Sacha Jerzy, Gierlotka Marek, Feusette Piotr, Dudek Dariusz
Department of Cardiology, University Hospital, Faculty of Natural Sciences and Technology, University of Opole, Opole, Poland.
Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland.
Postepy Kardiol Interwencyjnej. 2019;15(2):127-136. doi: 10.5114/aic.2019.86007. Epub 2019 Jun 22.
Contrast-induced nephropathy is a serious complication after intravascular administration of iodinated contrast media and is associated with numerous adverse outcomes. Its prevalence is particularly high in patients with multiple comorbidities who undergo coronary angiography and percutaneous coronary intervention (PCI). Currently, the only effective method to prevent contrast-induced kidney injury is adequate hydration and a reduction of contrast volume during the intervention. Recently, new approaches aiming to minimize contrast usage have been proposed, i.e., ultra-low contrast angiography and zero-contrast PCI. However, neither tutorials for these techniques nor reviews of their outcomes exist in the literature, and therefore dissemination of these approaches among the interventional community may be limited. This article presents a step-by-step description on how to perform ultra-low coronary angiography and zero-contrast PCI, which should help invasive cardiologists to adopt these techniques in daily practice. A review of clinical studies, case series and single case reports regarding these methods is also provided. Despite the promising results, such procedures still require some improvements and confirmation of their effectiveness as well as safety in large clinical studies. This article aims to spread these new techniques throughout the interventional community, which is paramount for their further development and wider utilization.
对比剂肾病是血管内注射碘化造影剂后的一种严重并发症,与众多不良后果相关。在接受冠状动脉造影和经皮冠状动脉介入治疗(PCI)的多种合并症患者中,其患病率尤其高。目前,预防对比剂所致肾损伤的唯一有效方法是充分水化并在介入过程中减少对比剂用量。最近,已经提出了旨在尽量减少对比剂使用的新方法,即超低剂量对比剂血管造影和零对比剂PCI。然而,文献中既没有这些技术的教程,也没有对其结果的综述,因此这些方法在介入领域的传播可能有限。本文介绍了如何进行超低剂量冠状动脉造影和零对比剂PCI的分步说明,这应有助于介入心脏病学家在日常实践中采用这些技术。还提供了关于这些方法的临床研究、病例系列和单病例报告的综述。尽管结果令人鼓舞,但此类手术仍需一些改进,并在大型临床研究中证实其有效性和安全性。本文旨在在介入领域推广这些新技术,这对它们的进一步发展和更广泛应用至关重要。