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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Imaging- and physiology-guided percutaneous coronary intervention without contrast administration in advanced renal
Ziad A Ali1,2, Keyvan Karimi Galougahi3, Tamim Nazif3,2
1Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA zaa2112@columbia.edu.
Insights
Percutaneous coronary intervention (PCI) without contrast medium is feasible and safe for patients with advanced chronic kidney disease (CKD). This zero-contrast PCI strategy preserves renal function and avoids the need for renal replacement therapy (RRT).
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.
Aims:
The feasibility, safety, and clinical utility of percutaneous coronary intervention (PCI) without radio-contrast medium in patients with advanced chronic kidney disease (CKD) are unknown. In this series, we investigated a specific strategy for 'zero contrast' PCI with the aims of preserving renal function and preventing the need for renal replacement therapy (RRT) in patients with advanced CKD.
Methods And Results:
A total of 31 patients with advanced CKD [creatinine = 4.2 mg/dL, inter-quartile range (IQR) 3.1-4.8, estimated glomerular filtration rate = 16 ± 8 mL/min/1.73 m2] who had clinical indication for PCI based on a prior minimal contrast coronary angiogram were included. Zero contrast PCI was performed at least 1 week after diagnostic angiography using real-time intravascular ultrasound (IVUS) guidance, with pre- and post-PCI measurements of fractional flow reserve and coronary flow reserve to confirm physiological improvement. This approach resulted in successful PCI, no major adverse cardiovascular events and preservation of renal function without the need for RRT within a follow-up time of 79 days (IQR 33-207) in all patients.
Conclusion:
In patients with advanced CKD who require revascularization, PCI may safely be performed without contrast using IVUS and physiological guidance with high procedural success and without complications.
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