Use of ultra-low contrast techniques in percutaneous coronary interventions

Abbreviations

CAD – Coronary artery disease
CIN – Contrast induced nephropathy
CKD – Chronic kidney disease
iFR – Instantaneous wave-free ratio
IVUS – Intravascular ultrasound
PCI – Percutaneous coronary intervention
ULCPCI – Ultra-low contrast percutaneous coronary intervention

Introduction

Over its entire history, percutaneous coronary intervention (PCI) has been linked to contrast opacification of coronary vessels through the use of iodinated contrast. As a consequence, it has been tacitly assumed that the liberal use of contrast media when undertaking percutaneous coronary intervention (PCI) is needed to achieve an optimal procedure. Yet, in specific patient subsets the administration of iodinated contrast during PCI can have detrimental effects, secondary to fluid overload, organ toxicity of contrast or to hydraulic injury caused by injections (e.g., coronary dissections). While chronic kidney disease (CKD) has been customarily identified as a scenario for reduced contrast administration during PCI, to decrease the risk of acute kidney injury (AKI), there are many other scenarios in which an ultra-low contrast (ULC) PCI approach may be helpful, particularly in patients with complex or high-risk clinical or anatomical profiles. Reaching the upper limit of a safe dose of iodinated...