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Updated: Jan 14, 2026

Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Intravascular Lithotripsy With Ultra-Low Contrast OCT Guidance for Calcified Coronary Lesions in Advanced CKD
Yoshinobu Murasato1, Takahiro Mori1, Yugo Fujimoto1
1Department of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Objective:
To demonstrate the feasibility and safety of optical coherence tomography (OCT)-guided, ultra-low contrast percutaneous coronary intervention with intravascular lithotripsy (IVL) for severely calcified coronary lesions in patients with advanced chronic kidney disease.
Key Steps:
As procedural steps: 1) use prior angiograms for procedural planning; 2) perform OCT with low-molecular weight dextran to assess calcium morphology; 3) apply IVL for targeted calcium modification; 4) reassess with OCT for calcium fracture, lumen gain, and stent optimization; and 5) limit total iodinated contrast volume to ≤10 mL.
Potential Pitfalls:
Potential issues include: 1) geographic stent miss when relying on fluoroscopic markers-use side-branch wiring for reference; 2) side-branch compromise-consider jailed balloon protection; 3) dextran-related allergic reaction-switch to intravascular ultrasound if needed; and 4) excessive dextran (>100 mL)-avoid to reduce renal risk.
Take-Home Message:
OCT-guided ultra-low contrast percutaneous coronary intervention with IVL enables safe, precise treatment of heavily calcified lesions in advanced chronic kidney disease while minimizing renal injury risk.
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