Contrast-induced nephropathy (CIN) is a serious complication following percutaneous coronary interventions (PCI) . The amount of injected contrast media is a well established risk factor for CIN .
We assessed the safety and feasibility of contrast removal from the coronary sinus (CS) during coronary angiography (CAG), using a newly developed method and device for endovascular detection and removal of contrast media.
We used a contrast detection/aspiration catheter (CINtinel Catheter; Catharos Medical Systems, Campbell, CA, USA). The catheter has an expanding tip and integrated fiberoptics utilizing a light reflection-technology for endovascular contrast detection. The catheter system monitors CS blood for contrast presence and provides signals for CS evacuation. Aspiration is facilitated by a peristaltic pump that evacuates contrast-laden CS blood through the catheter’s central lumen (4 ml/s). In absence of contrast, the nonocclusive catheter tip allows blood flow to pass through from the CS into the right atrium naturally. Compared to previous methods, the device is less complex, minimizes volume of removed blood, and has independent functionality .
A 50-year-old woman with history of coronary artery disease presented with chest discomfort, and was referred for angiographic evaluation. During CAG, the patient underwent planned contrast removal from the CS, under an approved clinical protocol at Hospital Almater, Mexicali, Mexico.
A central-venous access was established via the right internal-jugular vein via an introducer sheath (AVANTI 10F, Cordis, FL, USA). Subsequently, the coronary sinus was cannulated using a standard coronary guiding catheter (INFINITI, MPB-2, 6F, Cordis, FL, USA), and a 0.035-in. Glidewire (Terumo, Japan). The Glidewire was advanced into the CS, and the tip was positioned in the proximal segment of the anterior interventricular vein. Finally, the contrast detection/aspiration catheter was inserted over the Glidewire, with the tip deployed in the terminal (proximal) segment of the CS. Access, wiring of the CS, and catheter tip deployment were accomplished under fluoroscopic guidance in 11 min, without use of contrast media.
The aspirant fluid was discharged into the collection reservoir of a standard autotransfusion system (COBE, Arvada, CO, USA) for blood salvage and return.
Per clinical protocol, contrast capture was limited to left CAG. The total contrast volume injected during left CAG ( capturable contrast ) was 43 ml. During left CAG, the catheter detected and removed contrast at CS level ( Figs. 1 and 2 ). The optical contrast (detection) signal (average duration, 9 s) was easily distinguishable from baseline (contrast-associated signal change reached 90% of baseline value) ( Fig. 3 ).
