CTO: How to Minimize Contrast Nephropathy

Acute contrast-induced kidney injury, or contrast induced nephropathy (CIN), is a major cause of morbidity and mortality in patients undergoing coronary angiography. Percutaneous coronary intervention (PCI) is now the preferred method for revascularization in many patients with coronary artery disease. The highly calcific nature of chronic total coronary occlusion (CTO) accounts for the increased difficulty in successful percutaneous recanalization. It has been hypothesized that CIN is caused by multiple pathologic processes, including vasoconstriction, direct nephrotoxicity, the formation of reactive oxygen specifies, and impaired nitric oxide production. Multivariate analysis has shown that the presence of baseline renal dysfunction, diabetes mellitus, congestive heart failure, and higher doses of contrast media increase that risk. Currently there is no available treatment to reverse CIN, and therapy is aimed at prophylaxis. As with various prophylactic measures, individual contrast agents have also been evaluated to determine their individual role in causing nephropathy.