Gadolinium-based coronary angiography in a patient with prior known anaphylaxis to iodine-based dye

Figures & data

Figure 1. Coronary angiography was performed using 24 cc of undiluted Gadodiamide with a power injector. The patient’s coronary artery disease was essentially unchanged from her prior angiogram

Table 1. Literature review about the use of gadolinium in patients with contrast allergy or renal failure

	Author/Study	No of patients	Amount of contrast	Indication	Contrast used	Adverse reaction renal	Adverse reaction cardiac
1.	Elizabeth Juneman,	1	24 ml	progressive angina and dyspnea on exertion + Severe allergic reaction	undiluted gadolinium	None	Ventricular arrhyhtmia
2	Ka¨lsch	19	32.6 ± 10.9 ml power injection used	14 stable angina, 5 unstable angina + allergy/anaphylaxis/thyrotoxicosis with iodinated contrast media	Undiluted gadolinium	No deterioration in renal function (normal baseline)	Cardiac arrhythmias
3	Ose	3	40 ml	Recurrent chest pain, preoperative evaluation, graft patency evaluation þ allergy/anaphylaxis with iodinated contrast media	Undiluted gadolinum	None	None
4	Reiger	29	0.23–0.44 mmol/kg body weight power injection used	Peripheral vascular disease, fistula and shunt disease, renal artery disease, aortic aneurysm + chronic renal insufficiency	Gd with (12) or without (10) carbon dioxide	No deterioration in renal function in all but one patient (abnormal baseline)	None
5	Sayin	26	57.1 ± 27.2 ml	Coronary angiography + chronic renal insufficiency	1 Gd: 1 nonionic low osmolar	No deterioration in renal function (abnormal baseline)	None
6	Sarkis	15	0.3 ± 0.1 mmol/kg gadolinium + 0.32 ± 0.2 ml/kg omnipaque	Coronary angiography + chronic renal insufficiency	2 Gd: 1 Nonionic low-osmolar iodinated (iohexol)	No deterioration in renal function (abnormal baseline)	None
7.	Erley	10	0.34–0.9 mmol/kg body weight	Peripheral artery disease, renal artery disease, aortic aneurysm + chronic renal insufficiency	Gadobuterol (10 patients) iohexol (11 patients)	Similar reduction in GFR to iodinated contrast media	None
8.	Brigouri	25	0.6 ± 0.3 mmol/kg body weight	Coronary angiography + chronic renal insufficiency	3 Gd: 1 nonionic low osmolar (iodixanol)	No reduction in CAN from to control (abnormal baseline)	None
9	Matuszczyk, A	1	30 ml	Myocardial infraction + iodine-induced hyperthyroidism	Gadolinium	None	None

Summary of Reported Cases and Case Series in Regards to Gadolinium Use in Patients with Contrast Allergy or Renal Failure.