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IVUS-Guided Zero-Contrast PCI in CKD Patients: Safety and Short-Term Outcome in Patients with Complex Demographics and/or Lesion Characteristics
Journal of Interventional Cardiology  (IF2.279),  Pub Date : 2021-05-08, DOI: 10.1155/2021/6626749
Prathap Kumar, Blessvin Jino, Ali Shafeeq, Stalin Roy, Manu Rajendran, Sandheep George Villoth

Background. Percutaneous coronary intervention (PCI) in patients with significant renal dysfunction is challenging because of the lesion characteristics and the risk of contrast-induced acute kidney injury (CI-AKI). With the advent of intravascular ultrasound- (IVUS-) guided zero-contrast PCI, outcomes have improved considerably. Objective. To assess the safety and short-term outcomes of IVUS-guided zero-contrast PCI in chronic kidney disease (CKD) patients with complex demographics or lesion morphology. Methods. Patients who underwent IVUS-guided zero-contrast PCI at a tertiary center, from November 2019 to May 2020, were included in this prospective analysis. Clinical characteristics, procedural data, and follow-up data were collected and analyzed. Results. A total of 15 patients (27 vessels), all men (mean age, 70.0 ± 11.0 years), underwent zero-contrast PCI. The mean estimated glomerular filtration rate (eGFR) and serum creatinine were 30.8 ± 7.3 mL/min/1.73 m2 and 2.6 ± 1.3 mg/dL, respectively. The mean BMC2 risk for dialysis was 2.1 ± 1.1%, mean SYNTAX score was 20.3 ± 10.3, and mean left ventricular ejection fraction (LVEF) was 42.4 ± 11.6%. Four patients (26.6%) underwent left main coronary artery (LMCA) PCI including one LMCA bifurcation. One patient underwent chronic total occlusion PCI. Technical and procedural success were 100% without any periprocedural complications. No major adverse cardiovascular events (MACE) were reported, and no patient required dialysis within three months of follow-up. Conclusion. Zero-contrast PCI guided by IVUS is safe in coronary artery disease (CAD) patients with moderate-to-severe CKD. High procedural success without complications can be achieved even in cases with complex clinical characteristics and lesion morphology.