Safety and efficacy of intravascular ultrasound-guided zero-contrast percutaneous coronary intervention in acute coronary syndrome patients with contrast agent contraindications

doi:10.3877/cma.j.issn.1674-0785.2025.06.002

Abstract

Abstract:

Objective

To evaluate the safety and efficacy of zero-contrast percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS) in patients with acute coronary syndrome (ACS) and contrast agent contraindications.

Methods

A retrospective analysis was conducted on the clinical data of acute coronary syndrome (ACS) patients who underwent IVUS-guided zero-contrast PCI at the Department of Cardiology, Peking University Third Hospital from January 2021 to December 2024. Data collected included demographic information, medical history, IVUS-assessed coronary lesion characteristics, procedural details, and follow-up cardiovascular events.

Results

A total of 8 ACS patients with contrast agent contraindications underwent IVUS-guided zero-contrast PCI, including 4 with severe contrast allergy and 4 with chronic kidney disease. All patients successfully completed the procedure without in-procedure complications such as dissection, hematoma, or occlusion. During a follow-up period of 1~3.5 years, no major adverse cardiovascular events (MACEs) occurred.

Conclusion

IVUS-guided zero-contrast PCI provides a safe and effective treatment option for ACS patients with contrast agent contraindications. This approach effectively avoids contrast-related complications and demonstrates favorable short-term outcomes. However, larger-scale, long-term follow-up studies are needed to further confirm its long-term efficacy and safety.

Key words: Intravascular ultrasound, Acute coronary syndrome, Percutaneous coronary intervention, Zero-contrast

Jisheng Zhou, Dan Li, Lin Mi, Jiangli Han. Safety and efficacy of intravascular ultrasound-guided zero-contrast percutaneous coronary intervention in acute coronary syndrome patients with contrast agent contraindications[J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(06): 408-413.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2025.06.002

https://zhlcyszz.cma-cmc.com.cn/EN/Y2025/V19/I06/408

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References 10

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序号	性别	年龄（岁）	临床诊断	既往史	对比剂禁忌原因	LVEF（%）	历史影像资料	随访时间（年）
1	女性	59	不稳定心绞痛	高脂血症	严重过敏	74	冠脉CT造影	3.5
2	男性	67	急性心肌梗死	高脂血症	严重过敏	48	冠脉CT造影	1.5
3	女性	59	不稳定心绞痛	无	严重过敏	70	冠脉造影	1.5
4	男性	52	不稳定心绞痛	2型糖尿病	严重过敏	59	冠脉造影	1.0
5	男性	57	不稳定心绞痛	高血压高脂血症	慢性肾功能不全	69	冠脉CT造影	3.5
6	男性	69	急性心肌梗死	高血压	慢性肾功能不全	45	冠脉造影	2.5
7	男性	86	急性心肌梗死	高血压	慢性肾功能不全	45	冠脉CT造影	2.0
8	男性	59	不稳定心绞痛	无	慢性肾功能不全	38	无	1.5

序号	性别	年龄（岁）	临床诊断	既往史	对比剂禁忌原因	LVEF（%）	历史影像资料	随访时间（年）
1	女性	59	不稳定心绞痛	高脂血症	严重过敏	74	冠脉CT造影	3.5
2	男性	67	急性心肌梗死	高脂血症	严重过敏	48	冠脉CT造影	1.5
3	女性	59	不稳定心绞痛	无	严重过敏	70	冠脉造影	1.5
4	男性	52	不稳定心绞痛	2型糖尿病	严重过敏	59	冠脉造影	1.0
5	男性	57	不稳定心绞痛	高血压高脂血症	慢性肾功能不全	69	冠脉CT造影	3.5
6	男性	69	急性心肌梗死	高血压	慢性肾功能不全	45	冠脉造影	2.5
7	男性	86	急性心肌梗死	高血压	慢性肾功能不全	45	冠脉CT造影	2.0
8	男性	59	不稳定心绞痛	无	慢性肾功能不全	38	无	1.5

序号	靶血管	术前IVUS评估							支架植入情况	术后IVUS评估
序号	靶血管	MLA（mm²）	MLD（mm）	PB（%）	靶病变斑块性质	远端参考管腔直径（mm）	近端参考管腔直径（mm）	病变长度（mm）	支架尺寸	MLA（mm²）	MLD（mm）
1	LAD	1.86	1.39	76	纤维脂质钙化斑块（钙化角度270°）	3.20	3.47	16.82	3.0 mm×24 mm	6.73	2.82
2	LAD	预扩张后3.59	预扩张后1.77	84	纤维脂质钙化斑块、破裂（钙化角度270°）	3.04	4.0	38.7	3.0 mm×38 mm	9.62	3.30
3	RCA	2.67	1.81	60	纤维脂质斑块	2.98	3.5	43.87	3.0 mm×30 mm 3.5 mm×18 mm	8.84	3.21
4	LAD	2.27	1.25	65	纤维脂质钙化斑块（钙化角度360°）	3.05	3.63	41.69	3.0 mm×32 mm 3.5 mm×22 mm	7.36	2.86
5	LAD	2.74	1.74	68	纤维脂质斑块	2.99	3.94	40.49	3.0 mm×30 mm 3.5 mm×32 mm	7.74	3.06
6	LCX	1.78	1.33	77	纤维脂质斑块	2.97	3.63	49.29	2.75 mm×26 mm 3.0 mm×24 mm	6.58	2.82
7	LAD	2.62	1.66	60	纤维脂质钙化斑块（钙化角度180°）	2.47	2.99	29	2.5 mm×30 mm	6.55	2.75
8	LAD	2.66	1.76	72	纤维脂质钙化斑块（钙化角度180°）	3.13	4.22	72.51	3.0 mm×38 mm 4.0 mm×38 mm	13.58	3.97

序号	靶血管	术前IVUS评估							支架植入情况	术后IVUS评估
序号	靶血管	MLA（mm²）	MLD（mm）	PB（%）	靶病变斑块性质	远端参考管腔直径（mm）	近端参考管腔直径（mm）	病变长度（mm）	支架尺寸	MLA（mm²）	MLD（mm）
1	LAD	1.86	1.39	76	纤维脂质钙化斑块（钙化角度270°）	3.20	3.47	16.82	3.0 mm×24 mm	6.73	2.82
2	LAD	预扩张后3.59	预扩张后1.77	84	纤维脂质钙化斑块、破裂（钙化角度270°）	3.04	4.0	38.7	3.0 mm×38 mm	9.62	3.30
3	RCA	2.67	1.81	60	纤维脂质斑块	2.98	3.5	43.87	3.0 mm×30 mm 3.5 mm×18 mm	8.84	3.21
4	LAD	2.27	1.25	65	纤维脂质钙化斑块（钙化角度360°）	3.05	3.63	41.69	3.0 mm×32 mm 3.5 mm×22 mm	7.36	2.86
5	LAD	2.74	1.74	68	纤维脂质斑块	2.99	3.94	40.49	3.0 mm×30 mm 3.5 mm×32 mm	7.74	3.06
6	LCX	1.78	1.33	77	纤维脂质斑块	2.97	3.63	49.29	2.75 mm×26 mm 3.0 mm×24 mm	6.58	2.82
7	LAD	2.62	1.66	60	纤维脂质钙化斑块（钙化角度180°）	2.47	2.99	29	2.5 mm×30 mm	6.55	2.75
8	LAD	2.66	1.76	72	纤维脂质钙化斑块（钙化角度180°）	3.13	4.22	72.51	3.0 mm×38 mm 4.0 mm×38 mm	13.58	3.97

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