一名76岁男性，患有严重合并症和多种心血管危险因素，包括IV期慢性肾脏疾病，表现为非ST段抬高型心肌梗死。使用DyeVert系统和等渗造影剂进行的超低对比侵入性冠状动脉造影显示多支血管疾病，涉及左主干及其分叉，需要复杂的经皮冠状动脉介入治疗。由于造影剂引起的急性肾损伤的高风险，使用血管内超声引导和具有最佳成像的专用支架技术进行零对比介入,临床,和肾脏结果。即使在复杂的临床情况下，也可以安全地实施零对比策略，但应始终获取至少两个正交血管造影投影以排除远端并发症。
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.
