Carbon Dioxide Gas as an Angiographic Contrast Agent in the Cerebral Circulation
Carbon dioxide gas (CO2) has been in limited use in radiology as an intra-arterial, digital subtraction angiographic contrast medium for more than 20 years. It has a number of advantages over conventional iodinated contrast media, including its low cost, low viscosity, rapid pulmonary elimination, buoyancy, and lack of nephrotoxic and allergenic effects. Its disadvantages include the need to avoid air contamination and to use a dedicated injector system (Kerns et al.,1995). It has the potential to be used in all areas where iodine-containing contrast media are used, with the exception of the cerebral vasculature (Hawkins and Caridi, 1998). This exception is due to continuing concerns about the neurotoxicity of CO2 within the cerebral vessels. These concerns are due to a number of conflicting animal studies on the neurotoxicity of CO2 in the cerebral vasculature. Some studies have reported severe neurotoxicity (Coffey et al.,1984; Linstedt et al.,1997), while others have reported no neurotoxicity at all (Shifrin et al.,1990; Dimakakos et al,1998; Hawkins and Caridi, 1998). Interpretation of these inconsistent results is complicated by the fact that most have not used a systematic experimental approach, with different volumes, pressures, injection numbers and injection sites used within the same experiment. There have also been suspicions that air contamination, large volumes and explosive delivery of the CO2 may have contributed to the adverse findings (Hawkins and Caridi, 1998).
KeywordsDigital Subtraction Angiography Evans Blue Cerebral Vasculature Histological Damage Evans Blue Staining
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