A 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.
Keywords: ACS, acute coronary syndrome; CAD, coronary artery disease; CHIP, complex high-risk and indicated patients; CI-AKI, contrast-induced acute kydney injury; CKD, chronic kidney disease; IVUS, intravascular ultrasound; bifurcation lesions; intravascular imaging; left main intervention; zero-contrast PCI.
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