CO2 digital subtraction angiography for renal artery angioplasty in high-risk patients

OBJECTIVE. The efficacy of CO2 digital subtraction angiography for performi ng renal artery angioplasty in high-risk patients was evaluated. SUBJECTS AND METHODS. From January 1997 to July 1998, 21 high-risk patients underwent 29 renal artery angioplasties using carbon dioxide as the princi pal contrast agent. Six patients had a known allergy to iodinated contrast material and 15 had elevated levels of creatinine. Iodinated contrast mater ial was used only if necessary. All periprocedural allergic reactions were recorded. Before and 24 hr after the procedure, serum creatinine levels wer e obtained. If the creatinine level had become significantly elevated (>0.5 mg/dl), the creatinine level was acquired a second time. RESULTS. Twenty-one patients (13 men and eight women) underwent 29 angiopla sties (two were bilateral and six were repeated). Four kidney transplantati on patients had ostial stenosis and the remaining 17 patients had nonostial stenosis. For all patients except one angioplasty initially was a technica l success, as defined by a residual stenosis of less than 30%. Supplemental iodinated contrast material was used in only six patients (average dose, 8 .5 ml). A range of 80-200 ml of carbon dioxide per procedure was used (aver age dose, (114.6 ml). One renal artery dissection occurred, which was unrel ated to the carbon dioxide. There were no allergic reactions. The level of serum creatinine remained the same after 11 procedures, decreased after 12 procedures, and increased minimally after four procedures (<0.5 mg/dl). CONCLUSION. On the basis of our preliminary findings in a small group of pa tients, using carbon dioxide as an intravascular contrast agent to perform renal artery angioplasty in patients who have an allergy to iodinated contr ast material or who suffer from renal insufficiency is safe and efficacious .