الفهرس | Only 14 pages are availabe for public view |
Abstract Intravascular ultrasound (IVUS) was largely used to guide percutaneous coronary interventions (PCIs). Because of its ability to accurately measure lumen, plaque, and vessel dimensions, it is possible that IVUS might serve as an adjuctive tool to angiography in many steps during PCI, therefore it is hypothesized that IVUS imaging during coronary angioplasty may lead to a reduced use of contrast media. Contrast-induced acute kidney injury (CI-AKI) is a potential complication of diagnostic and therapeutic angiographic procedures. Almost unanimously, previous studies have shown that CI-AKI is associated with worse clinical outcomes. It remains debatable, however, whether CI-AKI is solely a marker for future morbidity and mortality or, conversely, it is also causally implicated in the occurrence of adverse events. Although the incidence of CI-AKI is modulated by several clinical characteristics, the volume of iodine contrast seems to be a major factor leading to CI-AKI, independently of the baseline risk profile. Curiously, thus far, few approaches have been described to reduce the primary cause of CI-AKI after PCI, namely, the contrast agent dose.The aim of our study to evaluate the impact of intravascular ultrasound guidance on the final volume of contrast agent utilized in diabetic patients undergoing PCI for chronic stable angina and its clinical implications. Our study was conducted upon 100 Diabetic Egyptian patients with chronic stable angina who were selected to angiography-guided PCI (n= 50 patients) or IVUS-guided PCI (n=50 patients) from June 2019 to January 2020. All patients were subjected to full history taking and clinical examination including diabetes mellitus, hypertension, smoking and family history of IHD, thorough clinical examination, surface Electrocardiogram (ECG) and laboratory investigations as serum creatinine and glycated hemoglobin (HbA1c). All patients signed the informed consent. Patients with known allergy to contrast agents, unstable or unknown renal function prior to PCI and anticipated technical impossibility for intravascular ultrasound (Extreme calcifications) were excluded from the study. The interventional plan was left to the discretion of the operator, but regardless of the allocated arm, operators was strongly recommended to follow strict strategies to reduce the total volume of contrast for all patient. All percutaneous procedures were performed using nonionic, low-osmolar or iso-osmolar, iodine-based contrast media (iopromide [Ultravist® ; Bayer Pharma AG, Berlin, Germany] or iodixanol [Visipaque™; GE Healthcare Ireland, Cork, Ireland]).For those allocated to the IVUS-guided group, intravascular ultrasound was performed with the Eagle Eye Plantium ST Pro Imaging Catheter 40 MHz connected to VOLCANO Ultrasound Imaging System by PHILLIPS. Analysis of baseline characteristics of our study population showed that mean age(years) was 60.20±10.33 (conventional PCI group ) and 59.58 ± 8.29 ( IVUS group), Mean weight(Kg) was77.78 ± 6.09 (conventionl PCI group) and 81.50 ± 8.61 (IVUS group), 14 (28.0%) were females and 36 (72.0 %) were males (conventional PCI group), 13 (26.0%) were females and 37 (74.0%) were males (IVUS group), 24 (48.0%) were hypertensive (conventional PCI group) and 26 (52.0%) were hypertensive (IVUS group) and all patients were diabetic in both groups It was found in our study that the median total volume of contrast was 111.65 ml (interquartile range [IQR] 170.40 ± 52.91ml, range from 100 ml to 300 ml) in angiography-guided group vs. 56.99 ml (IQR 94.70 ± 19.28ml, range from 70 ml to 180 ml) in IVUS-guided group (p<0.001). The present study concluded that thoughtful and extensive utilization of IVUS as the primary imaging tool to guide percutaneous coronary intervention is safe and markedly reduces the volume of iodine contrast, compared to angiography-alone guidance. |