Carbon dioxide guided endovascular renal artery intervention: Initial results

We evaluated the technical and clinical efficacy of carbon dioxide (CO₂) as a contrast media for endovascular intervention in patients with symptomatic renal artery stenosis. Data analysis for the treatment of 11 main renal artery stenosis in 10 patients utilizing 18 CO₂ guided interventions (11 percutaneous transluminal angioplasties [PTA] and seven endovascular stent placements) were performed comparing clinical indications, previous surgical or endovascular treatment, comorbidity, complications, creatinine level, mean arterial pressure (MAP), and number of antihypertensive medications for the period of February 1996 to May 1997 at a tertiary care institution. One to four month postintervention follow-up was performed. The mean preprocedure creatinine level, MAP, and number of antihypertensive medications were 3.47 mg/dL +/- 1.27, 113 mmHg +/-20 and 2.82 +/- 1.32, respectively. Seven (64%) of 11 percutaneous transluminal renal angioplasties (PTRA) required adjuvant endovascular stenting. Nine (82%) of 11 procedures required iodinated contrast supplementation with a mean of 36 cc +/- 32 cc per exam. Postprocedure (24-72 h) creatinine level, MAP and number of antihypertensive medications were 3.50 mg/dl +/-1.64 (P < 0.10), 99 mmHg +/-14 (P = 0.004), and 2.45 +/- 0.82 (P = 0.045), respectively. At 1-4 months follow-up (mean 1.6 months) the creatinine level, MAP and number of antihypertensive medications were 3.27 mg/dL +/-2.11 (P < 0.10), 100 mmHg +/-12 (P = 0.01) and 2.36 +/- 1.03 (P = 0.045), respectively. Two procedural complications occurred without long-term sequela. CO₂ guided endovascular renal artery intervention is a technically feasible alternative for treating patients with symptomatic renal artery stenosis in whom iodinated contrast must be minimized.