Zero Contrast Multivessel PCI in a CKD patient not on dialysis.

About the Patient and Condition

A 64-year-old male patient was a known case of Diabetic, Hypertensive and Diabetic Nephropathy with Chronic kidney disease with serum creatinine of 6.16 mg /dl , on medical management. Patient had an episode of rest angina 10 days back and exertional SOB of class III since 3 months and diagnosed as Unstable angina.

Case Scenario

Patient underwent coronary angiogram in another hospital and was detected to have Triple vessel disease. He was advised CABG in view of multivessel disease. He approached Apollo Hospitals, Hyderabad and was further managed the cardiology team – Dr. A Sreenivas Kumar, Dr. Gokul Reddy M, Dr. Sanjeeva Kumar E and Dr. Ramakrishna J.

With the help of coronary angiogram images done from other hospital as a guide, Coronary ostia were engaged with XBU catheter for left side and JR catheter for right coronary artery. Catheter engagement was confirmed with intracoronary injection of 10 ml of normal saline and ECG changes during saline injection. Coronary arteries were wired under fluoroscopy without injecting any contrast. We assessed the morphology of coronary lesions and length of the stents with Intravascular imaging with IVUS, avoiding use of contrast. We placed another wire in nearby branches to guide as a land mark for stent placement and balloon dilatation (wire silhouette technique). Tight lesion was pre dilated before stenting. With this strategy we placed stents in LAD with 2.5 X 28 mm DES, LCX 2.5 x 28 DES, and another 2.75 X 32 DES in RCA. Adequate post dilatation done with appropriate size non-compliant balloons. Post stent IVUS imaging demonstrated good apposition of stents and no significant edge dissections. At the end, we used 8-10 ml of Visipaque contrast to demonstrate the successful procedure and for documentation.

Worldwide Scenario

Many therapies have been tested to avoid contrast-induced nephropathy. However, the only potent preventative strategy involves aggressive fluid administration and reduction of contrast volume as low as possible.

Expertise at Apollo Hospitals

At Apollo Heart Institute, our Cardiac team had a discussion with our Cardiac Surgeon along with patient and his family and decided to go for multivessel PCI with dialysis support immediately after PCI (if required). The main goal was to limit the amount of contrast volume as minimal as possible. Contrast-induced nephropathy is a serious complication after intravascular administration of iodinated contrast media.

Apollo Hospitals – Touching Lives

Apollo Heart Institute at Hyderabad has a dedicated team of doctors and medical staff who have led the way in nearly every sub-specialisation, including interventional cardiology, cardiac surgery, structural heart interventions, pediatric surgery, electrophysiology, robotic surgery, robotic cardiology and heart transplants.

Patient’s Testimonial

Post procedure patient had stable renal parameters and serum creatinine was 5.26 mg /dl. After the procedure, patient did not required dialysis for 3 months and was angina free on follow up. Patient was extremely satisfied with the treatment and care provided by Apollo Hospitals, Hyderabad.