Automated Contrast Injection and Targeted Renal Therapy: Strategies to Prevent Contrast-Induced Nephropathy (FULL TITLE BELOW)

Volume 3 - Issue 3 - May/June 2006
Posted on: 9/5/08
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Author(s):

David E. Allie, MD, Chris J. Herbert, RT, RCIS, and Craig M. Walker, MD

Recently, our group reported our 64-channel infrainguinal validation study with a revised protocol.^38,39 The revised protocol was used for 60 consecutive patients with severe infrainguinal disease. Protocol revisions included the automated trigger being lowered from the mid-chest to 1 cm above the aortic bifurcation in the distal aorta. The automated trigger Hounsfield units were increased from 180H to 250H with a 5-second scan delay. The contrast volume was reduced from 125 cc to 70 cc (Isovue, BRACCO Diagnostics, Princeton, New Jersey) with a 40 cc NS bolus chase. All other parameters remained unchanged. In concept, we were resetting the system to “delay or slow down” to better acquire infrapopliteal images. The resolution quality and post-processing imaging time were improved and validated when compared to 60 matched patients. This protocol has allowed us to minimize and optimize contrast exposure in our PAD patients, especially those with infrainguinal disease (Figures 4A and 4B).

Conclusion
The mortality and morbidity of CIN is significant and likely underappreciated. The potential for increased CIN morbidity during PPI is unknown; therefore, the need for strategies to optimize contrast exposure in the treatment of PAD is likely greater than during PCI. The rapid adoption of MDCTA and the proliferation of endovascular and surgical treatments of PAD underscore the need for optimizing novel strategies designed to preserve renal function. Several such novel strategies, utilizing the ACIST Injection System, TRT, and revised MDCTA protocols, hold promise in optimizing contrast utilization and preventing CIN when treating PAD.

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