Coronary Angioplasty using stents is a well-established treatment for blockages involving the blood vessels of the heart. During angioplasty dye is used for visualisation of the blood vessels. This dye is removed from the body by the kidneys. In patients with kidney problems, the dye can further damage the kidneys leading to dialysis and this is always a concern in patients with kidney problem undergoing angiogram or angioplasty.
With newer technological advancements in the field of angioplasty and intracoronary imaging (IVUS), it is possible to do angioplasty safely in these patients with no or minimal dye. Intravascular Ultrasound (IVUS) is a device which acts as a camera and give 3 dimensional view of the blood vessel. This can help in deciding the exact size of the stent to be used without the need for dye injection. This zero contrast angioplasty have been used in certain situations where the anatomy is simple. But it is extremely difficult to use this in patients with complex anatomy.
One such patient with kidney problem (Cr >3.5) who had severe blockage of the main coronary artery, was treated by Dr Refai Showkathali, Senior Consultant Interventional Cardiologist in Apollo Main Hospital, Chennai. Mrs MB is a 65 yr old lady who is known to have kidney problem for last 3 years with a creatinine level of more than 3.5. She had breathing problem and an angiogram showed blockages involving the main artery in the heart. She underwent a Zero Contrast /minimal contrast complex two vessel angioplasty of Left Main- LAD/LCX bifurcation and LCX using 2 stents with the guidance of IVUS in 2016. This procedure was successfully done without causing further damage to the kidneys and the patients creatinine remained the same. She was discharged home after 2 days and her creatinine level remains the same even after 2 weeks. The complexity of this procedure is due to the blockage involving the level of division of the two arteries (otherwise called “LMS bifurcation”). This required use of marker wires to keep in the artery and IVUS to confirm the size and location of the stent. This is more time consuming than normal angioplasty as at every step, we have to check the alignment with the already taken pictures, thereby avoiding the use of dye injection.
IVUS guided angioplasty with zero or minimal dye usage is a promising option for renal failure patients who need to undergo angioplasty and to our knowledge, this was performed first time in India for the left main artery angioplasty.