[Severe coronary artery disease and severely impaired renal function. Focused fluid expansion and ultra-low dose...

Area of Science:

• Cardiology
• Nephrology
• Interventional Cardiology

Background:

• Severe coronary artery disease (CAD) and impaired renal function present significant management challenges.
• Percutaneous coronary intervention (PCI) in such patients requires careful consideration of contrast medium administration to avoid further renal compromise.
• Contrast-induced nephropathy (CIN) is a known risk in patients undergoing procedures involving iodinated contrast agents.

Observation:

• A 75-year-old patient with severe CAD and severely impaired renal function was evaluated for complex PCI.
• Fluid expansion was meticulously monitored using echocardiography prior to the procedure.
• An ultra-low dose contrast medium protocol was employed during the percutaneous coronary intervention.

Findings:

• The patient successfully underwent complex percutaneous coronary intervention utilizing an ultra-low dose contrast medium protocol.
• No evidence of contrast-induced nephropathy was observed post-procedure.
• The patient experienced a safe discharge without complications related to renal function or the intervention.

Implications:

• This case demonstrates the feasibility and safety of performing complex PCI in high-risk patients with severe renal impairment.
• Ultra-low dose contrast protocols, combined with careful fluid management guided by echocardiography, can mitigate the risk of contrast-induced nephropathy.
• This approach may expand treatment options for patients with complex coronary artery disease and compromised kidney function, improving outcomes.