Zero-contrast percutaneous coronary intervention for chronic total occlusions guided by intravascular ultrasound with
Chen-Yang Chen1, Wei Huang1, Jun Liu1
1Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Changsha, Hunan 410013, China.
Insights
This study demonstrates the successful use of zero-contrast percutaneous coronary intervention (PCI) for complex coronary artery disease in a patient with contrast allergy. This approach offers a safe alternative when contrast media use is contraindicated.
Area of Science:
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Contrast agent allergy poses a significant risk for patients undergoing percutaneous coronary intervention (PCI), particularly those with complex coronary lesions.
- Severe adverse events associated with contrast agents can preclude PCI, necessitating alternative strategies.
Purpose of the Study:
- To report a case of successful zero-contrast PCI in a patient with a history of contrast allergy and complex coronary artery disease.
- To highlight the feasibility and safety of performing PCI without iodinated contrast media in selected, well-prepared patients.
Main Methods:
- A 59-year-old male patient with multi-vessel disease and contrast allergy underwent a two-stage zero-contrast PCI.
- Intravascular ultrasound (IVUS) was utilized for lesion assessment and stent placement guidance, including identification of the chronic total occlusion (CTO) entry point.
- ChromaFlo imaging was employed post-PCI to confirm stent expansion and assess for edge dissection or incomplete apposition.
Main Results:
- The zero-contrast PCI procedure was successfully completed without any complications.
- Intravascular ultrasound and ChromaFlo imaging confirmed adequate stent deployment and vessel patency.
- The patient tolerated the procedure well, avoiding the risks associated with contrast agents.
Conclusions:
- Zero-contrast PCI is a feasible and safe alternative for carefully selected patients with contrast agent allergy and complex coronary lesions.
- This case underscores the importance of advanced imaging techniques like IVUS in facilitating contrast-sparing interventions.
- The successful management of CTO lesions without contrast highlights potential advancements in interventional cardiology for high-risk patients.
Background:
Contrast agent allergy may result in severe adverse events that prevent the use of percutaneous coronary intervention (PCI) in some patients, especially for those with complex lesions.
Case Summary:
We describe a 59-year-old man who presented with the multi-vessel disease and suffered from contrast allergy. The patient refused to have coronary artery bypass grafting surgery, thus two-stage PCI procedures without iodinated contrast media were performed after a detailed discussion with the heart team, including a chronic total occlusion (CTO) lesion in the proximal left anterior descending artery. The intravascular ultrasound (IVUS) was used for finding the entry point of the proximal fibre cap, and assessing the lesion, thereby marking the positions of the proximal and distal edges of the stent. After PCI, stent expansion and subtle edge dissection or incomplete apposition were confirmed by IVUS and ChromaFlo imaging. Zero-contrast PCI was done successfully without any complication.
Discussion:
This case report illustrates the feasibility and safety of performing CTO-PCI without contrast agent in carefully and well prepared selected patients.
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