AKI After PCI: Optimizing Contrast Selection for Real‑World Prevention-Slides: Cases Illustrating Optimized Contrast Use, Dr. Sundaram

Slides: Cases Illustrating Optimized Contrast Use, Dr. Sundaram

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This presentation reviews practical strategies for minimizing contrast use during coronary angiography, PCI, and peripheral vascular intervention, especially in patients with chronic kidney disease and high risk for contrast-induced nephropathy.<br /><br />Across five cases, the speaker shows how careful planning, staging procedures, and using prior angiograms, fluoroscopic landmarks, and intravascular ultrasound (IVUS) can substantially reduce contrast volume. Key procedural strategies include holding nephrotoxic medications, using LVEDP-guided hydration before and after procedures, and selecting supportive or selective guide catheters.<br /><br />Case examples include:<br />- A woman with stage 4 CKD undergoing staged PCI with only 15 cc for diagnostic angiography and 10 cc for PCI.<br />- A post-cardiac arrest NSTEMI patient with CKD who required staged high-risk PCI with low contrast use and avoidance of unnecessary injections.<br />- A peripheral intervention for SFA chronic total occlusion using roadmap techniques, IVUS, and only 15 cc contrast.<br />- An NSTEMI patient with stage 4 CKD treated with PCI using 20 cc contrast and a guideliner for improved imaging.<br />- A woman undergoing diagnostic angiography using a “swing” technique with optimized acquisition settings.<br /><br />The presentation emphasizes that contrast can be minimized by:<br />- Using roadmap features and fluoroscopic calcification as landmarks<br />- Wiring side branches to define anatomy<br />- Using IVUS to determine lesion length and optimize stent placement<br />- Avoiding repeated contrast injections when anatomy is already known<br />- Adjusting imaging settings for efficiency<br /><br />The concluding message is that contrast volume should be kept as low as possible relative to eGFR, ideally near a 1:1 ratio, and that a structured, staged, imaging-guided approach can improve safety without compromising procedural success.

Keywords

contrast minimization

coronary angiography

PCI

peripheral vascular intervention

chronic kidney disease

contrast-induced nephropathy

IVUS

staged procedures

low contrast volume

LVEDP-guided hydration