Selection of contrast media

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A generation of angiographers have witnessed the development of new and improved contrast agents. For a quarter of a century, contrast media available for radiological studies have been salts of iodinated organic acids. The structural formula consists of a benzene ring, iodine atoms, side chains (anions), and sodium, calcium, magnesium, or meglumine salts (cations).

With advances in the basic understanding of the available contrast agents in the 1950s and the demonstration of safe and satisfactory intravascular studies in animals and humans, deliberate efforts to visualize the coronary artery circulation by nonselective and selective techniques were attempted by several investigators.1–6 After fear of serious ventricular arrhythmias secondary to transient myocardial ischemia and other serious adverse reactions had been challenged successfully, and selective coronary arteriography became the technique of choice, a search for contrast media followed that would improve opacification and at the same time provide patient safety.

The original experience in the performance of cine coronary arteriography in 1020 patients at the Cleveland Clinic with Hypaque 90 and Cardiografin 85 was reported in 1962.7 Only major complications were recorded. Ventricular fibrillation occurred in 12 patients (1.2%), and two deaths (0.19%) were probably related to the injection of contrast media. For comparison, angiographic studies with and without selective coronary arteriograms performed with these and other agents between July 1, 1960 and June 30, 1962 were reviewed. Results of some of the studies are included in the original report. The characteristics of the agents and the incidence of major adverse reactions attributed . . .



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