title: Use of gadolinium as an intraarterial contrast agent in digital subtraction angiography of the cervical carotid arteries and intracranial circulation. Technical note.
abstract: Patients with renal insufficiency or other contraindications to iodine-based contrast agents present a significant management dilemma when conventional arteriography is required. The authors describe the use of gadolinium as an alternative contrast agent for arterial digital subtraction (DS) angiography of the cervical carotid arteries (CAs) and intracranial circulation. Three patients with renal insufficiency presented with symptoms of ischemic cerebrovascular disease and inconclusive noninvasive imaging studies, which necessitated conventional angiography. Traditional transfemoral catheterization of the cervical CAs was performed and DS angiographic studies were obtained using gadolinium as an intraarterial contrast agent. In one case, selective arteriographic examination of the internal carotid arteries and vertebrobasilar system was performed as well. High-quality, diagnostic images essentially indistinguishable from routine angiographic studies were obtained in all cases. No patient suffered a complication related to the use of gadolinium, and no patient demonstrated worsened renal function after the procedure. In the setting of a contraindication to iodine-based contrast agents, gadolinium represents an important alternative contrast material that allows for excellent visualization of the cervical CAs and intracranial circulation.
authors.affiliation: Department of Neurological Surgery, University of Minnesota Hospital and Clinic, Minneapolis, 55455, USA.
authors.forename: E S
authors.initials: ES
authors.lastname: Nussbaum
authors.forename: S O
authors.initials: SO
authors.lastname: Casey
authors.forename: L A
authors.initials: LA
authors.lastname: Sebring
authors.forename: M T
authors.initials: MT
authors.lastname: Madison
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging; D001488:Basilar Artery / Q000000981:diagnostic imaging; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging; D002406:Catheterization, Peripheral; D002560:Cerebrovascular Circulation / Q000502:physiology*; D000075202:Contraindications; D003287:Contrast Media / Q000008:administration & dosage*; D005682:Gadolinium / Q000008:administration & dosage; D019786:Gadolinium DTPA; D006801:Humans; D007269:Injections, Intra-Arterial; D007455:Iodine; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging; D009333:Neck / Q000098:blood supply; D051437:Renal Insufficiency / Q000150:complications; D014711:Vertebral Artery / Q000000981:diagnostic imaging
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D007455:Iodine; D005682:Gadolinium; D019786:Gadolinium DTPA