Ultra-low contrast, complex left main coronary intervention case series using novel intravascular ultrasound technology
- Resource Type
- Authors
- Omar Assaf; R S More; Tawfiq Choudhury; Amjad Nabi; Hesham K. Abdelaziz; Andrew Wiper; Billal Patel
- Source
- European Heart Journal: Case Reports
- Subject
- medicine.medical_specialty
medicine.diagnostic_test
business.industry
Percutaneous coronary intervention
surgical procedures, operative
Low contrast
Chronic kidney disease
Intervention (counseling)
Case report
Intravascular ultrasound
Left main
medicine
Coronary Heart Disease
Case Series
AcademicSubjects/MED00200
Bifurcation
cardiovascular diseases
Radiology
Cardiology and Cardiovascular Medicine
business
- Language
- ISSN
- 2514-2119
Background Contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) carries a high morbidity and mortality. Ultra-low contrast percutaneous coronary intervention (ULPCI) has previously been described. Complex left main (LM) ULPCI using two-stent strategy guided by novel intravascular ultrasound (IVUS) co-registration software has not been described. We report a series of complex LM ULPCI using IVUS co-registration. Case Summaries Five patients with estimated glomerular filtration rate ≤20 mL/min who presented with stable angina or non-ST segment elevation acute coronary syndrome underwent percutaneous coronary intervention (PCI). The patients previously had diagnostic angiography performed as a separate procedure. Successful LM ULPCI was performed in all patients with a provisional and two-stent bifurcation strategies. These were complex procedures, some of which required haemodynamic support and rotational atherectomy. Discussion This report describes the first ULPCI using a dedicated two-stent LM bifurcation strategy and using rotational atherectomy and IVUS co-registration. This technology facilitated complex PCI in this high-risk patient group with minimal contrast use (≤6 mL) with optimal results and no patients developed acute kidney injury after intervention. The adaptation of ULPCI to daily practice in patients at risk of CIN will improve treatment for this underserved patient group.