Use of gadolinium as an intraarterial contrast agent in digital subtraction angiography of the cervical carotid arteries and intracranial circulation- Technical note

Patients with renal insufficiency or other contraindications to iodine-base d contrast agents present a significant management dilemma when conventiona l arteriography is required. The authors describe the use of gadolinium as an alternative contrast agent for arterial digital subtraction (DS) angiogr aphy of the cervical carotid arteries (CAs) and intracranial circulation. Three patients with renal insufficiency presented with symptoms of ischemic cerebrovascular disease and inconclusive noninvasive imaging studies, whic h necessitated conventional angiography. Traditional transfemoral catheteri zation of the cervical CAs was performed and DS angiographic studies were o btained using gadolinium as an intraarterial contrast agent. In one case, s elective arteriographic examination of the internal carotid arteries and ve rtebrobasilar system was performed as well. High-quality, diagnostic images essentially indistinguishable from routine angiographic studies were obtai ned in all cases. No patient suffered a complication related to the use of gadolinium, and no patient demonstrated worsened renal function after the p rocedure. In the setting of a contraindication to iodine-based contrast agents, gadol inium represents an important alternative contrast material that allows for excellent visualization of the cervical CAs and intracranial circulation.