JACC: Contrast removal system shows promise

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A contrast removal system safely removed radiographic contrast media in patients undergoing coronary angiography and intervention, which reduced systemic exposure and nephrotoxicity, according to research correspondence Aug. 3 in Journal of American College of Cardiology.

Certain patients undergoing coronary angiography or coronary intervention are at high-risk for contrast-induced nephropathy (CIN). These include those with pre-existing chronic renal impairment, diabetes and advancing age.

When CIN develops in this population, it is associated with higher mortality, longer hospitalizations and a higher likelihood of complications, according to Steven J. Duffy, MD, and colleagues of the Heart Failure Research Group at Baker IDI Heart and Diabetes Institute in Melbourne, Australia.

In the correspondence, Duffy and colleagues reported their initial experience with a system developed for the aspiration of contrast media from the coronary sinus (Osprey Medical, St. Paul, Minn.).

The coronary sinus was successfully cannulated with the aspiration catheter in 31 of 41 patients and the mean time to cannulate was 11 minutes. There also were no device-related serious adverse events.

They compared renal outcomes of 26 coronary angiography and intervention patients undergoing the procedure with the system to remove contrast media to a matched comparator cohort of 148 standard care patients.

The contrast removal cohort had a baseline estimated glomerular filtration rate (eGFR) of <60 ml/min and experienced no changes in baseline eGFR to 72 hours post-procedure eGFR. The matched comparator group experienced a significant decrease in eGFR from 42.7 ml/min at baseline to 40.1 ml/min at 48 hours post-procedure.

In 65 standard care patients with a baseline eGFR <40 ml/min, the eGFR fell from 33.1 ml/min to 31.7, whereas in 11 patients with concomitant coronary sinus aspiration and an eGFR <40 ml/min, there was no significant change in the eGFR.

The researchers measured radiographic contrast capture in the 26 patients undergoing contrast removal and found that the system recaptured an average of 32 percent of delivered contrast.

“The present study provides supportive evidence of the safety and feasibility of a coronary sinus based aspiration system for the removal of radiographic contrast in patients undergoing angiography and intervention,” concluded Duffy. The study provides a preliminary indication that the system reduces contrast exposure and reduces nephrotoxicity, added the researchers. However, further research including a large-scale randomized trial is needed.

One member of the study group is the founder and stockholder of Osprey Medical, while another is an employee and stockholder. Lead author Duffy reported no conflicts of interest.