Related Experiment Videos
Influence of contrast media on thrombus formation during coronary angioplasty
C M Gasperetti1, M D Feldman, L R Burwell
1Department of Medicine, University of Virginia Health Sciences Center, Charlottesville 22908.
Insights
Nonionic contrast media increased thrombus formation during percutaneous transluminal coronary angioplasty compared to ionic contrast media. This finding was particularly noted in patients with recent myocardial infarction or eccentric plaques, leading to higher complication rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Radiology
Background:
- Contrast media are essential for visualizing coronary anatomy during percutaneous transluminal coronary angioplasty (PTCA).
- The potential influence of different contrast media types on thrombus formation during PTCA is not fully understood.
Purpose of the Study:
- To investigate the effect of ionic versus nonionic contrast media on thrombus formation during PTCA.
- To identify patient subgroups at higher risk for thrombus development with specific contrast media.
Main Methods:
- A prospective study of 124 patients undergoing PTCA, randomized to receive either ionic (n=57) or nonionic (n=67) contrast medium.
- Thrombus presence was assessed by blinded angiographic analysis pre- and post-procedure.
- Stenosis severity, lesion characteristics, and dissection were also evaluated.
Main Results:
- New thrombus formation occurred more frequently in patients receiving nonionic contrast medium (18%) compared to ionic (4%) (p<0.02).
- Patients with recent myocardial infarction, rest angina, or eccentric plaques were more prone to thrombus with nonionic media (p<0.05).
- Thrombus presence was associated with a higher incidence of acute procedural complications (36% with new thrombus, 23% with pre-existing thrombus).
Conclusions:
- Nonionic contrast media are associated with increased thrombus formation during PTCA compared to ionic contrast media.
- Specific patient and lesion characteristics may predispose individuals to thrombus development when using nonionic contrast agents.
- Thrombus formation during PTCA is linked to increased acute procedural complications.
Abstract:
The influence of contrast media on thrombus formation during percutaneous transluminal coronary angioplasty was assessed in 124 consecutive patients undergoing coronary angioplasty and receiving either ionic (n = 57) (Group I) or nonionic (n = 67) (Group II) contrast medium. The presence of thrombus was assessed by qualitative analysis of angiograms in identical pre- and postangioplasty projections by four observers who had no knowledge of other data. Quantitation of stenosis severity before and after angioplasty and qualitative analysis of lesion eccentricity and complexity and of the presence of dissection were also performed. Although the baseline clinical characteristics of the two groups (including presenting syndromes and procedural and angiographic variables) did not differ, more patients in Group II than Group I developed new thrombus during coronary angioplasty (18% vs. 4%, p less than 0.02). In particular, patients with a presenting syndrome of recent myocardial infarction or rest angina, or both, and patients with an eccentric coronary plaque were more likely to develop new thrombus if they received nonionic than if they received ionic contrast medium (p less than 0.05). Patients with new thrombus formation and patients with thrombus present both before and after angioplasty had a high incidence of acute procedural complications (36% and 23%, respectively). Patients in Groups I and II had a similar incidence of ischemic events during follow-up.