IVUS guided rota assisted left main zero-contrast PCI in a patient with CKD

Kumar, Pravin; Jino, Blessvin; Manu, R.; Roy, Stalin; Villoth, Sandheep George

doi:10.1016/j.ihjccr.2020.07.006

Cited by 4 publications

(7 citation statements)

References 8 publications

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“…Azzalini et al 15 performed a non-randomized, retrospective study including 8 patients of ULC-PCI with 88% technical success where no patient developed CI-AKI as compared to 15.5% patients developing CI-AKI in the conventional PCI group. Prathap kumar et al 33 , 34 performed zero contrast PCI in 15 patients with complex lesion characteristics like left main lesions and chronic total occlusion lesions with 100% technical success under IVUS guidance and reported favorable outcomes. These studies suggest that ULC-PCI either guided by angiography alone or with additional IVUS usage is feasible and can safely be used in patients with renal dysfunction to reduce the incidence of CI-AKI.…”

Section: Discussionmentioning

confidence: 99%

Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI)

Shrivastava

Nath

Mahapatra

et al. 2022

Indian Heart Journal

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Section: Discussionmentioning

confidence: 99%

Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI)

Shrivastava

Nath

Mahapatra

et al. 2022

Indian Heart Journal

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“…Of the six papers included, five studies were single-center—USA (Ali, Patel, and Rahim) [ 12 , 13 , 20 ], Poland (Sacha) [ 10 ], India (Kumar) [ 19 ], while one study was performed in multiple centers from Japan (Sakai) [ 16 ]. Of the included studies, one trial was non-randomized (Sakai), two case series (Ali, Sacha), and three case reports (Kumar, Patel, and Rahim).…”

Section: Resultsmentioning

confidence: 99%

“…Kumar et al [ 19 ] reported a case of a complex patient with non-ST-elevation myocardial infarction, advanced CKD, and several previous hemodialysis sessions for acute kidney injury. In addition, the patient had three-vessel disease (SYNTAX-1 score = 35).…”

Section: Resultsmentioning

confidence: 99%

Safety and Efficacy of Minimum- or Zero-Contrast IVUS–Guided Percutaneous Coronary Interventions in Chronic Kidney Disease Patients: A Systematic Review

Burlacu

Tinică

Brinza³

et al. 2021

JCM

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Conventional percutaneous coronary interventions (PCIs) frequently cause severe complications in chronic kidney disease (CKD) patients. Low-to-zero contrast intravascular ultrasound (IVUS) guided PCIs are promising alternatives in the CKD setting. We aim to systematically review up-to-date literature that have reported data and outcomes of low-to-zero contrast PCIs performed in CKD patients. We searched Embase, PubMed, and Cochrane databases for full-text articles that reported original data regarding efficacy and/or safety outcomes of IVUS-guided PCIs in patients with CKD. The quality of non-randomized trials included was assessed using the Newcastle–Ottawa scale. Six papers were included in the present systematic review: One non-randomized trial, two case series, and three case reports. Given the literature reported so far, contrast-free and IVUS-guided PCI procedures in patients with CKD appear to be safe (both in cardiac and renal outcomes) with a comparable efficacy to the conventional procedure, even in complex atherosclerotic lesions. No patient included in the mentioned studies showed renal function deterioration and did not need renal replacement therapy after the zero-contrast IVUS-guided percutaneous procedures. From a cardiovascular point of view, this technique proved to be safe in terms of cardiovascular outcomes. The undesirable consequences of conventional PCI in the CKD population might soon be effectively hampered by safer low-to-zero contrast IVUS-guided PCI procedures after a mandatory and rigorous evidence-based validation in long-awaited randomized controlled trials.

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“…Moreover, from a cardiovascular standpoint, this technique has proven to be safe with favorable cardiovascular outcomes. 63,64,65,66,67,68,69 The CONSaVE-AKI study was a prospective, randomized study that assessed short-term outcomes and safety of ULC-PCI compared to conventional PCI in patients with ACS who were at high risk for contrast induced acute kidney injury (CI-AKI). Patients who had an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² with a moderate to very high Maioli score for pre-procedural risk of developing CI-AKI were included in the study.…”

Section: Monitoring Plaque Morphology and Changes With Therapymentioning

confidence: 99%

“…Two patients died of non-cardiac causes on follow up (3-12 months), and all the remaining were symptom free. 67 IVUS-guided 'absolute' zero-contrast PCI is feasible and safe for CKD patients, allowing successful completion of the procedure without any contrast or complications, even in complex lesion morphologies.…”

Section: Monitoring Plaque Morphology and Changes With Therapymentioning

confidence: 99%

Role of Intravascular Ultrasound and Optical Coherence Tomography in Intra Coronary Imaging for Coronary Artery Disease

Sarwar,

Adedokun,

Anantha Narayanan

2023

Preprint

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Coronary angiography, long considered the gold standard for coronary imaging, faces limitations in assessing coronary vessel wall anatomy and guiding percutaneous coronary intervention (PCI). Despite its prevalence, studies have demonstrated that it is suboptimal in estimating the severity of coronary disease and physiologic significance of stenosis. Intracoronary imaging techniques, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), offer promising alternatives to overcome these limitations. This review delves into the nuances of IVUS and OCT, highlighting their strengths and limitations as adjuncts to PCI. IVUS, utilizing ultrasound technology, and OCT, based on near-infrared light, each provide unique insights into coronary pathology. They differ in terms of temporal and spatial resolution, influencing their capabilities in plaque characterization and vessel assessment. The discussion navigates their historical evolution, technical specifications, and clinical utility. Meta-analyses and adjusted observational studies suggest that both IVUS and OCT-guided PCI correlate with reduced cardiovascular risks compared to angiographic guidance alone. While IVUS has demonstrated consistent benefits in terms of clinical outcomes, the evidence supporting OCT is less robust. However, the utilization of these imaging modalities remains variable across regions, with increasing adoption in recent years, particularly in IVUS-guided PCIs. Intravascular ultrasound's journey from early motion detection to current high-resolution mechanical systems is traced, including improvements in catheter size and compatibility. On the other hand, optical coherence tomography has advanced significantly, utilizing near infrared light to achieve unparalleled resolutions, albeit requiring temporary blood clearance for optimal imaging. In conclusion, IVUS and OCT offer valuable insights into coronary pathophysiology and guide interventions with improved precision compared to traditional angiography. While IVUS remains more extensively utilized, OCT's growing potential is underscored by advancements in technology, culminating in enhanced imaging capabilities. Both modalities demonstrate comparable clinical outcomes, emphasizing the need for tailored imaging choices based on individual clinical scenarios. The continued refinement and broader integration of intravascular imaging are expected to play a pivotal role in optimizing coronary interventions and patient outcomes.

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IVUS guided rota assisted left main zero-contrast PCI in a patient with CKD

Cited by 4 publications

References 8 publications

Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI)

Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI)

Safety and Efficacy of Minimum- or Zero-Contrast IVUS–Guided Percutaneous Coronary Interventions in Chronic Kidney Disease Patients: A Systematic Review

Role of Intravascular Ultrasound and Optical Coherence Tomography in Intra Coronary Imaging for Coronary Artery Disease

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