Ultra-low contrast, complex left main coronary intervention case series using novel intravascular ultrasound
Billal Patel1, Omar Assaf1, Amjad Nabi1
1Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Whinney Heys Road, Blackpool FY3 8NR, UK.
Insights
Ultra-low contrast percutaneous coronary intervention (ULPCI) successfully treated complex left main disease in patients with severe chronic kidney disease (CKD). This novel approach used minimal contrast, preventing acute kidney injury in high-risk patients.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Contrast-induced nephropathy (CIN) poses significant risks for patients with chronic kidney disease (CKD).
- Ultra-low contrast percutaneous coronary intervention (ULPCI) offers a potential solution for contrast-related complications.
- Complex left main interventions in CKD patients remain challenging due to high morbidity and mortality.
Observation:
- A series of five patients with estimated glomerular filtration rate ≤20 mL/min underwent complex left main ULPCI.
- Procedures involved a two-stent strategy, intravascular ultrasound (IVUS) co-registration, and in some cases, hemodynamic support and rotational atherectomy.
- Diagnostic angiography was performed as a separate procedure prior to intervention.
Findings:
- The study reports the first successful ULPCI utilizing a dedicated two-stent left main bifurcation strategy with IVUS co-registration.
- Minimal contrast volume (≤6 mL) was used, achieving optimal procedural outcomes.
- No patients developed acute kidney injury post-intervention.
Implications:
- This technique facilitates complex percutaneous coronary intervention (PCI) in high-risk CKD patients with minimal contrast.
- The adaptation of ULPCI can improve treatment outcomes for patients at risk of CIN.
- This approach addresses an unmet need in managing cardiovascular disease in patients with severe renal impairment.
Background:
Contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) carries a high morbidity and mortality. Ultra-low contrast percutaneous coronary intervention (ULPCI) has previously been described. Complex left main (LM) ULPCI using two-stent strategy guided by novel intravascular ultrasound (IVUS) co-registration software has not been described. We report a series of complex LM ULPCI using IVUS co-registration.
Case Summaries:
Five patients with estimated glomerular filtration rate ≤20 mL/min who presented with stable angina or non-ST segment elevation acute coronary syndrome underwent percutaneous coronary intervention (PCI). The patients previously had diagnostic angiography performed as a separate procedure. Successful LM ULPCI was performed in all patients with a provisional and two-stent bifurcation strategies. These were complex procedures, some of which required haemodynamic support and rotational atherectomy.
Discussion:
This report describes the first ULPCI using a dedicated two-stent LM bifurcation strategy and using rotational atherectomy and IVUS co-registration. This technology facilitated complex PCI in this high-risk patient group with minimal contrast use (≤6 mL) with optimal results and no patients developed acute kidney injury after intervention. The adaptation of ULPCI to daily practice in patients at risk of CIN will improve treatment for this underserved patient group.
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