Imaging- and physiology-guided percutaneous coronary intervention without contrast administration in advanced renal...

Area of Science:

• Cardiology
• Nephrology
• Interventional Cardiology

Background:

• Advanced chronic kidney disease (CKD) poses challenges for cardiovascular interventions.
• Radio-contrast media used in percutaneous coronary intervention (PCI) can exacerbate renal dysfunction.
• The safety and efficacy of contrast-free PCI in advanced CKD patients remain largely unexplored.

Purpose of the Study:

• To evaluate the feasibility, safety, and clinical utility of a zero-contrast PCI strategy.
• To preserve renal function in patients with advanced CKD undergoing PCI.
• To prevent the need for renal replacement therapy (RRT) in this vulnerable patient population.

Main Methods:

• Retrospective analysis of 31 patients with advanced CKD (eGFR 16 ± 8 mL/min/1.73 m²).
• Zero-contrast PCI performed using real-time intravascular ultrasound (IVUS) guidance.
• Assessment of fractional flow reserve (FFR) and coronary flow reserve (CFR) to confirm physiological improvement.

Main Results:

• Successful PCI was achieved in all patients without major adverse cardiovascular events.
• Renal function was preserved post-procedure, with no requirement for RRT.
• A mean follow-up of 79 days demonstrated sustained renal function and procedural success.

Conclusions:

• Percutaneous coronary intervention (PCI) can be safely performed without contrast medium in advanced CKD patients.
• Intravascular ultrasound (IVUS) and physiological guidance enable successful contrast-free PCI.
• This approach offers a promising alternative for revascularization in CKD patients, mitigating risks associated with contrast agents.