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Endovascular therapy by CO 2 angiography to prevent contrast‐induced nephropathy in patients with chronic kidney disease: A prospective multicenter trial of CO 2 angiography registry
Author(s) -
Fujihara Masahiko,
Kawasaki Daizo,
Shintani Yoshiaki,
Fukunaga Masashi,
Nakama Tatsuya,
Koshida Ryouji,
Higashimori Akihiro,
Yokoi Yoshiaki
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25722
Subject(s) - medicine , angiography , kidney disease , radiology , angioplasty , nephropathy , clinical endpoint , iodinated contrast , acute kidney injury , surgery , randomized controlled trial , diabetes mellitus , computed tomography , endocrinology
Objectives To assess the safety and efficacy of carbon dioxide (CO 2 ) angiography‐guided endovascular therapy (EVT) for renal, iliofemoral artery disease. Background Patients with peripheral vascular disease (PVD) often have chronic kidney disease (CKD) and the use of iodinated contrast media may enhance the risk of contrast‐induced nephropathy (CIN). Contrast volume reduction is an effective CIN preventive strategy. Methods A prospective multicenter registry was developed and six clinical centers participated in the study. Patients with an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m 2 and stage‐3 CKD were recruited between February 2012 and March 2013. CO 2 angiography‐guided EVT was performed; incomplete CO 2 angiograms were supplemented by intravascular ultrasound, pressure wire, and/or minimal iodinated contrast media. The primary endpoint was a composite of freedom from renal events and freedom from major CO 2 angiography related complications. Results This study included 98 patients with 109 lesions. The mean eGFR baseline was 35.2 ± 12.7 ml min −1 . CO 2 angiography‐guided angioplasty were performed in 16 renal arteries, 31 aortoiliac arteries, and 62 superficial femoral arteries. The technical success rate was 97.9%. Average CO 2 consumption was 281.4 ± 155.8 ml, average dose of iodinated contrast media was 15.0 ± 18.1 ml. Primary endpoint was 92.8% (91/98). Incidence of CIN was 5.1% (5/98) and CO 2 angiography‐related complications occurred in 17.3% (17/98). Two cases (2%) developed severe, fatal, nonocclusive mesenteric ischemia (NOMI). Conclusions This trial showed that CO 2 angiography‐guided angioplasty was effective for preventing CIN, however, CO 2 angiography related complication was somewhat high. © 2014 Wiley Periodicals, Inc.