%0 Case Reports
%T Zero-contrast IVUS-guided complex PCI in a patient with NSTE-ACS and severe renal impairment.
%A Moretti F
%A Rondi M
%A Ottani F
%J Catheter Cardiovasc Interv
%V 101
%N 6
%D 2023 05
%M 36994869
%F 2.585
%R 10.1002/ccd.30651
%X 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.