Procedure of Coil Embolization, Utilizing a Gadolinium Contrast Agent, in a Patient with Severe Iodine Allergy: A Single Case Study Report
In a groundbreaking development in interventional radiology, a first-of-its-kind coil embolization of pulmonary arteriovenous malformations (PAVMs) using a gadolinium contrast agent has been successfully performed on an iodine-allergic patient. This innovative procedure addresses an unmet clinical need, expanding treatment options for PAVM patients with iodine allergies.
The case, reported in recent medical literature, involves a female patient in her 40s with Hereditary Hemorrhagic Telangiectasia (HHT). The patient's family history of repeated nasal bleeding in first-degree relatives, coupled with a chest X-ray showing 3 nodular shadows in the bilateral lower lung areas, led to the suspicion of HHT. A noncontrast enhanced computed tomography (CT) scan of the patient's chest revealed 3 PAVMs.
The patient was referred to the thoracic surgery department of another hospital due to difficulty breathing and nasal bleeding. Given the patient's iodine allergy, which was confirmed during an Iodine contrast agent (ICA) enhanced CT, a gadolinium contrast agent (GCA) was used for the TAE procedures instead of the conventional iodine-based contrast agents.
The TAE procedures were performed under local anesthesia after premedication with antihistamines and steroids. A microcatheter was carefully advanced to the target using a 0.014-in. microguidewire in each procedure. Gadoteridol (ProHance, Bracco, Milan, Italy) was used as the GCA in each procedure.
Manual digital subtraction angiography (DSA) was used to detect the PAVMs, and the GCA was visible on angiography. Coil embolization of the PAVM sacs and feeding arteries was then performed. Complete occlusion of the sac and feeding artery was confirmed using manual injection DSA after embolization.
The patient developed a wheal and itchy skin during the ICA enhanced CT, leading to the diagnosis of an iodine allergy. The 3 PAVMs had sacs with diameters of up to 20 mm and pulmonary feeding arteries with diameters of up to 5 mm. The patient experienced no allergic reactions during the procedure using the GCA.
This innovative approach offers a safer alternative for imaging during the embolization process in iodine-allergic patients. Coil embolization remains the preferred and more clinically successful technique for treating arteriovenous malformations compared to other embolic agents such as Gelfoam, which is associated with higher complication rates.
The reported case is the first successful use of a gadolinium contrast agent for coil embolization of 3 pulmonary arteriovenous malformations in a patient with severe iodine allergy. While explicit and comprehensive procedural details and case specifics would be found in the full published case report, this news article aims to highlight the significance of this development in the field of interventional radiology.
- This breakthrough in interventional radiology utilizes science to address medical-conditions like chronic-diseases and chronic-kidney-disease.
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- Thus, the interventional radiology breakthrough exemplifies the endless potential for science to reshape our world, elevating the quality of life for generations to come.
