Ultra-Low-Contrast PCI: A Structured Approach to Reducing Dependence on Contrast Vessel Opacification in PCI

Area of Science:

• Cardiology
• Interventional Cardiology
• Nephrology

Background:

• Percutaneous coronary intervention (PCI) traditionally relies on iodinated contrast for guidance.
• High-risk patients undergoing PCI may benefit from reduced contrast volumes.
• Contrast-induced nephropathy is a significant concern in interventional cardiology.

Purpose of the Study:

• To review contemporary scenarios where ultra-low-contrast PCI (ULCPCI) is beneficial.
• To provide a structured approach for transitioning from conventional PCI to ULCPCI.
• To highlight the feasibility and advantages of ULCPCI in diverse patient populations.

Main Methods:

• Review of current literature and clinical practices regarding contrast use in PCI.
• Discussion of technological innovations enabling ULCPCI.
• Exploration of intracoronary imaging and physiology as alternatives to contrast-based guidance.

Main Results:

• ULCPCI can decrease the incidence of acute kidney injury during PCI.
• Limiting contrast allows for more thorough interventions using intracoronary imaging and physiology.
• ULCPCI facilitates more complete revascularization, enhancing intervention efficacy and durability.

Conclusions:

• ULCPCI is feasible and beneficial in various clinical scenarios, including chronic renal dysfunction and multivessel coronary artery disease.
• Technological advancements, specialized skills, and redefined angiography roles support ULCPCI adoption.
• ULCPCI represents a valuable approach for improving PCI outcomes and patient safety.