Interventional Rounds The Use of Gadolinium in Patients with Contrast Allergy or Renal Failure Requiring Coronary Angiography, Coronary Intervention, or Vascular Procedure Layth Saleh, 1,2 MD, Elizabeth Juneman, 1,2 MD, and Mohammad Reza Movahed, 1,2 * MD, PhD, FACP , FACC, FSCAI Coronary artery angiography remains an important procedure for the assessment of coronary arteries. It requires injection of iodinated contrast for the opacification of cor- onary arteries. Severe allergy to iodine contrast and renal insufficiency are two main problems with iodine-based contrast media. Gadolinium (Gd) has different chemical structure with no cross reactivity with iodine-based contrast media in patients with io- dine allergy. The use of Gd is commonly used in contrast-enhanced magnetic reso- nance imaging for image enhancement, making it a potential alternative in patients in whom iodine is contraindicated. The aim of this manuscript is to review the available lit- erature on the use of Gd in patients with contraindication to iodine contrast due to allergy or in patients with severe renal failure requiring coronary or vascular procedures. V C 2011 Wiley Periodicals, Inc. Key words: gadolinium use; angiography; iodine contrast allergy; percutaneous coronary intervention; PCI complication; stenting; contrast allergy INTRODUCTION Coronary artery angiography remains an indispensi- ble tool in patients with cardiac disease. It requires injection of iodinated contrast for the opacification of coronary arteries. Severe allergy to iodine contrast and renal insufficiency remain two main problems with io- dine-based contrast media. As an alternative, gadolin- ium (Gd) has been studied as a potential agent in patients with severe allergy to iodine or renal failure requiring angiography. The use of Gd is very common in contrast-enhanced magnetic resonance imaging (MRI) for image enhancement. Gd demonstrates prop- erties that allow it to attenuate photon energy of X-ray beam, making it a potential alternative in patients in whom iodine is contraindicated. In this manuscript, we review available literatures on the use of Gd in patients with severe iodine allergy and in patients with severe renal failure requiring angiography. Hypersensitivity Reactions Iodine-based contrast media have the potential to cause a variety of reactions in humans. The pathophys- iology of most of these reactions remains unclear. They can be divided into two broad categories: chemo- toxic reactions and hypersensitivity reactions. Chemo- toxic reactions are a result of the chemical structure of the iodine contrast media. Effects like vasovagal reac- tion, seizures, arrhythmias, and renal toxicity could occur and are dependent on the infusion rate as well as total dose used [1–3]. Hypersensitivity reactions, on 1 Division of Cardiology, The Southern Arizona VA Health Care System, Tucson 2 Arizona and Division of Cardiology, University of Arizona Col- lege of Medicine, Tucson, Arizona Conflict of interest: Nothing to report. *Correspondence to: Mohammad Reza Movahed, MD, PhD, FACP, FACC, FSCAI, Professor of Medicine, The Southern Arizona VA Health Care System, and the University of Arizona Sarver Heart Center, 1501 North Campbell Avenue, Tucson, AZ 85724. E-mail: rmovahed@email.arizona.edu Received 15 October 2010; Revision accepted 18 November 2010 DOI 10.1002/ccd.22907 Published online 21 July 2010 in Wiley Online Library (wileyonlinelibrary.com) V C 2011 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions 78:747–754 (2011)