Zero-contrast IVUS-guided complex PCI in a patient with NSTE-ACS and severe renal impairment

Area of Science:

• Cardiology
• Interventional Cardiology
• Nephrology

Background:

• Severe comorbidities and cardiovascular risk factors, including stage IV chronic kidney disease, pose challenges in managing non-ST-elevation myocardial infarction.
• Contrast-induced acute kidney injury is a significant concern in patients with pre-existing renal impairment undergoing procedures requiring contrast agents.

Observation:

• A 76-year-old male with stage IV chronic kidney disease presented with non-ST-elevation myocardial infarction and multivessel disease with heavy calcifications.
• Conventional angiography revealed complex anatomy requiring intervention, but the high risk of contrast-induced acute kidney injury necessitated an alternative approach.

Findings:

• A zero-contrast percutaneous coronary intervention was successfully performed using intravascular ultrasound guidance and specialized stenting techniques.
• The procedure yielded optimal imaging, clinical, and renal outcomes, effectively managing the complex coronary anatomy without contrast exposure.

Implications:

• Zero-contrast interventions can be safely implemented in complex percutaneous coronary intervention scenarios, even in high-risk patients with chronic kidney disease.
• This approach offers a viable strategy to mitigate contrast-induced nephropathy, improving patient safety and outcomes.
• Acquiring at least two orthogonal angiographic projections is crucial for detecting distal complications in zero-contrast procedures.