Angiographic contrast agents: conventional and new media compared

The contrast agents in current use are generally safe, but have certain undesirable side effects. These can be divided into four major areas: systemic reactions, cardiac effects, renal effects, and general vascular effects. For the most part, particularly in regard to cardiac and vascular manifestations, adverse effects are due to a combination of hypertonicity of the ionic contrast agent to blood, calcium binding, and direct chemical toxicity of the specific anion used. There have been many attempts to develop new agents, with a primary aim of lessening the adverse effects. Several of these compounds have undergone extensive experimental evaluation and are currently being used in clinical trials. All of these new agents have lower tonicity than conventional media at the same iodine content. They also appear to bind calcium less. Compared to conventional agents, these new compounds have less effect on the vessel wall and probably on blood coagulation, less effect on renal function, which is particularly important in patients with compromised renal function, and less effect on hemodynamic and electrocardiographic parameters. They also seem to cause much less discomfort during peripheral arteriography than current contrast media. These new agents may be commercially available by 1984 and probably will be significantly more expensive than conventional agents. It is not yet clear, because of higher cost, whether these agents will be used for all patients, or only for patients at particular risk of side effects from conventional contrast media.
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