Zero‐contrast IVUS‐guided complex PCI in a patient with NSTE‐ACS and severe renal impairment

Abstract

AbstractA 76‐year‐old male with severe comorbidities and multiple cardiovascular risk factors including stage IV chronic kidney disease presents with non‐ST‐elevation myocardial infarction. An ultra‐low contrast invasive coronary angiography using the DyeVert system and iso‐osmolar contrast agent revealed a multivessel disease with heavy calcifications involving the left main stem and its bifurcation requiring a complex percutaneous coronary intervention. Because of the high risk of contrast‐induced acute kidney injury, a zero‐contrast intervention was performed using intravascular ultrasound guidance and dedicated stenting techniques with optimal imaging, clinical, and renal outcomes. Zero‐contrast policies can be safely implemented even in complex clinical scenarios but at least two orthogonal angiographic projections should always be acquired to rule out distal complications.