A Single-Center Study Using IVUS to Guide Rotational Atherectomy for Chronic Renal Disease's Calcified Coronary
Guangxin Hu1, Xijuan Qi1, Ben Li1
1Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People's Republic of China.
Insights
Intravascular ultrasound (IVUS)-guided rotational atherectomy (RA) percutaneous coronary intervention (PCI) is safe and effective for patients with chronic kidney disease and complex coronary calcification. This technique reduces contrast use and may lower the risk of contrast-related acute kidney injury (AKI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Nephrology
Background:
- Complex coronary calcification poses challenges during percutaneous coronary intervention (PCI).
- Patients with chronic kidney disease (CKD) are at increased risk for contrast-related acute kidney injury (AKI).
- Rotational atherectomy (RA) is used for complex calcified lesions, but its safety in CKD patients requires assessment.
Purpose of the Study:
- To evaluate the effectiveness and safety of IVUS-guided RA PCI in CKD patients with complex coronary calcification.
- To compare IVUS-guided RA PCI with standard RA PCI regarding procedural outcomes and safety endpoints.
- To assess the impact of IVUS guidance on contrast volume and AKI incidence.
Main Methods:
- A randomized controlled trial involving 48 CKD patients undergoing RA PCI.
- Patients were assigned to either IVUS-guided RA PCI or standard RA PCI.
- Intravascular ultrasound (IVUS) was used to guide lesion assessment, burr selection, and stent deployment in the study group.
Main Results:
- No significant differences in baseline clinical characteristics or eGFR between groups.
- IVUS-guided RA PCI was associated with more elective procedures (87.5% vs 58.3%, p=0.02).
- Shorter fluoroscopy time (20.6 vs 36 min, p<0.01) and reduced contrast volume (32 vs 184 mL, p<0.01) in the IVUS-guided group.
- Contrast-induced nephropathy occurred in 4.1% of the IVUS-guided group versus 20.8% in the standard group (p=0.19).
Conclusions:
- IVUS-guided RA PCI is an effective and safe strategy for CKD patients with complex coronary calcification.
- This technique can significantly reduce contrast agent administration.
- IVUS guidance may potentially decrease the incidence of contrast-related AKI in this high-risk population.
Objective:
To assess the effectiveness and safety of an IVUS-guided rotational atherectomy (RA) percutaneous coronary intervention (PCI) in chronic renal patients with complex coronary calcification who are at risk for contrast-related acute kidney injury (AKI).
Methods:
From October 2018 to October 2021, 48 patients with chronic renal disease who were receiving PCI with RA at the General Hospital of NingXia Medical University were informed for data collection for this research. They were randomly assigned to the IVUS-guided RA group and the Standard RA group, which did not use IVUS. According to a clinical expert consensus document on rotational atherectomy in China, both PCI procedures were performed. The intravascular ultrasound (IVUS) results from the study group were used to describe the morphology of the lesion and to guide the selection of burrs, balloons, and stents. IVUS and angiography were used to evaluate the outcome in the end. IVUS-guided RA PCI and Standard RA PCI groups' effects and results were contrasted.
Results:
There were no appreciable differences in the clinical baseline characteristics between the IVUS-guided RA PCI group and the Standard RA PCI group. The average estimated glomerular filtration rate (eGFR) of two groups was (81.42 ± 20.22 vs 82.34 ± 22.19) mL/min/1.73 m2. Most of them (45.8% vs 54.2%) was in stage 60-90 mL/min/1.73m2. When compared to the standard RA PCI group, RA in IVUS-Guided group was more performed electively (87.5% vs 58.3%; p = 0.02). The IVUS-guided RA PCI group was associated with shorter fluoroscopy time (20.6 ± 8.4 vs 36 ± 22; p<0.01) and less contrast amount (32 ±16 vs 184 ±116mL; p<0.01) than Standard-RA group. Five patients in the Standard RA PCI group developed contrast-induced nephropathy, which was 5 times than the IVUS-guided RA PCI group (20.8% VS 4.1%; p=0.19).
Conclusion:
In chronic renal patients with complex coronary calcification, an IVUS-guided RA PCI technique is effective and safe. It can also lower the volume of contrast and perhaps the incidence of contrast-related AKI.
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