Wilson AJ, Boxer MM. Neurotoxicity of Angiographic Carbon Dioxide in the Cerebral Vasculature. Invest Radiol 2002;37:542–551.
Rationale and Objectives.
This study was undertaken to resolve conflicting evidence about the neurotoxicity of carbon dioxide gas as an angiographic contrast medium within the cerebral vasculature.
Materials and Methods.
Single intracarotid injections or five consecutive intracarotid injections, at 2-minute intervals, of carbon dioxide, iopromide or saline, were given to 32 rabbits under clinically relevant conditions. Extravasation of Evans blue and 99mTc-pertechnetate was used to determine blood-brain barrier damage at 30 minutes or 6 hours after injection. At 6 hours after multiple injections, brains were removed for histologic examination.
A single intracarotid injection of carbon dioxide caused minimal blood-brain barrier breakdown, whereas multiple injections caused significant breakdown that was still present at 6 hours after the injections. All carbon dioxide-injected brains that underwent histologic examination showed evidence of irreversible brain damage in the injected hemisphere.
The study confirms the neurotoxicity of carbon dioxide within the cerebral vasculature and its unsuitability for clinical use in cerebral angiography.