Contrast Agent Iopromide Research Articles

Novel Nanoliposomes Alleviate Contrast-Induced Nephropathy by Mediating Apoptosis Response in New Zealand Rabbits.

The aim of this study was to test the preventive effects of nano liposomes against contrast-induced nephropathy (CIN) in New Zealand rabbits. Sixty New Zealand rabbits were randomly divided into four groups, with 15 rabbits in each group: control group, contrast group, hydration group and nano liposome group. Serum creatinine (Scr) and Blood Urea Nitrogen (BUN) were measured before and after injection of the contrast agent iopromide. Oxidative stress markers, such as superoxide dismutase (SOD) and malondialdehyde (MDA), and apoptosis markers, such as Bcl2-Associated X (Bax) and B-cell lymphoma-2 (Bcl-2), were measured by enzyme-linked immunosorbent assay (ELISA). Rabbits were killed 24 h after injection of the contrast medium and both kidneys were removed. Real-time Polymerase Chain Reaction (RT-PCR) and Western blot assays were performed in kidney tissue. Pathological changes were analyzed under the optical and electron microscope. Compared with the hydration group, the nano liposome group showed improved protection of renal function, with significantly different Scr and BUN levels, incidence of CIN, apoptosis index, RT-PCR and Western blot protein expression patterns. Under the optical and electron microscope, the renal injury in the nano liposome group was less than in the hydration group. However, based on SOD and MDA, there was no significant difference in oxidative stress when compared with the hydration group. Apoptosis is an important mechanism in CIN. Nano liposomes can prevent the occurrence of CIN by decreasing apoptosis, reducing damage to the kidney by the contrast agent.

Distribution and Removal of Pharmaceuticals in Liquid and Solid Phases in the Unit Processes of Sewage Treatment Plants.

In this study, we analyzed 27 pharmaceuticals in liquid and solid phase samples collected from the unit processes of four different sewage treatment plants (STPs) to evaluate their distribution and behavior of the pharmaceuticals. The examination of the relative distributions of various categories of pharmaceuticals in the influent showed that non-steroidal anti-inflammatory drugs (NSAIDs) were the most dominant. While the relative distribution of antibiotics in the influent was not high (i.e., 3%–5%), it increased to 14%–30% in the effluent. In the four STPs, the mass load of the target pharmaceuticals was reduced by 88%–95% mainly in the biological treatment process, whereas the ratio of pharmaceuticals in waste sludge to those in the influent (w/w) was only 2%. In all the STPs, the removal efficiencies for the stimulant caffeine, NSAIDs (acetaminophen, naproxen, and acetylsalicylic acid), and the antibiotic cefradine were high; they were removed mainly by biological processes. Certain compounds, such as the NSAID ketoprofen, contrast agent iopromide, lipid regulator gemfibrozil, and antibiotic sulfamethoxazole, showed varying removal efficiencies depending on the contribution of biodegradation and sludge sorption. In addition, a quantitative meta-analysis was performed to compare the pharmaceutical removal efficiencies of the biological treatment processes in the four STPs, which were a membrane bioreactor (MBR) process, sequencing batch reactor (SBR) process, anaerobic–anoxic–oxic (A2O) process, and moving-bed biofilm reactor (MBBR) process. Among the biological processes, the removal efficiency was in the order of MBR > SBR > A2O > MBBR. Among the tertiary treatment processes investigated, powdered activated carbon showed the highest removal efficiency of 18%–63% for gemfibrozil, ibuprofen, ketoprofen, atenolol, cimetidine, and trimethoprim.

Is there any role of epithelial to mesenchymal transition in the pathogenesis of contrast nephropathy?

Aim: Contrast medium-induced nephropathy is one of the major complications of intravenous contrast medium use. But its pathogenesis is unclear. Epithelial mesenchymal transition (EMT) is defined as the transformation of the primer epithelial cells to mesenchymal cells. EMT in tubular cells might cause tubulointerstitial damage. In this study, we investigated whether or not EMT has a role in radiocontrast-induced nephropathy. Radiocontrast medium might be triggering reversible EMT via serum and glucocorticoid-regulated kinase 1 (SGK 1). We investigated the effect of different concentrations of the contrast agent iopromide on human proximal tubule cell (HK-2) culture by measuring the level of SGK1, snail family zinc finger 1 (SNAIL1), connective tissue growth factor (CTGF), and collagen type I alpha 1 (COL1A1).Methods: We conducted a scratch assay and qPCR. HK-2 cells were cultured in the petri dishes/flasks and starved with serum-free medium. The 40, 20, and 10 mg/mL doses of iopromide were administrated to cells. The scratches were photographed immediately and again at the 20th hour. The levels of gene expression of SGK1, SNAIL1, CTGF, and COL1A1 were measured using the real-time qPCR system at the end of the 24th hour.Results: Iopromide caused the breaking of intercellular connections, the disappearance of the cobblestone appearance of cells, and the migration of cells at the 20th hour in the scratch assay. It also increased the expression of SGK1, SNAIL1, CTGF, and COL1A1 genes.Conclusion: Our study concluded that certain important markers of EMT increase in different concentrations of the contrast agent. High osmolality might trigger EMT. The relationship between contrast agent and EMT has not been defined before. Further in vivo and in vitro studies are required.

In vitro evaluation of paclitaxel coatings for delivery via drug-coated balloons

Lately, drug-coated balloons have been introduced in interventional cardiology as an approach to treat occluded blood vessel. They were developed for the rapid transfer of antiproliferative drugs during the angioplasty procedure in stenosed vessels with the intent to reduce the risk of restenosis. In this study five different paclitaxel (PTX) balloon coatings were tested in vitro in order to examine how solvents and additives influence coating stability and drug transfer rates. PTX-coated balloons were advanced through a guiding catheter and a simulated coronary artery pathway under perfusion and were then inflated in a hydrogel acceptor compartment. The fractions transferred to the gel, remaining on the balloon and the PTX lost in the simulated coronary pathway were then analysed. The results obtained suggest that the solvent used for the coating process strongly influences the surface structure and the stability of the coating.Ethanol/water and acetone based PTX coatings showed the lowest drug transfer rates to the simulated vessel wall (both <1%) due to their high drug losses during the prior passage through the coronary artery model (more than 95%). Balloons coated with PTX from ethyl acetate-solutions showed smaller drug loss (83%±9%), but most of the remaining PTX was not transferred (mean balloon residue approximately 15%).Beside the solvent, the use of additives seemed to have a great impact on transfer properties. The balloon pre-treatment with a crosslinked polyvinylpyrrolidone (PVP) film was able to increase the PTX transfer rate from less than 1% (without PVP) to approximately 6%. The best results in this study were obtained for balloon coatings with commercially available SeQuent© Please balloons containing the contrast agent iopromide. For this formulation drug transfer rates of approximately 17% were determined. Fluorescence microscopic imaging could visualize the particulate transfer of labelled PTX from the balloon surface during dilatation. The findings of this study underline the importance of drug adhesion and coating stability for the efficiency of PTX transfer.

Elimination of polar micropollutants and anthropogenic markers by wastewater treatment in Beijing, China

Anthropogenic contamination of surface waters in Asia is on the increase. While polar organic contaminants are gradually recognized for their impacts on aquatic ecosystems in the Western World, less is known about the situation in Asia. In developing countries like China, water resources are particularly vulnerable. We investigated the occurrence, elimination, and per capita loads of a wide range of pharmaceuticals, household chemicals and pesticides in five Beijing WWTPs representative for megacities in China, and compare the efficiency of different treatment processes. Based on initial screening for 268 micropollutants using high-resolution mass spectrometry, 33 compounds were examined in detail. Pollutant concentrations in raw wastewater ranged from <0.02μgL−1 for pesticides to >20μgL−1 for caffeine and the contrast agent iopromide. Concentrations in the WWTP effluents were generally <1μgL−1, except for some pharmaceuticals, iopromide (1.2–18μgL−1), caffeine (0.025–2.3μgL−1), and the artificial sweetener sucralose (2.7–3.5μgL−1). Elimination efficiencies varied greatly from <1% to close to 100%, with macrolides, some sulfonamides, metronidazole, iopromide, and 4-acetamidoantipyrine being the most persistent compounds. Total per capita loads of the investigated micropollutants were lower than in communal wastewater of Europe, amounting to 7.9–12.2 and 2.0–6.5gd−11000 inhabitants−1 in the influents and effluents, respectively, with an average release of ∼100kgd−1 by the 11.4 million people and 2.3millionm3 of wastewater treated per day. Since the wastewater effluents are often used for agricultural irrigation, residual organic pollutants pose a threat to food safety, the development of antibacterial resistance, and combined effects of micropollutants in the aquatic environment.

Is hypoalbuminemia a prognostic risk factor for contrast-induced nephropathy in peritoneal dialysis patients?

ObjectiveResidual renal function (RRF) is an important predictor of outcome in peritoneal dialysis (PD) patients. Hypoalbuminemia was found to be an independent risk factor for the development of acute kidney injury. We investigated the possibility of an association between serum albumin levels and the development of iodine contrast media-induced nephropathy (CIN) in PD patients.MethodsA total of 103 PD patients who underwent invasive angiographies with exposure to iodine contrast media (ICM) were reviewed retrospectively. All patients received 0.9% saline intravenously at a rate of 75 mL per hour for 12 hours prior, during, and 12 hours after exposure to ICM. Acetylcysteine was given orally at a dose of 600 mg twice daily, on the day before and on the day of exposure to ICM. The nonionic, low-osmolar contrast agent iopromide was used at a mean dose of 75.0±15.2 mL. The changes in RRF from baseline to 1 week and 4 weeks after exposure to ICM were recorded. Outcomes of patients with serum albumin levels <3.8 g/dL and those with serum albumin levels ≥3.8 g/dL were compared. A reduction >30% in RRF at 7 days after exposure to ICM was considered CIN.ResultsCIN developed in 27.2% (28/103) of patients. Of the 103 patients, 59.2% (61) had serum albumin levels <3.8 g/dL. Of those, 37.7% (23/61) developed CIN, compared with 11.9% (5/42) of those with serum albumin levels ≥3.8 g/dL (P=0.004). After adjustment for all tested variables in a logistic regression with a stepwise selection model, serum albumin level at exposure to ICM was found to be the most powerful predictor of the development of CIN (odds ratio =4.5; confidence interval =1.5–13.0; P=0.006).ConclusionPD patients with serum albumin levels <3.8 g/dL should be monitored carefully when exposed to ICM. Serum albumin level may be considered a potential therapeutic target in the prevention of CIN and preservation of RRF in PD patients.

Biodegradation of the X-ray contrast agent iopromide and the fluoroquinolone antibiotic ofloxacin by the white rot fungus Trametes versicolor in hospital wastewaters and identification of degradation products

This paper describes the degradation of the X-ray contrast agent iopromide (IOP) and the antibiotic ofloxacin (OFLOX) by the white-rot-fungus Trametes versicolor. Batch studies in synthetic medium revealed that between 60 and 80% of IOP and OFLOX were removed when spiked at approximately 12 mg L−1 and 10 mg L−1, respectively. A significant number of transformation products (TPs) were identified for both pharmaceuticals, confirming their degradation. IOP TPs were attributed to two principal reactions: (i) sequential deiodination of the aromatic ring and (ii) N-dealkylation of the amide at the hydroxylated side chain of the molecule. On the other hand, OFLOX transformation products were attributed mainly to the oxidation, hydroxylation and cleavage of the piperazine ring.Experiments in 10 L-bioreactor with fungal biomass fluidized by air pulses operated in batch achieved high percentage of degradation of IOP and OFLOX when load with sterile (87% IOP, 98.5% OFLOX) and unsterile (65.4% IOP, 99% OFLOX) hospital wastewater (HWW) at their real concentration (μg L−1 level). Some of the most relevant IOP and OFLOX TPs identified in synthetic medium were also detected in bioreactor samples. Acute toxicity tests indicated a reduction of the toxicity in the final culture broth from both experiments in synthetic medium and in batch bioreactor.

Determination of iodinated X-ray contrast agents in pharmaceutical formulations and artificial urine samples by differential pulse voltammetry

This manuscript shows how to quickly detect the concentration of three iodinated X-ray contrast agents (iopromide, iodixanol and amidotrizoic acid) using differential pulse voltammetry.

English

This study aims to investigate influences of different doses of hypisotonic non-ionic contrast agent (Iopromide) on renal function of elderly patients. A total of 30 cases of elderly patients without a history of nephrosis and with normal renal function were divided into two groups according to the different doses of received contrast agent. Influences of Iopromide on renal function were observed by detecting blood urea nitrogen (BUN), serum creatinine (Scr) and creatinine clearance rate (Ccr) at the postoperative 2nd and 5th day. There was no significant difference for BUN, Scr and Ccr levels before angiography and at the 2nd and 5th days after operation between two groups of patients (P &gt; 0.05). At the postoperative 2nd day, Scr of two groups of patients slightly increased and Ccr slightly reduced. At the 5th day, they restored to the levels before angiography. Based on the results, we believe one dosage of not more than 294 ml non-ionic contrast agent Iopromide is relatively safe for elderly patients. &nbsp; Key words:&nbsp;Non-ionic contrast agent, contrast induced nephropathy, elderly patients.

Consideration of emerging pollutants in groundwater-based reuse concepts

Elimination of pathogens and emerging pollutants represents a key factor in integrated water resources management in arid regions. Within the SMART Jordan Valley project it is the objective of this study to assess the occurrence and examine the elimination of selected emerging pollutants and pathogens in waste water treatment and aquifer recharge. In batch and soil column studies non-chlorinated organophosphorous compounds (tri-n-butylphosphate, triphenylphosphate) and endocrine disruptors (e.g. 17-ß-estradiol, bisphenol A) proved to be biodegradable, while the X-ray contrast agents iomeprol and iopromide were eliminated in the soil columns only, and the chlorinated trialkylphosphates showed persistency. Treating waste water in a membrane bioreactor (MBR) in combination with powdered activated carbon (PAC) resulted in considerable removal rates also for the more persistent compounds such as the antiepileptic carbamazepine. Viruses were shown to be present in most of the Jordan Valley surface water samples. MBR treatment resulted in a decrease of MS2 bacteriophages used as model viruses.

Occurrence and behavior of pharmaceuticals, steroid hormones, and endocrine-disrupting personal care products in wastewater and the recipient river water of the Pearl River Delta, South China

The occurrence and behavior of β-blockers, antiepileptic drug carbamazepine and its metabolites, X-ray contrast agent iopromide, natural and synthetic hormones, and several groups of hormone-like personal care products (PCPs), including antiseptics (triclocarban, triclosan, and 2-phenylphenol), parabens and bisphenol A, were investigated in municipal wastewater, sewage sludge, and urban river water of the Pearl River Delta, South China. The pharmaceuticals, natural hormones and PCPs were ubiquitously detected in the raw wastewater from a sewage treatment plant (STP). Only triclocarban and triclosan were detected at significant amounts in the dewatered sludge. Iopromide and the PCPs were greatly removed/transformed from the aqueous phase of the wastewater. The β-blockers were only moderately removed/transformed. Carbamazepine passed through the STP almost unchanged. Biodegradation was the dominant process for elimination/transformation of the pharmaceuticals, hormones, and most PCPs in the STP. However, sorption also played an important role in the fate of triclocarban with nearly 50% of the mass load entering the STP ended up and persisted in the dewatered sludge. The pharmaceuticals, estrone, and PCPs were also widely detected in the Pearl River at Guangzhou. Bisphenol A had the highest concentration. The pharmaceutical concentrations in the Pearl River were higher in March than in May, most likely due to less dilution by lower precipitation. The omnipresence and high levels of the pharmaceuticals and PCPs in the Pearl River may be associated with direct discharge of untreated wastewater and pose potential risks to the ecological system.

Myocardial infarction secondary to contrast agent. Contrast effect or type II Kounis syndrome?

The diagnostic administration of contrast agents has been increased recently in various fields, including coronary angiography, but reports of coronary artery spasm caused by contrast agents are rare. However, myocardial infarction following administration of nonionic contrast agents has not been reported, as far as we are aware. Herein, we described a case of acute anterior myocardial infarction induced by the contrast agent iopromide (Ultravist). We also discussed the possible reasons for this situation.

Drug-Coated Balloons for the Prevention of Vascular Restenosis

From early in the history of percutaneous cardiovascular intervention, restenosis has been one of the most important clinical and biological measures of success, and a great deal of effort has been put into understanding the mechanisms responsible.1,2 Restenosis is the result of the interaction of a variety of mechanical and biological processes that begin immediately after balloon injury, including early vessel recoil,3,4 negative vascular remodeling,5 and excessive neointimal proliferation.5–7 The most important limitations of balloon angioplasty, abrupt vessel closure resulting from elastic recoil and occlusive plaque dissection, were effectively solved by the introduction of balloon-expandable stents.8 However, in-stent restenosis (ISR), the result of the initial injury and the vascular response to the implanted metallic prosthesis leading to excessive neointimal proliferation, remained as the most important cause of failure of these devices.9,10 Drug-eluting stents (DES) effectively reduced ISR by addressing the biological mechanisms of neointimal proliferation and have become the mainstay of the interventional treatment of coronary atherosclerotic disease.11 However, the demonstrated efficacy of DES is balanced by the small but unpredictable risk of very late stent thrombosis thought to be due to delayed vascular healing resulting from either the initial antiproliferative effect (and associated late acquired incomplete stent apposition) or a hypersensitivity reaction to the drug, polymer coating, or their combination.12,13 Moreover, beyond the coronary vasculature, there has been a paucity of effective therapies to manage restenosis after intervention. In recent years, drug-coated balloons (DCBs) have emerged as a therapeutic alternative in the interventional field.14 With this technology, short-term transfer of antiproliferative drugs to the arterial wall is achieved without the requirement of an implanted drug delivery system, thus potentially reducing the untoward effects associated with polymer-based stent technologies. In small clinical randomized trials, paclitaxel-coated balloons have been shown to be …

AS-217: Can the Use of an Iso-osmolar Contrast Agent (Iodixanol) Reduce the Incidence of Contrast-Induced Nephropathy Compared with a Low-Osmolar Contrast Agent (Iopromide)?

AS-217: Can the Use of an Iso-osmolar Contrast Agent (Iodixanol) Reduce the Incidence of Contrast-Induced Nephropathy Compared with a Low-Osmolar Contrast Agent (Iopromide)?

Gastro intestinal tracking and gastric emptying of solid dosage forms in rats using X-ray imagining

The aim of this research was to study the gastrointestinal transit and gastric emptying of non-disintegrating solid dosage forms in rats using X-ray imaging. Commercial gelatin minicapsules were filled with barium sulfate and enterically coated using Eudragit S100. The capsules were administered orally to rats followed by a solution of iodine based contrast agent iopromide. Images were obtained using a standard X-ray camera and digital film processing. Capsules were followed through the GI tract from the stomach to the small intestine, cecum and large intestine and the capsule location could be easily identified. Gastric emptying of different sized capsules was studied. The effect of fasting and time of administration on gastric retention was also studied. It was found that shortened capsules of 3.5 and 4.8 mm length were emptied from the stomach whereas the commercial length 7.18 mm capsules were retained. Surprisingly, 2.5 h post administration more rats retained the capsules in the stomach in the fasted state than in the fed state. We found that X-ray imaging can be used for simple visualization and localization of solid dosage forms in rats in the fed state using shortened commercial minicapsules on rats.

Elucidation of phototransformation reactions of the X‐ray contrast medium iopromide under simulated solar radiation using UPLC‐ESI‐QqTOF‐MS

The highly polar, nonionic X-ray contrast agent iopromide (C(18)H(24)N(3)O(8)I(3); 791 Da) is resistant to microbial degradation during the activated sludge process in wastewater treatment plants and hence is released into the aquatic environment. Against this background, the present study was conducted to evaluate the phototransformation, potentially constituting the most relevant removal mechanism in rivers and streams. The photolysis of the iodinated aromatic compound was investigated in a Suntest solar simulator using aqueous solutions. Following a 120-min irradiation period, an almost complete primary degradation of iopromide gave rise to a series of photoproducts that were chromatographed on a reversed-phase UPLC and subsequently characterized by a combination of accurate mass measurements on a ESI-QqToF-MS instrument and H/D-exchange experiments. This analytical approach facilitated confident identification of eight prominent products with the following elemental compositions and molecular weights: C(18)H(25)N(3)O(9)I(2) (681 Da); C(18)H(25)N(3)O(8)I(2) (665 Da); C(17)H(23)N(3)O(8)I(2) (651 Da); C(18)H(24)N(3)O(9)I (553 Da); C(17)H(24)N(3)O(8)I (525 Da); C(15)H(20)N(3)O(6)I (465 Da); C(14)H(18)N(3)O(6)I (451 Da); and C(18)H(25)N(3)O(9) (427 Da). Their formation was the result of four principal photoreactions: (1) gradual, and eventually complete, deiodination of the aromatic ring; (2) substitution of the halogen by a hydroxyl group; (3) N-dealkylation of the amide in the hydroxylated side chain; and (4) oxidation of a methylene group in the hydroxylated side chain to the corresponding ketone. In conclusion, the findings of the artificial sunlight irradiation experiments indicated that in real environmental settings iopromide might suffer partial or even complete deiodination.

A prospective study comparing different iodine concentrations for triphasic multidetector row CT of the upper abdomen

Objectives To investigate the effect of different iodine concentrations at either constant injection or iodine administration rates but constant total iodine load on contrast enhancement of liver, pancreas and spleen by multidetector row CT. Materials and methods One hundred and twenty consecutive patients (70 ± 6 years) underwent triphasic liver CT at a four-channel multidetector-row CT using the non-ionic contrast medium iopromide. Patients were divided into six equal groups—I: 150 ml, 240 mg/ml at 4 ml/s; II: 120 ml, 300 mg/ml at 4 ml/s; III: 97.3 ml, 370 mg/ml at 4 ml/s; IV: 150 ml, 240 mg/ml at 5 ml/s; V: 120 ml, 300 mg/ml, 60 ml at 6 ml/s, 60 ml at 3 ml/s; VI: 97.3 ml, 370 mg/ml at 3.3 ml/s. ROIs were measured in the liver, the pancreas, and the spleen in unenhanced, arterial, portal venous, and equilibrium phase. Results At a constant injection rate of 4 ml/s, pancreatic enhancement over baseline only in the arterial phase was significantly higher at 370 mg/ml (58 ± 15 HU versus 59 ± 18 HU versus 74 ± 20 HU for groups I–III, respectively ( p < 0.02)). Comparison of different iodine concentrations at constant iodine administration rate (groups II, IV and VI) and of all six protocols revealed no significant differences at either phase. Conclusions At a constant iodine load and constant injection rates, the high-iodinated contrast agent iopromide at 370 mg/ml improves pancreatic enhancement in the arterial phase. At constant iodine load and constant iodine administration rates, there is no significant effect of different iodine concentrations.

Structural Characterization of Metabolites of the X-ray Contrast Agent Iopromide in Activated Sludge Using Ion Trap Mass Spectrometry

Identification of degradation products of environmental contaminants is a challenging task because not only are they present in very low concentrations but they are also mixed with complex matrixes that interfere with detection. This work illustrates a simple approach using ion trap mass spectrometry combined with H/D-exchange experiments to elucidate the structures of iopromide metabolites formed during biodegradation in activated sludge. Iopromide is an X-ray contrast agent that has been detected frequently in effluents of wastewater treatment plants and in surface waters due to its persistence and high usage. Three metabolites produced by oxidation of the primary alcohols (forming carboxylates) on the side chains of iopromide were identified in a batch reactor with mixed liquor from a conventional activated sludge. Derivatization of the carboxylic acid to form a methyl ester and interpretation of the MS2 data of this derivative aided in the confirmation of the identities of these metabolites. Furthermore, one metabolite formed by dehydroxylation at the two side chains was identified in a batch reactor with mixed liquor from a nitrifying activated sludge. The MS2 fragmentation pattern of iopromide and its metabolites revealed that the iodinated ring remains intact and that minor transformations in the structure occur during biodegradation of iopromide in biological wastewater treatment plants.

Universal Use of Nonionic Iodinated Contrast Medium for CT: Evaluation of Safety in a Large Urban Teaching Hospital

We evaluated the safety of the universal use of the nonionic iodinated contrast agent iopromide in patients undergoing CT in a large urban teaching hospital. For 2 years, we prospectively recorded all adverse events temporally associated with the administration of iopromide in 29,508 consecutive patients undergoing contrast-enhanced CT at our institution. The types, intensities, treatments, and outcomes of adverse events were recorded along with relevant patient history, including risk factors. Descriptive analyses of the variables, comparisons of means, and proportions using Student's t and chi-square tests, and logistic regressions were conducted. Adverse events were observed in 211 patients (0.7%) and were categorized as follows: urticaria (n = 161), facial or laryngeal edema (n = 13), bronchospasm (n = 8), severe nausea or vomiting (n = 10), or other (n = 19). One hundred eighty-eight adverse events (89%) were rated mild, 19 moderate (9%), and four severe (2%), including one fatality. Adverse events required treatment in 89 patients (42%). A history of allergy was present in 92 patients (44%), and 29 (14%) had a prior contrast reaction. Other relevant risk factors were identified in 63 patients (30%). No relationship existed between the occurrence of adverse events and any of the following: patient age, dose of iodine administered, or time of study (i.e., month, season, and year). Women (p < 0.001) and outpatients (p < 0.001) had a statistically significant higher incidence of adverse events. The universal use of iopromide as an IV CT contrast agent has a favorable safety profile.

Addition of paclitaxel to contrast media prevents restenosis after coronary stent implantation

ObjectivesThe present study was designed to test the efficacy of paclitaxel added to the contrast agent iopromide in the prevention of restenosis. BackgroundContrast media adhere to the coronary vessel wall for some seconds after injection. Such a layer of contrast agent could serve as a matrix for antiproliferative drugs. MethodsThirty-four stents were implanted into the left anterior descending and circumflex coronary arteries of 17 pigs, using a 1.2:1.0 overstretch ratio. The unsupplemented contrast agent iopromide-370 was used as a control; the treatment groups were treated with 80 ml intracoronary iopromide plus either 100 or 200 μmol/l paclitaxel, or 80 ml intravenous iopromide plus 200 μmol/l paclitaxel. Quantitative angiography and histomorphometry were used to assess comparable baseline parameters between the treatment groups. ResultsA short time incubation (3 min) almost completely inhibited vascular smooth muscle cell proliferation, sustained for up to 12 days. Whereas intravenous paclitaxel had no effect, intracoronary application of paclitaxel reduced the diameter stenosis from 55 ± 13% to 29 ± 18% and 13 ± 12%. Late lumen loss dropped from 1.94 ± 0.35 mm under the control condition to 1.19 ± 0.55 mm with 100 μmol/l paclitaxel and to 0.82 ± 0.54 mm with 200 μmol/l paclitaxel. Histomorphometry revealed a corresponding dose-dependent reduction of the neointimal area and restenosis by intracoronary iopromide paclitaxel. Assessment of left ventricular function and myocardial histology revealed no adverse effects of intracoronary paclitaxel application. ConclusionsThis study provides evidence that intracoronary application of a taxane dissolved in a contrast medium profoundly inhibits in-stent restenosis. This novel, widely feasible approach may be suited for the prevention of restenosis in a broad spectrum of interventional treatment regimens.