Zeroing on Gadolinium to Complement Intravascular Ultrasound in Zero-Contrast Percutaneous Coronary Interventions

Many techniques have been developed to minimize the risk of contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) through drastic reductions in iodinated contrast volume and the use of intravascular ultrasound (IVUS). While some of the described techniques completely avoid contrast use and rely on transthoracic echocardiography to check for potential pericardial bleeding, this strategy may miss or delay the treatment of potentially life-threatening complications. We hereby propose the use of group II gadolinium (Gd)-based contrast agents, instead of iodinated contrast, to complement IVUS, in order to achieve the goal of zero-contrast percutaneous coronary intervention, without raising the risk of CIN. These agents have been shown to be relatively safe in the setting of advanced CKD, with an overall reported risk of nephrogenic systemic fibrosis of <0.07% and no significant nephrotoxicity. Combining the use of Gd with the "live IVUS technique" in patients with advanced CKD seems to achieve the goal of high-precision PCI, without significantly compromising procedural safety.