Zero-Contrast Percutaneous Coronary Intervention Guided by Dextran-Based Optical Coherence Tomography.

Area of Science:

• Cardiology
• Nephrology
• Medical Imaging

Background:

• Advanced chronic kidney disease (CKD) and coronary artery disease (CAD) pose significant challenges for cardiac interventions.
• Percutaneous coronary intervention (PCI) is often avoided in these patients due to the risk of contrast-induced nephropathy (CIN).
• Novel strategies are needed to enable safe and effective coronary revascularization in patients with severely impaired renal function.

Observation:

• A 76-year-old male patient with stage 4 CKD and significant CAD required coronary revascularization.
• Traditional PCI with contrast agents was contraindicated due to the high risk of worsening kidney function.
• A zero-contrast PCI procedure was performed, utilizing dextran-based optical coherence tomography (OCT) for imaging guidance.

Findings:

• The zero-contrast PCI procedure guided by dextran-based OCT was successfully completed.
• This case demonstrates the technical feasibility of performing PCI without iodinated contrast agents in a patient with advanced CKD.
• Optical coherence tomography proved effective for visualizing coronary anatomy and guiding intervention in the absence of contrast.

Implications:

• Dextran-based OCT-guided, zero-contrast PCI represents a potentially viable and safer alternative for patients with advanced CKD and CAD.
• This approach may expand treatment options for a vulnerable patient population previously denied necessary interventions.
• Further clinical studies are warranted to establish the safety, efficacy, and long-term outcomes of this innovative zero-contrast PCI technique.