Saline-Enhanced Optical Coherence Tomography (OCT) and Combined Orbital Atherectomy and Intravascular Lithotripsy in Complex Right Coronary Artery Stenosis With Chronic Kidney Disease

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2025-02-04 DOI:10.1002/ccd.31441

Zubair Naeem-Shaukat, Javed Ehtisham, Naeem Shaukat, Ayman Helal

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引用次数: 0

Abstract

Managing coronary artery disease (CAD) in patients with chronic kidney disease (CKD) poses significant challenges, particularly in reducing contrast volume to prevent worsening renal function. We present the case of a 67-year-old male with an initial presentation of inferior STEMI and 2:1 Mobitz Type II AV block, who underwent successful primary percutaneous coronary intervention (PPCI) for a thrombotic occlusion in the right coronary artery (RCA) then staged procedure for calcium modification and stenting. This report highlights two key aspects of the procedure: using saline instead of contrast for optical coherence tomography (OCT) to minimize contrast exposure, and and employing combination of orbital atherectomy followed by intravascular lithotripsy (IVL) for calcium modification in a heavily calcified lesion. The case underscores the importance of individualized procedural strategies to optimize outcomes in patients with complex coronary anatomy and comorbid CKD. In conclusion, using saline-enhanced OCT provides adequate imaging and helps to minimize contrast use to prevent kidney injury while the combined use of orbital atherectomy and IVL allowed for optimal calcium modification, enabling excellent stent deployment in a severely calcified coronary disease.

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盐增强光学相干断层扫描（OCT）和联合眶动脉粥样硬化切除术和血管内碎石术在复杂右冠状动脉狭窄合并慢性肾脏疾病中的应用。

慢性肾脏疾病（CKD）患者的冠状动脉疾病（CAD）管理面临重大挑战，特别是降低造影剂体积以防止肾功能恶化。我们报告了一名67岁男性的病例，他最初表现为下段STEMI和2:1 Mobitz II型房颤阻滞，他成功地接受了原发性经皮冠状动脉介入治疗（PPCI），治疗右冠状动脉血栓闭塞（RCA），然后进行了分阶段的钙修饰和支架植入手术。本报告强调了手术的两个关键方面：在光学相干断层扫描（OCT）中使用生理盐水代替造影剂以减少造影剂暴露，以及在严重钙化病变中采用眶动脉粥样硬化切除术后血管内碎石术（IVL）联合进行钙修复。该病例强调了个体化手术策略对于优化复杂冠状动脉解剖和合并CKD患者预后的重要性。总之，使用盐增强OCT提供了足够的成像，并有助于减少造影剂的使用，以防止肾损伤，而联合使用眶动脉粥样硬化切除术和IVL允许最佳的钙修饰，使支架部署在严重钙化的冠状动脉疾病。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.