Successful Complete Revascularization With PCI Using Super-Low Volume of Contrast Medium in a Patient With
Masahiro Koide1, Masayuki Kato2, Kimihito Usui2
1Department of Cardiovascular Medicine, Japanese Red Cross Kyoto Daini Hospital.
Insights
Minimizing contrast volume is key for preventing contrast-induced nephropathy (CIN) in severe renal dysfunction patients undergoing percutaneous coronary intervention (PCI). This case study demonstrates successful complete revascularization using a super-low contrast volume across three PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Nephrology
Background:
- Severe renal dysfunction poses a significant risk for contrast-induced nephropathy (CIN) during percutaneous coronary intervention (PCI).
- Minimizing contrast media volume is the primary strategy for CIN prevention in these high-risk patients.
- Managing complex coronary artery disease, including chronic total occlusions (CTOs), in patients with renal impairment presents unique challenges.
Observation:
- A 70-year-old male with severe renal dysfunction (eGFR 19 mL/min/1.73 m²) presented with exertional angina and 3-vessel disease, including two CTOs.
- The patient underwent three separate PCI procedures for complete revascularization, utilizing a total of 31 mL of contrast medium.
- Diagnostic angiography initially used 15 mL of contrast, followed by procedural use of 9 mL (RCA), 6 mL (LAD), and 16 mL (LCX).
Findings:
- Complete revascularization was successfully achieved through staged PCI procedures.
- Super-low contrast volume (31 mL total) was employed, significantly below typical volumes, without inducing CIN.
- Advanced techniques including microcatheter tip injection and intravascular ultrasound were instrumental in optimizing contrast use and procedural success.
Implications:
- This case highlights the feasibility of performing complex PCI, including CTO interventions, with extremely limited contrast volumes in patients with severe renal dysfunction.
- The described techniques offer a potential strategy to reduce CIN risk, enabling revascularization in renally impaired patients who might otherwise be excluded.
- Further research into super-low contrast PCI techniques could expand treatment options and improve outcomes for high-risk cardiac patients.
Abstract:
The most important factor for preventing contrast-induced nephropathy (CIN) during percutaneous coronary intervention (PCI) in patients with severe renal dysfunction is to minimize the contrast volume. Herein, we report a successful case of complete revascularization after 3 separate PCI procedures using a super-low volume of contrast medium in a patient with 3-vessel disease, including two chronic total occlusions (CTOs). A 70-year-old man having exertional angina despite maximal medical therapy was referred to our hospital. He had severe renal dysfunction (estimated glomerular filtration rate 19 mL/minute/1.73 m2). Coronary angiography, in which a total volume of 15 mL (over 3 injections) of contrast medium was used after hydration with normal saline, demonstrated 2 CTOs in the proximal left circumflex artery (LCX) and the proximal right coronary artery (RCA) as well as focal stenosis in the mid left descending artery (LAD). Because the patient refused coronary artery bypass grafting, we opted for revascularization with PCI, divided into 3 procedures. We made full use of microcatheter tip injection and evaluation with intravascular ultrasound and achieved complete revascularization with a total of 31 mL of contrast medium: 9 mL for RCA, 6 mL for LAD, and 16 mL for LCX, without the occurrence of CIN. Additionally, we present tips for performing PCI using super-low contrast medium.
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