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Ultra-low-contrast angiography in patients with advanced chronic kidney disease and previous coronary artery bypass surgery

Rahim, Hussein M.a; Flattery, Erina; Gkargkoulas, Fotisb; Maehara, Akikoa,b; Mintz, Gary S.b; Hardy, Mark A.c; Cohen, David J.d; Dube, Geoffrey K.d; Crew, Russell J.d; Mohan, Sumitd,e; Radhakrishnan, Jaid; Ratner, Lloyd E.c; Moses, Jeffrey W.a,b,f; Ben-Yehuda, Oria,b; Kirtane, Ajay J.a,b; Stone, Gregg W.a,b; Leon, Martin B.a,b; Karmpaliotis, Dimitria,b; Ali, Ziad A.a,b

doi: 10.1097/MCA.0000000000000741
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Objective We sought to describe a technique for ultra-low-contrast angiography (ULCA) in patients with advanced chronic kidney disease (CKD) and previous coronary artery bypass surgery (CABG).

Background Patients with advanced CKD and previous CABG are at high risk of developing contrast-induced nephropathy (CIN) because of the additional contrast often required to identify bypass grafts. Apart from hydration, reduced contrast administration is the only established method to minimize the risk of CIN.

Patients and methods Ten patients underwent ULCA, whereby an intracoronary injection of saline and coronary guidewires were used instead of test injections of contrast for engagement of bypass grafts with catheters. Estimated glomerular filtration rate (eGFR) before and 30 days following angiography were recorded as was the need for renal replacement therapy 1 year after the procedure.

Results All patients completed a diagnostic angiogram without complications. The median volume of contrast delivered was 13.5 ml (interquartile range: 10.5–17.8). The median eGFR was 18.3 ml/min/1.73 m2 (interquartile range: 16.5–28.2). There was no statistically significant difference in eGFR before the procedure and 30 days after the procedure (P=0.79). No patient required dialysis 30 days after the procedure. Two patients required initiation of dialysis at 1 year after the procedure.

Conclusion In patients with advanced CKD and previous CABG, ULCA may be performed with high procedural success and without complications, minimizing the risk of CIN in these high-risk patients.

aCenter for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center

bClinical Trials Center, Cardiovascular Research Foundation

cDepartment of Surgery, Division of Transplantation, Columbia University Medical Center

dDepartment of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons

eDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York

fSt Francis Hospital, Roslyn, New York, USA

Correspondence to Ziad A. Ali, MD, DPhil, Division of Cardiology, Center for Interventional Vascular Therapy, NewYork-Presbyterian Hospital/Columbia University Medical Center, 161 Fort Washington Avenue, Herbert Irving Pavilion, 6th Floor, New York, NY 10032, USA Tel: +1 212 305 5233; fax: +1 212 342 3660; e-mail: zaa2112@columbia.edu

Received March 21, 2019

Accepted March 24, 2019

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