Percutaneous Carotid Angioplasty and Stenting with the Use of Gadolinium in Lieu of Iodinated Contrast Medium: Technical Case Report and Review of the Literature

Abstract

ABSTRACT OBJECTIVE AND IMPORTANCE We describe a patient who underwent percutaneous transluminal carotid angioplasty and stent placement with the use of intra-arterial gadolinium (Gd-DTPA) instead of iodinated contrast medium. This represents one of the first published reports of the use of Gd-DTPA as an angiographic contrast agent for an interventional neuroradiological procedure. CLINICAL PRESENTATION A 75-year-old man with renal insufficiency and multiple comorbidities developed amaurosis fugax. Doppler examination revealed high-grade stenosis of the right internal carotid artery. INTERVENTION The patient underwent percutaneous transluminal balloon angioplasty with endovascular stent placement for 95% narrowing of the proximal right internal carotid artery. Because of his impaired renal function, the procedure was performed with the use of Gd-DTPA as the sole contrast agent. Approximately 60 ml of contrast medium (twice the volume typically used for a magnetic resonance imaging study) was used. There were no neurological, renal, or other complications. CONCLUSION Intra-arterially administered Gd-DTPA may be substituted for iodinated contrast agents in complex neuroendovascular procedures. This capacity expands the armamentarium for interventional neuroradiological procedures.