Chen Chen-Yang, Huang Wei, Liu Jun, Cao Yu
Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Changsha, Hunan 410013, China.
Eur Heart J Case Rep. 2020 Nov 12;4(6):1-6. doi: 10.1093/ehjcr/ytaa349. eCollection 2020 Dec.
Contrast agent allergy may result in severe adverse events that prevent the use of percutaneous coronary intervention (PCI) in some patients, especially for those with complex lesions.
We describe a 59-year-old man who presented with the multi-vessel disease and suffered from contrast allergy. The patient refused to have coronary artery bypass grafting surgery, thus two-stage PCI procedures without iodinated contrast media were performed after a detailed discussion with the heart team, including a chronic total occlusion (CTO) lesion in the proximal left anterior descending artery. The intravascular ultrasound (IVUS) was used for finding the entry point of the proximal fibre cap, and assessing the lesion, thereby marking the positions of the proximal and distal edges of the stent. After PCI, stent expansion and subtle edge dissection or incomplete apposition were confirmed by IVUS and ChromaFlo imaging. Zero-contrast PCI was done successfully without any complication.
This case report illustrates the feasibility and safety of performing CTO-PCI without contrast agent in carefully and well prepared selected patients.
造影剂过敏可能导致严重不良事件，使某些患者无法进行经皮冠状动脉介入治疗（PCI），尤其是那些有复杂病变的患者。
我们描述了一名59岁患有多支血管病变且对造影剂过敏的男性患者。该患者拒绝接受冠状动脉旁路移植手术，因此在与心脏团队进行详细讨论后，为其实施了两阶段无碘化造影剂的PCI手术，其中包括左前降支近端的慢性完全闭塞（CTO）病变。血管内超声（IVUS）用于寻找近端纤维帽的进入点，并评估病变，从而标记支架近端和远端边缘的位置。PCI术后，通过IVUS和ChromaFlo成像确认了支架扩张以及细微的边缘夹层或贴壁不良情况。零造影剂PCI手术成功完成，无任何并发症。
本病例报告说明了在精心准备的特定患者中进行无造影剂CTO-PCI的可行性和安全性。
