Removal of contrast medium from the coronary sinus during coronary angiography: feasibility of a simple and available technique for the prevention of nephropathy.
BACKGROUND
Contrast-induced nephropathy (CIN) is a major complication of percutaneous coronary interventions with currently limited preventive measures.


OBJECTIVE
To prevent CIN, we assessed the safety and feasibility of contrast removal from the coronary sinus (CS) during coronary angiography.


METHODS
We attempted contrast removal on seven patients undergoing coronary angiography with preexisting renal insufficiency (mean serum creatinine=262+/-56 mg%).


RESULTS
In four patients, a balloon catheter could not be successfully deployed in the CS. In three patients, a balloon catheter with distal side holes was positioned in the CS orifice. The balloon was inflated to occlude the CS concurrent with coronary injections, and 12-16 ml of blood was aspirated after each injection. The procedure appeared to be safe, without adverse events and elevations of serum creatinine levels. Contrast media were effectively withdrawn (44%+/-8%) as assessed by fluoroscopy and dilution of blood. The increased venous pressure at the time of injection reduced coronary flow, allowing for small volumes of administered contrast.


CONCLUSIONS
Occlusion of the CS during coronary angiography with aspiration of contrast media is safe and effective in reducing contrast load during coronary interventions. This procedure may reduce the risk for CIN in prone patients.
Danenberg
Haim D
HD
Department of Cardiology, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem 91120, Israel. danen@md.huji.ac.il
Lotan
Chaim
C
Varshitski
Boris
B
Rosenheck
Shimon
S
Weiss
A Teddy
AT
D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D054326:Coronary Sinus / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D006801:Humans; D007267:Injections; D007485:Ioxaglic Acid / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications*; D013396:Suction
D003287:Contrast Media; D007485:Ioxaglic Acid