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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
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 anatomic assessment of the aortic root and valve annulus,
allowing annulus diameter measurement for valve sizing; besides assessment of aortic-iliac vessel and prediction of valve deployment angle Figure 1.
The great majority of patients with severe aortic stenosis are elderly,
with multiple comorbidities including chronic kidney disease (CKD).
While intravenous contrast medium (CM) is a prerequisite during the CT for TAVR planning,
it can cause CM induced acute kidney injury (AKI),
notably in patients with CKD.
The volume of CM is considered a major factor of AKI.
Acute kidney injury is associated with early and late mortality in TAVR patients (4-10).
The purpose of the study was to evaluate an individually tailored eGFR and bodyweight based low CM dose CTA protocol in patients with CKD undergoing TAVR.