Hatem Raja, Finn Matthew T, Riley Robert F, Mathur Moses, Lombardi William L, Ali Ziad A, Karmpaliotis Dimitri
Columbia University, 161 Fort Washington Avenue, 6th Floor, New York, NY, USA.
Cardiovascular Research Foundation, 1700 Broadway, 8th Floor, New York, NY, USA.
Eur Heart J Case Rep. 2018 Apr 2;2(2):1-5. doi: 10.1093/ehjcr/yty036. eCollection 2018 Jun.
Percutaneous coronary intervention (PCI) in patients with advanced chronic kidney disease (CKD) is associated with a high risk of contrast-induced nephropathy and resulting progression of CKD to need for renal replacement therapy. Chronic total occlusions (CTO) PCI is increasingly utilized in the treatment of refractory stable angina and ischaemic heart failure. Recent studies have described the feasibility of 'minimal' or 'zero' contrast PCI by employing intravascular imaging and intra-coronary physiology to guide successful stent implantation with resolution of ischaemia. We extended these techniques to CTO lesions via the retrograde approach.
Two patients with estimated glomerular filtration rate ≤15 mL/min who presented with angina symptoms and had subsequent positive stress tests were referred for CTO-PCI. The patients had diagnostic angiography with minimal contrast. After a recovery period, the patients underwent successful retrograde zero contrast CTO-PCI with the use of adjunctive intravascular ultrasound imaging.
The described reports are the first two successful attempts at zero contrast retrograde procedures and demonstrate the feasibility of imaging and physiology-guided retrograde PCI without contrast administration in two patients with significant coronary artery disease requiring intervention. When indicated, zero contrast PCI offers the ability to treat obstructive coronary disease without worsening renal function in patients with severe CKD.
晚期慢性肾脏病（CKD）患者进行经皮冠状动脉介入治疗（PCI）与造影剂肾病的高风险相关，进而导致CKD进展至需要肾脏替代治疗。慢性完全闭塞（CTO）PCI越来越多地用于治疗难治性稳定型心绞痛和缺血性心力衰竭。最近的研究描述了通过采用血管内成像和冠状动脉内生理学来指导成功植入支架并解决缺血问题，从而实现“最小化”或“零”造影剂PCI的可行性。我们通过逆行途径将这些技术扩展至CTO病变。
两名估计肾小球滤过率≤15 mL/分钟且出现心绞痛症状并随后应激试验呈阳性的患者被转诊进行CTO-PCI。患者接受了使用最少造影剂的诊断性血管造影。经过恢复期后，患者通过辅助血管内超声成像成功进行了逆行零造影剂CTO-PCI。
所描述的报告是零造影剂逆行手术的首例两次成功尝试，并证明了在两名需要干预的严重冠状动脉疾病患者中，在不使用造影剂的情况下进行成像和生理学指导的逆行PCI的可行性。在有指征时，零造影剂PCI能够在不恶化严重CKD患者肾功能的情况下治疗阻塞性冠状动脉疾病。
