acute coronary syndrome
- Long-term impact: HORIZONS-AMI and ACUITY
- Ischaemic and bleeding events after contrast nephropathy
Prevention: contrast minimisation and renal protection
- Core preventive measures
- Intravenous fluid regimen
- Dynamic coronary roadmap to reduce contrast volume
- Dynamic coronary roadmap: subgroups and safety
- The COURT trial
- COURT trial: the thrombus signal
- The ICON trial
- The VICC and VIP trials
- The NITRATE-CIN trial
- NITRATE-CIN: one-year outcomes
- The PRESERVE trial
- Interpreting PRESERVE
- Renin-angiotensin blockade before contrast
- Choice of contrast agent in high-risk patients
- Iso-osmolar versus low-osmolar in primary intervention
Future directions and remaining questions
- Nanoparticle-based contrast agents
- Materials used in nanoparticle agents
- Safety profile of nanoparticle agents
- Gadolinium as an alternative contrast agent
Summary
- Key numbers to remember
- What is established and what is not
- Unresolved questions
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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