Combination Gadolinium Angiography and Intravascular Ultrasound Study for Coronary Artery and Graft Assessment

Contrast allergies may range from minor to life-threatening, such as Stevens-Johnson syndrome, and pose a challenge to obtaining timely coronary angiography. Here, we present a complex patient with a history of 5-vessel coronary artery bypass grafting and end-stage renal disease who required native coronary and bypass graft angiogram prior to listing for renal transplant. Due to a history of iodinated contrast-induced Stevens-Johnson syndrome, this patient was unable to undergo standard angiography. This diagnostic challenge was overcome with the safe, hybrid approach of using intravascular ultrasound to guide minimal administration of gadolinium contrast media to obtain a complete angiography.