Intravascular contrast agents. Current problems and future solutions-- a review.
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M A Bettman
Publications and source records attributed to M A Bettman.
Double-blind study of a new nonionic contrast agent for cardiac angiography.
A randomized, double-blind study of a new nonionic contrast agent (ioversol) was performed in 80 patients undergoing routine coronary angiography and left ventriculography. Its hemodynamic and electrocardiographic (ECG) effects were compared with those of a conventional ionic contrast agent (sodium meglumine diatrizoate). There were 40 patients in each group. The radiographic quality and incidence of adverse reactions were comparable for both agents. Following left ventriculography, there was a smaller decrease in systemic and left ventricular systolic blood pressure and a smaller increase in heart rate and pulmonary artery systolic pressure (P less than .05) with ioversol than with meglumine diatrizoate. There was also a slight decrease in cardiac output with ioversol at 1 and 3 minutes after left ventriculography, while meglumine diatrizoate produced a modest increase. In selective coronary angiography, the fall in diastolic blood pressure was also greater (P less than .05). The Q-T interval was more prolonged with meglumine diatrizoate. Ioversol appears to be both safe and efficacious for cardiac angiography, causing fewer and less severe hemodynamic and ECG alterations than meglumine diatrizoate.
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Left heart catheterization and angiography via the percutaneous femoral approach using an arterial sheath.
An arterial sheath with a proximal hemostasis valve and a side-arm extension tube was used in 562 consecutive patients undergoing cardiac catheterization and angiography via the femoral approach. Serious complications were rare. There was one death, one peripheral embolism, and one episode of delayed groin hemorrhage. The incidence of minor complications, including hematoma formation, in this series compares favorably with our own and the reported experience of others using the conventional percutaneous femoral approach. The sheath technique facilitated catheter exchanges and reduced patient discomfort. In addition, femoral artery pressure could be monitored via the side arm of the sheath during the catheterization. This proved helpful during retrograde catheterization of patients with aortic stenosis, as well as in detection of damping of coronary artery catheter tip pressure during coronary arteriography and hypotension following left ventriculography. Based upon this experience, use of an arterial sheath has become our standard practice when left heart catheterization is performed via the femoral approach, and the use of several different catheters is anticipated.
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