Volume Of Contrast Medium Research Articles

Abstract 11562: Contrast Minimization Devices in the Cath Lab: Real-World Outcomes Within a VA Hospital

Introduction: Contrast-induced acute kidney injury (CI-AKI) remains one of the leading causes of hospital acquired AKI. Patients with baseline chronic kidney disease (CKD) and/or elevated risk scores are at increased risk of developing CI-AKI. Contrast minimization devices have been proposed as a mechanism for contrast usage reduction in the cath lab. Since May 2017, the cardiac catheterization lab at the Michael E DeBakey VA Medical Center has used the Osprey Medical DyeVert contrast minimization device. Methods: We retrospectively evaluated the outcomes of 120 patients with known CKD who underwent cardiac catheterization with the DyeVert Contrast Reduction System for contrast monitoring and minimization. Results: The results of 120 DyeVert cases from Q2 2019 through Q4 2020 were analyzed. The mean baseline eGFR of the evaluated patients was 50. Mean overall contrast media volume (CMV) savings were 37 +/- 21 mL per procedure or 36%. 90% of DyeVert cases achieved a procedure CMV/eGFR ratio < 3. Mean attempted CMV/eGFR ratio was 2.5 versus actual ratio of 1.6 after device contrast diversion. Conclusions: Our results suggest that contrast minimization devices in the cath lab can reduce the overall contrast media volume usage and result in improved CMV/eGFR ratios for at-risk patients undergoing coronary angiography.

Abstract 9418: Contrast Volume to Estimated Glomerular Filtration Rate Ratio as a Predictor for 30-Day All-Cause Mortality After Transcatheter Aortic Valve Implantation

Introduction: Contrast-induced acute kidney injury (AKI) has been proven to be associated with early mortality and adverse events. However, in the setting of transcatheter aortic valve implantation (TAVI), previous literature has failed to establish a correlation between the absolute volume of contrast media administered and mortality. Objective: We aimed to investigate the impact of contrast volume administered normalised to estimated glomerular filtration rate ratio (V/eGFR) on 30-day all-cause mortality in TAVI patients. Secondary outcomes were AKI and new renal replacement therapy (RRT). Methods: We retrospectively analysed a cohort of 1150 patients who underwent TAVI at our unit between 2015-2018. Results: Follow-up was complete for all patients. There were 23 deaths within the follow-up period. Receiver operating curve (ROC) analysis showed fair discrimination for 30-day all-cause mortality at a V/eGFR ratio of 3.6 (C-statistic 0.68). 69.7% (n=801) of patients had a V/eGFR of <3.6 and 30.3% (n=349) had a V/eGFR of ≥3.6. In multivariate Cox proportional hazards analysis, V/eGFR as a cut point ≥3.6 was the strongest predictor of 30-day all-cause mortality (hazards ratio 4.35, 95% confidence interval [1.74-10.89], p=0.002). Other independent predictors were procedural urgency (3.40 [1.46-7.92]) and being under general anaesthesia (4.23 [1.62-11.08]). In Kaplan-Meier analysis, patients with V/eGFR ≥3.6 had a significantly greater 30-day mortality than those <3.6 (log rank test p<0.0001). A similar V/eGFR cut point of 3.6 was found to be an excellent predictor for new RRT (C-statistic 0.82), and 3.3 for AKI (C-statistic 0.60). Conclusions: In conclusion, a V/eGFR ≥3.6 after TAVI was found to be a strong predictor of 30-day mortality. The maximum contrast volume which can be safely administered in each patient without significantly increasing the risk of mortality can be calculated using this ratio. Future studies are indicated to validate our findings.

Effect of Extrinsic Warming of Low-Osmolality CT Contrast Media (Iohexol 350) on Extravasations and Patient Reaction Rates: A Retrospective Study.

BACKGROUND. Extrinsic warming of iodinated CT contrast media to body temperature reduces viscosity and injection pressures. However, studies examining the effect of extrinsic warming on clinical adverse events are limited in number and provide conflicting results. Therefore, consensus practice recommendations have been sparse. OBJECTIVE. The purpose of this study is to compare rates of extravasation, allergic and allergiclike reactions, and physiologic reactions between iohexol 350 mg I/mL warmed to body temperature (37°C) versus this agent maintained at room temperature. METHODS. This retrospective study compared adult patients who received CT examinations using IV iohexol 350 that had either been warmed to body temperature or maintained at room temperature. At our institution, contrast media had historically been warmed to body temperature before a protocol change unrelated to this investigation. Information on the patient and CT examination was extracted from the electronic medical record. Adverse events, including extravasations, allergic and allergiclike reactions, and physiologic reactions, were compared between groups. RESULTS. A total of 3939 patients received contrast media warmed to body temperature before the protocol change; 3933 patients received contrast media at room temperature after the protocol change. The body temperature group experienced 11 (0.28%; 95% CI, 0.14-0.50%) adverse events, all extravasations; the allergic and allergic-like reaction rate was 0.00% (97.5% CI, 0.00-0.09%). The room temperature group experienced 17 (0.43%; 95% CI, 0.25-0.69%) adverse events: 13 (0.33%; 95% CI, 0.17-0.56%) extravasations and four (0.10%; 95% CI, 0.03-0.26%) allergic and allergiclike reactions. No physiologic reaction occurred in either group. The two groups were not different in terms of overall reaction rate (p = .19), extravasation rate (p = .69), allergic and allergiclike reaction rate (p = .06), or physiologic reaction rate (p > .99). Logistic regression adjusting for patient and CT characteristics (age, sex, conventional CT vs CTA, contrast media volume, injection location) showed no significant association of patient group and adverse reaction rate (odds ratio, 2.19; 95% CI, 0.68-7.00). Multivariable regression modeling showed an excess of 0.27 adverse events per 100 patients within the room temperature group, which is below a 0.6% noninferiority margin. CONCLUSION. The data suggest that maintaining iohexol 350 at room temperature is noninferior to warming the agent to body temperature before injection. CLINICAL IMPACT. The resources involved to prewarm iohexol 350 before injection may not be warranted.

Feasibility of sub-second CT angiography of the abdomen and pelvis with very low volume of contrast media, low tube voltage, and high-pitch technique, on a third-generation dual-source CT scanner

BackgroundConcerns about potential risks of using contrast media in patients with chronic renal insufficiency limit the utilization of CT angiography in this population. PurposeTo evaluate the feasibility of abdominopelvic CTA with very low volumes of contrast media. Material and methodsIn this retrospective study, 20 patients with chronic renal insufficiency underwent high-pitch abdominopelvic (AP) CTA on a third-generation dual-source CT scanner with 30 mL of nonionic iodinated contrast. The homogeneity of intravascular attenuation at the suprarenal aorta, infrarenal aorta, and the right common iliac artery was measured. Image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were used to assess objective image quality. Subjective image quality was evaluated on a 5-point scale (1 = unacceptable; 5 = excellent). ResultsTwelve male and eight female patients underwent CTA of the abdomen and pelvis at 80 kVp. Five CTAs also included the chest (CAP). The mean scan duration was 0.78 ± 0.19 s for AP and 0.96 ± 0.06 s for CAP CTAs. The mean ± SD of attenuation at suprarenal aorta, infrarenal aorta, and right common iliac artery were 235.1 ± 68.0, 249.2 ± 61.3, and 254.4 ± 67.7 HU, respectively. The attenuation was homogeneous across vascular levels (P = 0.06). All scans had diagnostic subjective image quality with the median (IQR) of 3.5 (1.75). CNR and SNR were homogeneous across vascular levels (P = 0.08 and P = 0.14, respectively). ConclusionSub-second, high-pitch abdominopelvic CTA with a low volume of contrast in patients with chronic renal insufficiency is technically and clinically feasible with good diagnostic image quality and homogenous attenuation across vascular levels.

Radial versus femoral approach for rotational atherectomy – technical aspects and procedural outcomes

Abstract Background Rotational atherectomy (RA) is a well-established therapy for the treatment of heavily calcified coronary lesions. While the radial approach has evolved into the gold-standard for standard percutaneous coronary intervention (PCI), RA is still often performed via a femoral approach. Concerns over guiding size, sheath size, the delivery of the burr as well as the need for a temporary pacemaker play a role in that decision. Methods This retrospective analysis includes all patients undergoing RA from 03/2013 to 06/2019 at one institution. We sought to investigate the procedural outcome and the influence of the percutaneous approach. Results A total of 228 patients were planned to undergo RA. Based on operator preference, RA was attempted via the radial approach (RAD) in 78 (34.2%) patients and via the femoral approach (FEM) in 150 (65.8%) patients. The procedure failed in 2.6% (RAD 1.3% vs. FEM 3.3%, p=0.359) due to crossing failure of either the RotaWire (n=5) or the burr (n=1). The left anterior descending was the most frequently treated vessel in the radial group and significantly more often targeted in comparison to the femoral group (LAD: RAD 44.6% vs. FEM 26.5%, p=0.004). All other vessels were similarly often treated in both groups (LM: RAD 13.3% vs. FEM 17.3%, p=0.414; LCX: RAD 15.7% vs. FEM 23.5%, p=0.155; RCA: RAD 25.3% vs. FEM 31.5%, p=0.315; Bypass: RAD 1.2% vs. FEM 1.2%, p=0.984). RAD-RA was significantly more often performed with a 6F sheath in comparison to FEM-RA (RAD 47.4% vs. FEM 16.7%, p<0.001). A 7F sheath was used in 52.6% of the cases for RAD-RA (men: 85.4%, women: 14.6%, p=0.176) and is therefore the most frequently chosen sheath size within that group. A 7F or 8F sheath was used in 75.3%, respectively 8.0% of the cases in the FEM group (7F: p<0.001; 8F: p=0.010 compared to RAD). There were no significant differences regarding the burr sizes (RAD 1.43±0.17mm vs FEM 1.41±0.18mm, p=0.442). Whereas the placement of a temporary pacemaker was equal in both groups (RAD 20.8% vs. FEM 30.8%, p=0.110), the femoral group showed a higher number of patients with any back-up pacing, permanent or temporary (RAD 24.7% vs. FEM 39.0%, p=0.031). There were no significant differences in terms of fluoroscopy time (RAD 00:24:65±00:12:48 vs. FEM 00:28:33±00:17:05, p=0.180) and the volume of contrast medium (RAD 217.2±96.3ml vs. FEM 192.9±86.0ml, p=0.118). Moreover, procedural complications (RAD 17.9% vs. FEM 18.0%, p=0.992) and access site related complications (RAD 6.4% vs. FEM 10.0%, p=0.363) occurred equivalently in both groups. Conclusion This analysis shows that RA via radial access is as safe and successful as via femoral access. Despite the more frequent use of 6F sheaths, burr sizes did not differ. Additionally, neither fluoroscopy time nor contrast volume indicated a higher complexity of the RAD approach. Funding Acknowledgement Type of funding sources: None.

The Predictive Value of Soluble Urokinase-Type Plasminogen Activator Receptor in Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention.

ObjectiveSoluble urokinase-type plasminogen activator receptor (SuPAR) is a circulating protein and a novel identified promising biomarker for various renal diseases and kidney injury. However, it remains unknown on the predictive value of suPAR in contrast induced acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary intervention (PCI).MethodsA total of 399 patients undergoing PCI were enrolled in the research from June 2020 to June 2021 in Zhongda Hospital. Patients were divided into CI-AKI and non-CI-AKI groups according to the preoperative and postoperative serum creatinine levels. Plasma suPAR level was detected through enzyme-linked immunosorbent assay on admission. Demographic data, hematological parameters, coronary angiography data and medications were recorded and compared between CI-AKI and non-CI-AKI groups. Logistic regression analysis and receiver operator characteristic (ROC) curve analysis were performed for identifying the independent risk factors of CI-AKI and assessment of the predictive value of suPAR for CI-AKI.ResultsCI-AKI occurred in 65 (16.3%) patients undergoing PCI. The level of suPAR in CI-AKI group was significantly higher than that in the non-CI-AKI group. Multivariate logistic regression indicated diabetes, lower LVEF, lower hydration rate, lower baseline eGFR, higher plasma suPAR (OR = 2.875, 95% CI = 2.038–3.672, P < 0.001) and volume of contrast media were all independent risk factors for CI-AKI after adjustment of the confounding factors. ROC analysis illustrated that the optimal area under the curve was 0.765, indicating plasma suPAR was a splendid predictor for CI-AKI. The corresponding cut-off value was 3.305 ng/mL, and the sensitivity and specificity were 63.1% and 82.3%, respectively.ConclusionIncreased suPAR level is independently associated with elevated risk of suffering CI-AKI, and suPAR is a strong predictor for CI-AKI in patients undergoing PCI. SuPAR might act as a novel biomarker for CI-AKI in clinical practice.

EndoNaut two-dimensional fusion imaging with a mobile C-arm for endovascular treatment of occlusive peripheral arterial disease

BackgroundEndovascular treatment has become the first-line strategy for peripheral arterial disease (PAD). Given the number of procedures required, any technology associated with a reduction in radiation exposure and contrast volume is highly relevant. In the present study, we evaluated whether two-dimensional (2D) fusion imaging could reduce the radiation exposure and contrast volume during endovascular treatment of occlusive PAD. MethodsOur consecutive, retrospective, single-center, nonrandomized comparative trial included patients with PAD at the femoral, popliteal, and/or tibial level, at any clinical stage, if they were candidates for endovascular revascularization. Patients were treated with or without the EndoNaut 2D fusion imaging system (Therenva, Rennes, France) in a nonhybrid room with the same Cios Alpha mobile C-arm (Siemens, Munich, Germany). The indirect dose-area product and contrast medium volume were recorded. ResultsBetween March 2018 and April 2020, 255 patients underwent endovascular femoropopliteal revascularization with (n = 124) or without (n = 131) 2D fusion imaging. The volume of injected contrast medium (34.7 ± 13.8 mL vs 51.3 ± 26.7 mL; P < .001) and dose-area product (8.9 ± 9.9 Gy/cm2 vs 13.5 ± 14.0 Gy/cm2; P = .003) were significantly lower for the 2D fusion imaging group than for the control group. A subgroup analysis of complex (TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease C/D) lesions showed similar results. Stratification of the fusion imaging group into three subgroups, according to the procedure dates, showed no effect of a potential learning curve on the operative parameters. ConclusionsThe results from the present study showed a significant reduction in the contrast volume and radiation dose for endovascular treatment of PAD when applying 2D fusion imaging technology. Overall, a reduction of >30% was observed for both operative parameters, without excessive training requirements, highlighting the potential benefits of using 2D fusion imaging when performing endovascular revascularization for PAD.

Risk assessment of contrast-induced acute kidney injury in patients with acute myocardial infarction after coronary angiography and percutaneous coronary intervention

Aim. To assess the risk of contrast-induced acute renal injury (CI-AKI) in patients with acute myocardial infarction in a highly specialized hospital after coronary angiography.Material and methods. The study sample included 502 patients who were treated in the cardiology department of a specialized hospital. CI-AKI was established by an increase in creatinine &gt;26 μmol/L within 48 hours after percutaneous coronary intervention (PCI) with radiopaque contrast agents or an increase in creatinine &gt;50% within a week after PCI. A multistage statistical analysis was used to search for possible predictors of CI-AKI.Results. In total, CI-AKI was diagnosed in 57 (11,3%) patients. Based on the analysis performed, 3 significant predictors of CI-AKI were identified: patient’s age, contrast medium volume (ml/kg) and anemia (presence/absence). An equation for assessing the risk of CI-AKI in patients after PCI has been created.Conclusion. A simple scale for assessing the CI-AKI risk makes it possible to identify a category of patients who requires preventive measures to reduce iatrogenic complications and mortality.

MDCT Angiography Evaluation of Arterial Involvement in Carcinoma Gall Bladder: An Institutional Experience

Purpose: Evaluation of pattern of arterial involvement in advance case of gallbladder carcinoma with MDCT Angiography. Method: All CT examinations were performed on a 64- MDCT scanner (Philips Medical System Version 6.4, Extended Brilliance Workspace). Technical features of MSCT were as following 64mm � 1mm collimation, minimum slice thickness of 0.625, gantry rotation time of 320ms, kV of 120, and mAs of 320. CT Angiography was performed with IV administration of nonionic contrast material i.e. omnipaque. The contrast medium and saline solution were injected with a medrad power injector at 4mL/sec through an 18-gauge plastic intravenous catheter placed in an antecubital vein in most of the cases. Contrast medium volumes varied between 100 and 150 mL at 1.5ml/Kg. Images were obtained in triphasic pattern at arterial (20-30 seconds), portal (60-70 seconds), and equilibrium (at 3 minutes) phases. Results: Nearly half of the cases (43.5%) of carcinoma gall bladder showed arterial involvement at the time of diagnosis; most commonly involved artery was found to be cholecystic artery (24.7%) followed by right hepatic artery (14.1%) and replaced right hepatic artery (3.5%). Conclusion: We conclude that nearly half of the patients with carcinoma gall bladder have arterial involvement at the time of diagnosis. The most commonly artery involved was Cholecystic artery followed by right hepatic artery and replaced right hepatic artery. Keywords: MDCT (Multidetector computed tomography); Carcinoma gall bladder; Cholecystic artery; Hepatic artery; Right hepatic artery

Comparison of transradial and transfemoral access for transcatheter arterial embolization of iatrogenic renal hemorrhage.

BackgroundThere are few reports of renal artery embolization (RAE) via transradial access (TRA) for renal hemorrhage, and none have compared outcomes of RAE via TRA and transfemoral access (TFA). The objective was to compare technical and clinical outcomes in patients undergoing RAE via TRA or TFA for iatrogenic renal hemorrhage.Materials and methodsThis study included 45 RAE procedures (16 TRA and 29 TFA) for iatrogenic renal hemorrhage in 43 patients performed at a tertiary referral center between October 2018 and December 2020. Information regarding underlying diseases, coagulation status, angiographic and embolization procedure details, technical and clinical successes, and complications were retrospectively evaluated.ResultsThere were no differences in demographics, underlying diseases, updated Charlson comorbidity scores, angiographic findings, and volume of contrast material between the TRA and TFA groups. By contrast, prothrombin time and international normalized ratio were significantly lower in the TRA than in the TFA group. Embolic materials differed significantly in the two groups. Procedure duration, fluoroscopy time, digital subtraction angiography number, and dose area product were slightly lower in the TRA than in the TFA group, but the differences were not statistically significant. Technical and clinical success rates in the TRA and TFA groups were 100% and 96.6%, and 100% and 96.6%, respectively. No patient in either group experienced procedure-related complications during a 4 week follow-up period.ConclusionRAE via TRA in the management of iatrogenic renal hemorrhage was safe and feasible, with similar procedure duration and radiation exposure to RAE via TFA. TRA may be an acceptable alternative to TFA in these patients.

Safe Limits of Contrast Media for Contrast-Induced Nephropathy: A Multicenter Prospective Cohort Study.

Background: The safe level of contrast media volume (CV) is an important modifiable risk factor for contrast-induced nephropathy (CIN). The safe limit of CV remains unclear and is limited to single-center studies. Our objective was to determine the association between the ratio of contrast volume-to-glomerular filtration (CV/GFR) and CIN in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI).Methods: We assessed the association between CV/GFR and the risk of CIN in 4,254 patients undergoing CAG or PCI from the year 2013 to 2016 and enrolled in the REICIN (REduction of rIsk for Contrast-Induced Nephropathy), a prospective, multicenter, observational cohort study. CV/GFR was calculated at the five primary GFR equation.Results: Sixty-nine (1.7%) patients with a median contrast volume-to-chronic kidney disease epidemiology collaboration (CV/CKD-EPI) ratio of 2.16 (1.30–3.93) have suffered from CIN. The CV/CKD-EPI demonstrated the best performance of model fit, discrimination (area under curve = 0.736), calibration, reclassification, and equation conciseness (1 variable). The CV/CKD-EPI ≥1.78 was the statistical significance associated with CIN [adjusted odds ratio, 4.64 (2.84–7.56); p < 0.001]. Furthermore, similar results were found in the subgroup analyses.Conclusions: The CV/CKD-EPI showed the best performance in patients undergoing CAG or PCI. CV/CKD-EPI ≥1.78 could be a more reliable and convenient predictor of CIN. Intraprocedural preventive measures should include a priori calculation of CV/GFR to limit contrast volume.

C-Reactive Protein/Albumin Ratio Predicts Acute Kidney Injury in Patients With Moderate to Severe Chronic Kidney Disease and Non-ST-Segment Elevation Myocardial Infarction.

In this study, we aimed to evaluate the predictive value of admission C-reactive protein/albumin ratio (CAR) for acute kidney injury (AKI) in cases with moderate to severe chronic kidney disease (CKD) not on dialysis who presented with non-ST-segment elevation myocardial infarction (NSTEMI) and underwent coronary angiography (CAG). This cross-sectional and observational study included 420 NSTEMI patients. The study population was categorized based on the CAR tertiles as groups T1, T2, and T3. The primary outcome of the study was AKI development; 92 (21.9%) cases developed AKI. The frequency of AKI was significantly higher in the T3 group compared with the T2 and T1 groups (34% vs 17% vs 14%, P < .001). Age, estimated glomerular filtration rate, contrast media volume, and CAR (odds ratio: 1.36; 95% CI: 1.17-1.57; P < .01) were significant predictors of AKI. In a receiver operating characteristic curve analysis, CAR levels >0.20 predicted AKI development with a sensitivity of 74% and a specificity of 45%. We observed that the CAR may be a promising inflammatory parameter for AKI in NSTEMI patients with moderate to severe CKD after CAG.

Systemic Immune-Inflammation Index Is a Predictor of Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction.

We evaluated the predictive value of admission systemic immune-inflammation index (SII) for the risk of contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and SII (platelet × NLR) levels were calculated in 1621 consecutive patients with STEMI. The relationship of these parameters with CIN development within 72 hours of pPCI was analyzed. Of the study population, 343 (21.1%) cases developed CIN. The frequency of CIN was 11.1% in the first SII quartile, 11.6% in the second SII quartile, 26.8% in the third SII quartile, and 35% in the fourth SII quartile, which differed significantly between groups (P < .01). Age, baseline glomerular filtration rate, contrast media volume, hypertension, C-reactive protein levels, and the quartiles of SII were independent predictors of CIN. Patients in the third SII quartile versus first SII quartile (OR: 2.906, 95% CI, 1.903-4.437; P < .001), and fourth SII quartile versus first SII quartile (OR: 4.168, 95% CI, 2.754-6.313; P < .001) had a significantly higher risk for CIN in the multivariable model. The SII may be a promising inflammatory parameter to predict CIN after pPCI.

Three-Dimensional Holographic Guidance, Navigation, and Control (3D-GNC) for Endograft Positioning in Porcine Aorta: Feasibility Comparison With 2-Dimensional X-Ray Fluoroscopy

Objectives Intraprocedural deployment of endovascular devices during complex aortic repair with 2-dimensional (2D) x-ray fluoroscopic guidance poses challenges in terms of accurate delivery system positioning and increased risk of x-ray radiation exposure with prolonged fluoroscopy times, particularly in unfavorable anatomy. The objective of this study was to assess feasibility of using an augmented reality (AR) system to position and orient a modified aortic endograft delivery system in comparison with standard fluoroscopy. Materials and Methods The 3-dimensional guidance, navigation, and control (3D-GNC) prototype system was developed for eventual integration with the Intra-Operative Positioning System (IOPS, Centerline Biomedical, Cleveland, OH) to project spatially registered 3D holographic representations of the subject-specific aorta for intraoperative guidance and coupled with an electromagnetically (EM) tracked delivery system for intravascular navigation. Numerical feedback for controlling the endograft landing zone distance and ostial alignment was holographically projected on the operative field. Visualization of the holograms was provided via a commercially available AR headset. A Zenith Spiral-Z AAA limb stent-graft was modified with a scallop, 6 degree-of-freedom EM sensor for tracking, and radiopaque markers for fluoroscopic visualization. In vivo, 10 interventionalists independently positioned and oriented the delivery system to the ostia of renal or visceral branch vessels in anesthetized swine via open femoral artery access using 3D-GNC and standard fluoroscopic guidance. Procedure time, fluoroscopy time, cumulative air kerma, and contrast material volume were recorded for each technique. Positioning and orientation accuracy was determined by measuring the target landing-zone distance error (δLZE) and the scallop-ostium angular alignment error (θSOE) using contrast-enhanced cone beam computed tomography imaging after each positioning for each technique. Mean, standard deviation, and standard error are reported for the performance variables, and Student’s t tests were used to evaluate statistically significant differences in performance mean values of 3D-GNC and fluoroscopy. Results Technical success for the use of 3D-GNC to orient and position the endovascular device at each renal-visceral branch ostium was 100%. 3D-GNC resulted in 56% decrease in procedure time in comparison with standard fluoroscopic guidance (p<0.001). The 3D-GNC system was used without fluoroscopy or contrast-dye administration. Positioning accuracy was comparable for both techniques (p=0.86), while overall orientation accuracy was improved with the 3D-GNC system by 41.5% (p=0.008). Conclusions The holographic 3D-GNC system demonstrated improved accuracy of aortic stent-graft positioning with significant reductions in fluoroscopy time, contrast-dye administration, and procedure time.

Low dose contrast media in step-and-shoot coronary angiography with third-generation dual-source computed tomography: feasibility of using 30 mL of contrast media in patients with body surface area

Reducing contrast media volume in coronary computed tomography angiography minimizes the risk of adverse events but may compromise diagnostic image quality. We aimed to evaluate coronary computed tomography angiography's diagnostic image quality while using 30 mL of contrast media in patients with a body surface area <1.7 m2. This prospective study included patients who underwent coronary computed tomography angiography from May 2018 to June 2019. The patients were divided into a low-dose group, who received 30 mL of contrast media, and a routine-dose group, who received contrast media based on body weight. Patient characteristics, coronary computed tomography angiography results, and quantitative and qualitative image results were assessed and compared. In total, 103 patients with a body surface area <1.7 m2 were 53 in the low-dose group and 50 in the routine-dose group. Sex, age, body surface area, body weight, and heart rate were similar between the groups (P>0.05). A contrast media volume of 30±0 mL was used for the low-dose group, and 41.62±4.59 mL was used for the routine-dose group. The low-dose group's computed tomography values were significantly different from those of the routine-dose group (P<0.05). The radiologists demonstrated agreement regarding diagnostic image quality and accuracy (kappa =0.91 and 0.85, respectively). Using 30 mL of contrast media for coronary computed tomography angiography in patients with a body surface area <1.7 m2 provided a suitable diagnostic image quality for coronary artery disease diagnosis. Although radiation doses were similar between the groups, the decreased contrast media volume was likely beneficial for the patients.

PUK10 Cost–Utility Analysis of DyeVert Contrast Reduction Systems for Preventing Contrast-Induced Acute Kidney Injury in Patients Undergoing Coronary and/or Peripheral Angiography

Contrast-induced acute kidney injury (CI-AKI) is a complication commonly associated with invasive arterial angiographic procedures and is among the leading causes of hospital-acquired acute kidney injury. CI-AKI is costly and associated with a higher morbidity and mortality. The DyeVert™ System is intended to reduce the overall volume of contrast media injected and potentially improve long-term health outcomes. A de novo decision analytic model was developed based on the current treatment pathway to estimate the costs and outcomes of using the DyeVert System in England. A meta-analysis was conducted to estimate the effectiveness of DyeVert System. Results from the meta-analysis and other clinical and economic inputs were extracted from local sources to inform the model. Costs were estimated from the National Health Service (NHS) and Personal Social Services perspective. Deterministic and probabilistic sensitivity analyses (PSA) were performed to explore the uncertainty surrounding the input parameters. Base-case results indicate that using DyeVert Systems as an adjunct to standard NHS clinical practice is less costly (£20,957 versus £19,865) and more effective (4.117 versus 4.158 quality-adjusted life years) than conventional hand or automated injection of contrast agent without using the DyeVert System. The sensitivity analysis results indicate that the cost saving per patient range from £141 to £1,092. Results from the PSA showed that the intervention has a high probability of being cost saving and cost effective (>99%). The cost savings are mainly driven by a lower risk of CI-AKI and associated subsequent complications. The introduction of the DyeVert System has the potential to reduce costs for the health care system and yield improved clinical outcomes for patients at risk of CI-AKI undergoing angiographic procedures.

MO415DOES LOW CONTRAST VOLUMES REDUCE RATES OF CONTRAST-INDUCED NEPHROPATHY IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY?

Abstract Background and Aims Coronary angiography (CAG) necessitates administration of iodinated contrast, which may precipitate an acute deterioration in renal function (contrast-induced nephropathy). Previous work on contrast-induced nephropathy (CIN) has identified contrast volume as a risk factor and suggested that there is a toxic contrast dose above which the risk of CIN is markedly increased. The focus of this study is to provide a critical appraisal of this modifiable risk factor. Method We prospectively enrolled 158 patients who CAG with or without percutaneous coronary intervention from December 2017 to February 2018 at a cardiology department . CIN was defined as an increase in serum creatinine level &amp;gt;25% or 0.5 mg/dL after 48 hours postcardiac catheterization. Toxic contrast dose was defined as a ratio volume of contrast media to estimated glomerular filtration rate (V/eGFR) &amp;gt; 2 . Multivariable regression was conducted to evaluate the effect of exceeding the toxic contrast dose on CIN. Results Of 158 patients (females = 36.1%, mean age 60.0 ± 11 years) who underwent CAG , 15 (9,5%) developed CIN . The volume administered of contrast was not related to the existence of postprocedure CIN (96,6±35,9 ml vs 102,5±33,7ml , p=0,16). However , it was associated with a higher incidence of CIN in patients with chronic renal failure (90±19,1 ml vs 116,6±73,7ml , p=0,008) . The mean V/eGFR value was 1,2±0,7.Nine percent of patients exceeded the toxic contrast dose. After adjusting for other known predictors of CIN, a V/eGFR ratio &amp;gt; 2 remained significantly associated with CIN (odds ratio 4.7, 95% confidence interval 1.28-17.7, P=0,02). Conclusion Low incidences of CIN suggest that a reduced dose of contrast agent is safe in high-risk patients with impaired renal function. A ratio volume of contrast media to estimated glomerular filtration rate &amp;gt; 2 is a significant and independent predictor of CIN after CAG.

MO416PREDICTORS OF CONTRAST-INDUCED NEPHROPATHY AND THE APPLICABILITY OF THE MEHRAN RISK SCORE IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY

Abstract Background and Aims Contrast-induced nephropathy (CIN) after coronary angiography (CAG) is associated with poor outcomes. The purpose of our study was to identify predictors of CIN in patients undergoing CAG and to evaluate the applicability of the Mehran Risk Score (MRS) in the prediction of CIN in our population. Method We prospectively enrolled 158 patients who underwent coronary angiography with or without percutaneous coronary intervention from December 2017 to February 2018 at a cardiology department . CIN was defined as an increase in serum creatinine level &amp;gt;25% or 0.5 mg/dL after 48 hours postcardiac catheterization. The patients who developed CIN were then analysed for the presence of specific risk factors. The patients were categorized into the 4 risk groups based on the MRS. Results The incidence of CIN was 9,5%. On multivariate analysis, the presence of anemia (p = 0.043), toxic contrast dose (as defined by ratio volume of contrast media to estimated glomerular filtration rate (V/eGFR) &amp;gt; 2) (p = 0.02) and chronic renal failure (p = 0.026) were independently found to confer a significant risk of CIN. In patients belonging to the high Mehran risk group (MRS10- 15) the risk of CIN was 3,7 fold (OR: 3.7, 95% CI: 0,88–15,6, p = 0.036) higher when compared to intermediate and low risk patients (MRS &amp;lt;10). Conclusion Mehran risk score is as a good score for predicting CIN in patients who underwent coronary angiography. According to this, we support its use in order to identify the ones at risk, and to optimize CIN prophylactic therapy prior to and after catheterization.

Predictive value of post-procedural hyponatremia on contrast-induced nephropathy in patients who underwent coronary angiography or percutaneous coronary intervention

Objective Hyponatremia is a prognostic marker for specific pathologies. However, the association between contrast-induced nephropathy (CIN) and post-procedural hyponatremia has not been explored. Our study aims to evaluate the association between hyponatremia developing after contrast media administration and CIN. Material and methods A total number of 236 patients who required nephrology consultation before coronary angiography (CAG) or percutaneous coronary intervention (PCI) because of the high risk for contrast nephropathy, were included. Serum sodium levels were measured at admission and within three consecutive days after contrast media administration. Results Hyponatremia was observed in 141patients (59.7%) following angiography. CIN was developed in 149 (63.4%) patients. Among the patients who developed hyponatremia, ejection fraction, serum haemoglobin level and serum albumin level were low whereas, contrast media volume and percentage of the diabetes mellitus were higher. Also, length of hospital stay, percentage of CIN, renal replacement requirement and mortality rate were higher in patients with hyponatremia. In univariable analysis to evaluate the risk factors for CIN, being female gender, age, diabetes mellitus, serum albumin concentration, haemoglobin level, contrast media volume and hyponatremia were associated with development of CIN. Multivariable logistic regression analysis revealed that advanced age, serum albumin concentration and hyponatremia were independent predictors of CIN. Conclusion Post-procedural hyponatremia was an independent risk factor for CIN in CAG or PCI patients.

Computed tomography image fusion, Coaxial guidewire technique, Fast intraprocedural cortisol testing technique improves success rate and decreases radiation exposure, procedure time, and contrast use for adrenal vein sampling.

Adrenal vein sampling (AVS) is recommended for discriminating patients with unilateral primary aldosteronism from bilateral disease. However, it is a technically demanding procedure that is markedly underused. We developed a computed tomography image fusion, coaxial guidewire technique, fast intraprocedural cortisol testing (CCF) technique to improve AVS success rate, which combines CT image fusion, coaxial guidewire technique, and fast intraprocedural cortisol testing. To evaluate the effectiveness and safety of the AVS--CCF technique. We retrospectively evaluated 105 patients who undervent AVS from June 2016 to October 2020. There were 51 patients in the AVS--CCF group and 54 patients in the AVS group. We compared two groups with technical success rate, procedure time, radiation exposure, volume of contrast medium, and complications (adrenal vein rupture, dissection, infarction, or thrombosis; intraglandular or periadrenal hematoma; and contrast-induced nephropathy). The technical success rate was higher for AVS--CCF than for AVS without CCF (98 vs. 83.3% for bilateral adrenal veins, P = 0.016). AVS--CCF was associated with a shorter procedure time (63.6 ± 24.6 vs. 94.8 ± 40.8 min, P < 0.001), shorter fluoroscopy time (15.6 ± 12.6 vs. 20.4 ± 15.0 min, P = 0.043), and lower contrast medium volume (25.10 ± 21.82 vs. 44.1 ± 31.0 ml, P < 0.001). There were no significant differences between groups with respect to the time for cannulating the left or right adrenal vein or the peak skin radiation dose. Adrenal vein rupture occurred in 14 patients and intraglandular hematoma in 1 patient. The CCF technique during AVS not only contributed to improved technical success rates but also associated with decreased procedure time, radiation exposure, and contrast medium volume.