IVUS Guidance to Reduce Contrast in Coronary Angioplasty

Contrast-induced acute kidney injury (CI-AKI) is an important adverse effect of percutaneous coronary interventions. Despite various efforts, very few preventive measures have been shown effective in reducing its incidence. The final volume of contrast media utilized during the procedure is a well-known independent factor affecting the occurrence of CI-AKI.

Intravascular ultrasound (IVUS) has been largely used as an adjunctive diagnostic tool during percutaneous coronary intervention (PCI). When fully explored, IVUS provides precise information for guiding the PCI strategy. IVUS allows accurate vessel and lesion sizing, determination of plaque calcification (and the need for pre-stent plaque preparation), assessment of post-stent results (including edge dissections and residual lesion, as well as stent underexpansion or incomplete apposition). Therefore, IVUS has the potential to reduce the utilization of contrast media during PCI.

In the present study, we hypothesize that IVUS guidance is associated with a significant reduction in the volume of contrast media during PCI, in comparison to standard angiography-guided intervention.

Inclusion criteria

• Written informed consent
• Age >=18 years
• Coronary artery disease scheduled for percutaneous intervention
• Technical feasibility for intravascular ultrasound to guide coronary angioplasty
• Increased risk for contrast-induced acute renal failure (e.g. age > 80 years, female gender, diabetes, urgent or emergent procedure priority, diabetes, congestive heart failure, increased baseline serum creatinine, decreased calculated or measured creatinine clearance, intra-aortic balloon pumping, previous renal transplantation or single kidney)

Exclusion criteria

• Anticipated technical impossibility for intravascular ultrasound
• Unknown baseline renal function
• Baseline end-stage renal failure needing dialysis
• Acute renal failure with dynamic change in renal function at the time of index procedure
• Iodine contrast administration <= 72 prior to index procedure
• Known allergy to iodine contrast