Absolute zero-contrast percutaneous coronary interventions: An intravascular ultrasound-guided case series and
Xenofon M Sakellariou1, Christos S Katsouras2, Michail I Papafaklis3
1First Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece.
Insights
Zero-contrast intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) is a feasible alternative for patients with complex coronary lesions and contraindications to contrast media (CM). This approach avoids CM-related adverse effects like kidney injury and hypersensitivity reactions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Contrast media (CM) administration during percutaneous coronary intervention (PCI) poses risks, including acute kidney injury and hypersensitivity reactions, particularly in vulnerable patients.
- Patients with contraindications to CM, such as chronic kidney disease (CKD) or prior hypersensitivity, face treatment challenges for coronary artery disease.
- Alternative revascularization strategies are needed to mitigate CM-associated risks in high-risk patient populations.
Purpose of the Study:
- To evaluate the feasibility of an absolute zero-contrast intravascular ultrasound (IVUS)-guided PCI strategy.
- To assess the safety and efficacy of this approach in patients with complex coronary lesions and contraindications to CM.
- To determine if zero-contrast IVUS-guided PCI can prevent CM-associated adverse events in susceptible individuals.
Main Methods:
- A case series of four patients with complex coronary lesions and contraindications to CM underwent PCI using a zero-contrast protocol.
- Intravascular ultrasound (IVUS) imaging was utilized for lesion assessment, stent placement, and complication identification.
- Diagnostic angiography was reviewed for landmark identification, and multiple guidewires served as a metallic roadmap.
Main Results:
- All procedures were successfully completed without any CM administration.
- No instances of renal function deterioration, pericardial effusion, or stent edge dissection were observed.
- IVUS imaging effectively guided lesion assessment, stent expansion, and apposition.
Conclusions:
- Absolute zero-contrast IVUS-guided PCI is a feasible and safe strategy for patients with complex coronary lesions and CM contraindications.
- This approach effectively avoids CM-related adverse effects, including kidney injury and hypersensitivity reactions.
- Evidence-based validation of this technique could alter treatment paradigms for vulnerable patients, minimizing risks associated with even minimal CM doses.
Purpose:
Contrast media (CM)-associated adverse effects including mainly acute kidney injury and hypersensitivity reactions still remain a significant treatment burden to vulnerable patients requiring percutaneous coronary intervention (PCI). The complete omission of CM administration accompanied by intravascular ultrasound (IVUS) guidance may offer an appropriate revascularization treatment.
Methods:
We hereby present a case series of four patients with challenging coronary lesions and relative/absolute contraindications to CM use [(hypersensitivity reaction owning to CM, history of contrast-induced acute kidney injury, solitary kidney, or advanced chronic kidney disease (CKD)] who underwent absolute zero-contrast IVUS-guided PCI following a predetermined protocol.
Results:
The initial diagnostic angiography was reviewed for landmark identification, and multiple guidewires created a metallic road map providing additional landmarks and protected side branches. IVUS imaging was performed to determine lesion length, reference segments and landing zones, assess stent expansion/apposition and identify major complications. All procedures were successfully completed without any CM administration, renal function deterioration, pericardial effusion, or stent edge dissection.
Conclusions:
We demonstrated the feasibility of absolute zero-contrast IVUS-guided PCI in patients with complex coronary lesions susceptible to CM-associated adverse effects. Since the safety of this strategy is well-documented in patients with CKD and challenging lesions morphology even in acute settings, evidence-based validation of this approach is capable of changing the otherwise conservative treatment of vulnerable patients where even minimum doses of CM may have detrimental effects.
Summary For The Annotated Table Of Contents:
Patients with vulnerable renal function as well as former hypersensitivity reaction to contrast media encounter a significant treatment burden regarding coronary artery disease. Zero-contrast IVUS-guided strategy based on a predetermined protocol provides a feasible alternative approach in patients susceptible to contrast media-associated adverse effects even in the presence of complex coronary lesions.
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