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#1
18.04.2008, 10:13
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Контрастные вещества для коронарографии
1. ДА, все контрастные в-ва, применяемые для коронарографии, содержат йод.
2. Нет, таких препаратов нет. 3. Есть способы подготовки больного с историей непереносимости КВ. 
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#2
18.04.2008, 12:02
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Контрастные вещества для коронарографии
Уважаемые коллеги-кардиологи! Мне кажется, вы немножко ошибаетесь, немало статей по гадолиниуму, например:Angiology, Vol. 58, No. 5, 561-564 (2007) Gadolinium:Nonionic Contrast Media (1:1) Coronary Angiography in Patients With Impaired Renal Function
Journal of Interventional Cardiology Volume 21 Issue 2 Page 167-174, April 2008 Gadolinium-Based Coronary Angiography in Patients with Contraindication for Iodinated X-Ray Contrast Medium Gadolinium-enhanced coronary angiography in patients with impaired renal function . The American Journal of Cardiology , Volume 91 , Issue 8 , Pages 974 - 975 etc....
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#3
18.04.2008, 13:11
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Большое спасибо за ссылку. У нас подобного опыта нет. Но есть обширный положительный опыт подготовки больных с непереносимостью контрастного вещества.
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#5
19.04.2008, 18:54
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Цитата:
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#8
19.04.2008, 19:28
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Тады еще понадоедаю.
Как то говорили, что спиральная КТ может в части диагностики заменить коронарографию? Реально это так? Или там все-равно будут делать контрастное усиление?
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#10
19.04.2008, 22:29
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Цитата:
Трижды, в качестве эксклюзивных случаев, при коронарографии, а в одном случае при PCI, мною использовалось магнитно-резонансное контрастное средство Гадобутрол (гадовист) с концентрацией 1 ммоль/мл. Йод не содержит. Рентгеноконтрастность препарата низкая, ниже омнипака-240, но для коронарографии достаточно информативная. METHOD OF X-RAY ATTENUATION AND THE USE OF GADOLINIUM Gadolinium chelates, widely used in magnetic resonance imaging, are generally thought to be safe and not associated with nephrotoxicity in patients with or without pre-existing renal impairment, despite their very high osmolality (B2000 mOsm/kg). These agents have been suggested as an alternative to iodinated CM for DSA or interventional procedures, particularly in those patients with renal insufficiency or prior reaction to iodinated contrast agents, although this represents an ‘off-label’ use. [Ссылки доступны только зарегистрированным пользователям ] Rieger J, Sitter T, Toepfer M et al. Gadolinium as an alternative contrast agent for diagnostic and interventional angiographic procedures in patients with impaired renal function. Nephrol Dial Transplant 2002; 17: 824–828. Hatrick A, Jarosz JM, Irvine AT. Gadopentate dimeglumine as an alternative contrast agent for use in interventional procedures. Clin Radiol 1997; 12: 948–952. Hammer F, Goffette PP, Malaise J, Mathurin P. Gadolinium dimeglumine: an alternative contrast agent for digital subtraction angiography. Eur Radiol 1999; 9: 128–136. Townsend R, Cohen DL, Katholi R et al. Safety of intravenous gadolinium (Gd-BOPTA) infusion in patients with renal insufficiency. Am J Kidney Dis 2000; 36: 1207–1212. Tombach B, Bremer C, Reimer P et al. Renal tolerance of a neutral gadolinium chelate (gadobutrol) in patients with chronic renal failure: results of a randomized study. Radiology 2001; 218: 651–657. Kim M, Kim H. Gadolinium dimeglumine as a contrast agent for digital subtraction angiography: in vitro Hounsfield unit measurement and clinical efficacy. Yonsei Med J 2003; 44: 138–142. Kaufman J, Geller SC, Bazari H, Waltman AC. Gadolinium-based contrast agents as an alternative at vena cavography in patients with renal insufficiency: early experience. Radiology 1999; 212: 280–284. Для Anelly добавлю, что все случаи использования этого контрастного препарата вне рекомендаций по его применению,т.е. "off label", и только в крайне эксклюзивных случаях. С уважением, Терёхин С.А.
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#12
21.04.2008, 08:51
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Нелишне напомнить, что имеются рекомендации не использовать гадолиниум у диализных па
Нелишне напомнить, что имеются рекомендации не использовать гадолиниум у диализных пациентов из-за риска нефрогенного системного фиброза:
Gadolinium — Gadolinium (Gd) is a non-tissue-specific, nonionic, hyperosmolal (650 mosmol/kg) contrast agent that is primarily administered during magnetic resonance (MR) imaging or MR angiography studies. Gadolinium chelates are excreted unchanged almost exclusively by the kidney. Its half-life is 1.3 hours in healthy volunteers, 10 hours at an estimated glomerular filtration rate (GFR) of 20 to 40 mL/min, and 34 hours in patients with end-stage renal disease. For patients with end-stage renal disease, the half-life is reduced dramatically to between 1.9 to 2.6 hours if hemodialysis follows the administration of gadolinium . The five most commonly used FDA approved gadolinium-chelates differ by biochemical structure and charge. The macrocylic chelates are more stable than the linear chelates, although NSF has been noted with both types . A sixth, gadofosveset trisodium (Vasovist), has been approved and differs from the other forms in that it is reversibly bound to albumin, which prolongs its transit through the vasculature. This enables a smaller dose (0.03 mmol/kg) to be used than with the other chelates (0.1 mmol/kg or higher), although it is unclear whether this will reduce its potential for NSF . Free Gd3+ is poorly soluble, highly toxic, and can form precipitates with anions that tends to be elevated in renal failure. This has led to the hypothesis that excess exposure to free Gd3+ in patients with kidney disease leads to tissue damage. Support for the pathogenic role of gadolinium comes from the demonstration of gadolinium deposition in tissue specimens of some patients with NSF . In one report, for example, gadolinium was noted in 4 of 13 specimens in seven patients . It was suggested that gadolinium had a tissue residence time of 4 to 11 months. In addition, observational clinical studies from the United States and Europe show a link between NSF and exposure to gadodiamide (Omniscan), a form of gadolinium that is the only approved MR contrast agent in Europe. In a case series from Austria, NSF developed in five of nine hemodialysis patients who received gadodiamide (Omniscan) for MR angiography, which may require up to three times the contrast dose used in routine MR imaging [ . Symptoms appeared two to four weeks after exposure. There was no correlation with age, sex, underlying renal disease, drug therapy, dialysis modality or comorbid conditions. In a case series from Denmark, 13 patients with end-stage renal disease (seven on hemodialysis, one on peritoneal dialysis, and five not requiring dialysis) developed symptoms of NSF a mean of 25 days (range 2 to 75 days) after exposure to gadodiamide (Omniscan) . There was no correlation between gadodiamide dose and NSF severity. No other exposure or event could be identified that was common to more than a minority of the patients. Of note, 6 of the 13 patients had been previously exposed to gadolinium without developing NSF. In a detailed review of 75 cases of NSF performed by the United States Food and Drug Administration (FDA), all had received a gadolinium-based contrast agent for an MR study two days to 18 months before disease onset . Similar findings were noted by the International NSF registry: more than 95 percent of cases reported to the registry had been exposed to gadolinium within two to three months of disease onset . NSF has been reported after the administration of all five gadolinium-based contrast agents currently approved in the United States (Magnevist, MultiHance, Omniscan, OptiMARK, and ProHANCE) . The FDA believes that the potential for NSF may be present for all approved agents. As a result, the FDA has added a boxed warning and new warnings to the product labeling about the risk of NSF with all gadolinium-based agents . Risk — A separate issue is the magnitude of the risk after exposure to gadolinium in patients with advanced kidney failure. The reported risk has ranged between 2.5 and 5 percent in studies of 400 and 450 dialysis patients from Denmark and the United States . There is some evidence that a dose-response relationship exists. This was illustrated in a report of 301 MR imaging studies with gadodiamide in dialysis patients: 207 were done with a double dose (0.2 mmol/kg) and 94 with a single dose (0.1 mmol/kg) . All 12 NSF patients (eight chronic dialysis patients and four with acute hepatorenal syndrome) had received a double dose. The odds ratio for the development of NSF after a double versus single dose of gadodiamide was calculated at 22.3 (95% CI 1.3-378). (статья из АпТУДейт, если кому нужна- пришлю со ссылками)
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#13
24.07.2008, 09:21
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Цитата:
-- С Уважением, Мальцев А.А.
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#15
24.07.2008, 10:11
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Цитата:
Трансплантация спасет? -- С Уважением, Мальцев А.А.
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Линейный вид
