Enhanced stent visualization system for percutaneous coronary intervention in patients with chronic kidney disease: effects on contrast media volume and radiation exposure

Abstract

Objective: We aimed to assess the impact of using enhanced stent visualization (ESV) systems on contrast media volume and radiation dose in percutaneous coronary intervention (PCI), especially for patients with chronic kidney disease (CKD). Background: Coronary heart disease (CHD) is associated with chronic kidney disease (CKD) as they share the similar pathological pathway. In addition, the iodinated contrast media used for angiography is a risk factor for contrast-associated acute kidney injury (CA-AKI), which could aggravate the progression of CKD. We hypothesized that ESV systems have the potential to reduce the use of contrast media as well as radiation dose, however, few study reported the impact on contrast media with use of ESV systems. Methods: We retrospectively collected 124 patients with acute coronary syndromes underwent PCI from May 2020 to July 2021. Patients were divided into ESV-guided group (n = 64) and angiography-guided group (n = 60). Procedural parameters including contrast media volume, radiation exposure (in Air Kerma), number of cines, cine frames, fluoroscopy and procedure time were recorded and analyzed.Results: Groups were comparable for patient characteristics. A significant reduction in contrast media volume (179.41 ± 16.76 ml vs. 114.5 ± 13.56ml, p = 0.0001), radiation exposure (693.99 ± 351.04 mGy vs. 1439.45 ± 973.01 mGy, p = 0.001) and procedure time (47.75 ± 15.43 min vs. 65.88 ± 23.81 min, p = 0.029) with the use of ESV systems. Similar results were observed in the subgroup analysis for the patients with CKD.Conclusion: This study suggested that the use of ESV is associated with reduced contrast media usage, radiation dose and procedure time during PCI. The same results were observed in subgroup analysis in patients with CKD, which is of great significance in decreasing the occurrence of contrast-induced nephropathy and mitigating the progression of CKD and CHD.