Zero Contrast and Ultra-Low Contrast Percutaneous Coronary Intervention

Abstract

Contrast-induced acute kidney injury (AKI) is a common complication following percutaneous coronary intervention (PCI) in patients with a background of chronic kidney disease (CKD). This complication can lead to short- and long-term dialysis requirements. There has been some interest in recent years in performing PCI in high-risk patients with minimal use of contrast to avoid this complication. We reviewed a case series of eight cases where ultra-low-contrast PCI was performed and a further case of zero-contrast PCI, which were primarily performed under the guidance of intravascular imaging. Pre- and post-renal functions were recorded, and clinical outcomes were measured based on the survival rate and the need for revascularisation in the culprit vessel. A step-by-step description of how to perform the procedure safely and effectively is provided. There were no procedural complications encountered in this cohort. The renal function remained stable 1 week after the procedure. The procedure was technically successful in all cases based on intravascular and angiographic measures. Patients were followed up for a minimum of 6 months and no adverse clinical events were recorded. A description of the procedural steps is provided based on current experience and review of the literature. Ultra-low-contrast PCI is feasible and safe in a carefully selected group of patients in centres with experience in the use of intravascular imaging.