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Ultra-low-contrast angiography in patients with advanced chronic kidney disease and previous coronary artery bypass
Hussein M Rahim1, Erin Flattery1, Fotis Gkargkoulas2
1Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center.
Insights
Ultra-low-contrast angiography (ULCA) offers a safe method for patients with advanced chronic kidney disease (CKD) and prior coronary artery bypass surgery (CABG). This technique minimizes contrast use, reducing the risk of contrast-induced nephropathy (CIN) in high-risk individuals.
Area of Science:
- Cardiology
- Nephrology
- Interventional Radiology
Background:
- Patients with advanced chronic kidney disease (CKD) and prior coronary artery bypass surgery (CABG) face a high risk of contrast-induced nephropathy (CIN).
- Minimizing contrast volume is a key strategy to prevent CIN in these vulnerable patients.
Purpose of the Study:
- To describe a novel ultra-low-contrast angiography (ULCA) technique for assessing coronary artery bypass grafts in patients with advanced CKD.
- To evaluate the safety and efficacy of ULCA in preventing CIN in this high-risk population.
Main Methods:
- ULCA was performed on ten patients with advanced CKD and previous CABG.
- The technique involved intracoronary saline injections and coronary guidewires, avoiding large contrast volumes for graft engagement.
- Estimated glomerular filtration rate (eGFR) and need for renal replacement therapy were monitored pre- and post-procedure.
Main Results:
- All ten patients successfully completed the ULCA procedure without complications.
- The median contrast volume used was 13.5 mL.
- No statistically significant change in eGFR was observed 30 days post-procedure, and no patient required immediate dialysis.
Conclusions:
- ULCA is a feasible and safe technique for angiography in patients with advanced CKD and prior CABG.
- This approach effectively minimizes contrast administration, thereby reducing the risk of CIN in high-risk cardiovascular patients.
Objective:
We sought to describe a technique for ultra-low-contrast angiography (ULCA) in patients with advanced chronic kidney disease (CKD) and previous coronary artery bypass surgery (CABG).
Background:
Patients with advanced CKD and previous CABG are at high risk of developing contrast-induced nephropathy (CIN) because of the additional contrast often required to identify bypass grafts. Apart from hydration, reduced contrast administration is the only established method to minimize the risk of CIN.
Patients And Methods:
Ten patients underwent ULCA, whereby an intracoronary injection of saline and coronary guidewires were used instead of test injections of contrast for engagement of bypass grafts with catheters. Estimated glomerular filtration rate (eGFR) before and 30 days following angiography were recorded as was the need for renal replacement therapy 1 year after the procedure.
Results:
All patients completed a diagnostic angiogram without complications. The median volume of contrast delivered was 13.5 ml (interquartile range: 10.5-17.8). The median eGFR was 18.3 ml/min/1.73 m (interquartile range: 16.5-28.2). There was no statistically significant difference in eGFR before the procedure and 30 days after the procedure (P=0.79). No patient required dialysis 30 days after the procedure. Two patients required initiation of dialysis at 1 year after the procedure.
Conclusion:
In patients with advanced CKD and previous CABG, ULCA may be performed with high procedural success and without complications, minimizing the risk of CIN in these high-risk patients.
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