Low contrast-medium CTA protocol for TAVR in patients with chronic kidney disease

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Congress:

ECR 2014

Poster Number:

C-1231

Type:

Scientific Exhibit

Keywords:

Cardiac, Cardiovascular system, Vascular, CT-Angiography, CT-Quantitative, Catheter arteriography, Contrast agent-intravenous, Imaging sequences, Drugs / Reactions, Toxicity, Arteriosclerosis

Authors:

A. Kino, A. S. Chin, S. Walters, W. C. Winkelmayer, W. Fearon, A. Yeung, M. Fischbein, D. C. Miller, D. Fleischmann; Stanford, CA/US

DOI:

10.1594/ecr2014/C-1231

DOI-Link:

https://dx.doi.org/10.1594/ecr2014/C-1231

Fig. 3: Pre TAVR CTA aortic annular dimensions were sucessfully measured in eGFR-based...

Fig. 4: None of the patients that underwent to an eGFR-based low CM dose CTA protocol...

Fig. 1: CT provides detailed anatomic assessment of the aortic root and valve annulus,...

Aims and objectives

Transcatheter aortic valve replacement (TAVR) has become the treatment of choice for inoperable patients with severe aortic stenosis (1) and is comparable to surgical aortic valve replacement (SAVR) for patients at high risk (2). Contrast-medium enhanced ECG-gated CT is a standard examination for screening/ treatment planning pre TAVR procedure (3). CT provides detailed anatomicassessment of the aortic root and valve annulus, allowing annulus diameter measurement for valve sizing; besidesassessment of aortic-iliac vessel and prediction of valve deployment angle Figure 1. The great majority of patients...

Methods and materials

Under an Institutional Review Board approved protocol, we performed a retrospective analysis of 145 patients undergoing TAVR. Eleven patients (6m/5f, mean age 85 ± 5 years) with CKD (Screatinine:1.2 ~ 4.4mg/dl ; eGFR 13.7 - 60.3 ml/min) underwent CTA with dedicated CM injection protocol based on renal function and body weight [CM volume was calculated as 2x eGFR (in mL/min/173m)] (Figure 2 and 3) and eleven patients matched for body weight that underwent a regular CM dose contrast CTA were chosen as control for qualitative...

Results

None of the 22 patients developed CIN. Mean contrast volumes administrated during the eGFR-based low contrast media (CM) dose CTA protocol were 66 ±16 ml for the CKD group and 134 ±30 ml for the control group. Image quality (3.75 vs 3.87, p = 0.12) and vascular opacification (284 HU vs 357 HU, p = 0.0002) were lower in patients with CKD; however annulus diameters and areas were measurable in all. There was no significant difference between the aortic annulus diameters, areas and pre TAVR...

Conclusion

Our data suggest that an eGFR-based low CM dose CTA protocol individually tailored to severity of renal impairment is safe in TAVR candidates with CKD, providingslightly lower quality but diagnostic CTA for pre-operative TAVR planning.

Personal information

References

Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010;363:1597– 607. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011; 364:2187–98. Jilaihawi H, Doctor N, Kashif M, et al. Aortic annular sizing for transcatheter aortic valve replacement using cross-sectional 3-dimensional transesophageal echocardiography. J Am Coll Cardiol. 2013 Mar 5;61(9):908-16 Aregger F, Wenaweser P, Hellige GJ, et al. Risk...