Minimizing the risk of contrast-induced nephropathy and hemodynamic collapse during chronic total occlusion...

Area of Science:

• Cardiology
• Interventional Cardiology
• Nephrology

Background:

• Percutaneous coronary revascularization (PCR) candidates are increasingly older and have complex conditions.
• Factors like patient comorbidities, lesion complexity, and hemodynamic status increase risks during PCI.
• High-risk PCI necessitates adequate patient support to ensure procedural safety.

Observation:

• A 77-year-old male with moderate left ventricular dysfunction and stage IV chronic kidney disease underwent PCI.
• The procedure involved recanalization of a chronically occluded left anterior descending artery.
• A micro-axial percutaneous left ventricular assist device (Impella 2.5) was used for hemodynamic stability.
• Minimal contrast medium (14 ml) was administered to mitigate acute kidney injury risk.

Findings:

• Successful recanalization of the chronically occluded artery was achieved.
• The patient remained hemodynamically stable throughout the procedure, despite aggressive techniques like rotational atherectomy.
• No contrast-induced nephropathy or periprocedural myocardial infarction occurred.
• The patient was discharged two days post-procedure.

Implications:

• This case highlights the feasibility of performing high-risk PCI safely in complex patients.
• The use of a left ventricular assist device and minimal contrast is a viable strategy for renal function preservation.
• Recommendations are provided for interventional cardiologists performing complex PCI, emphasizing renal protection.