Percutaneous carotid angioplasty and stenting with the use of gadolinium in lieu of iodinated contrast medium: technical case report and review of the literature.
OBJECTIVE
We describe a patient who underwent percutaneous transluminal carotid angioplasty and stent placement with the use of intra-arterial gadolinium (Gd-DTPA) instead of iodinated contrast medium. This represents one of the first published reports of the use of Gd-DTPA as an angiographic contrast agent for an interventional neuroradiological procedure.


METHODS
A 75-year-old man with renal insufficiency and multiple comorbidities developed amaurosis fugax. Doppler examination revealed high-grade stenosis of the right internal carotid artery.


METHODS
The patient underwent percutaneous transluminal balloon angioplasty with endovascular stent placement for 95% narrowing of the proximal right internal carotid artery. Because of his impaired renal function, the procedure was performed with the use of Gd-DTPA as the sole contrast agent. Approximately 60 ml of contrast medium (twice the volume typically used for a magnetic resonance imaging study) was used. There were no neurological, renal, or other complications.


CONCLUSIONS
Intra-arterially administered Gd-DTPA may be substituted for iodinated contrast agents in complex neuroendovascular procedures. This capacity expands the armamentarium for interventional neuroradiological procedures.
Amar
A P
AP
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 north State Street, Los Angeles, CA 90033-1029, USA. amar@aya.yale.edu
Larsen
D W
DW
Teitelbaum
G P
GP
D000368:Aged; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D003287:Contrast Media; D019786:Gadolinium DTPA; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D015607:Stents
D003287:Contrast Media; D019786:Gadolinium DTPA