In patients with renal insufficiency, advanced techniques have been described to achieve ultra-low contrast or zero contrast percutaneous coronary interventions (PCI). However, these techniques use intra-coronary imaging before stent placement to determine adequate landing zones, by correlating them with saved fluoroscopic landmarks. Still, this leaves the operator with a certain degree of uncertainty about the exact lesion coverage, which is checked with post-stent intra-coronary imaging. We hereby describe a novel technique which takes away the concern of uncertainty regarding stent-landing zones and allows for the highest amount of precision in stent positioning, arguably even better than with the use of angiography. This technique involves positioning coronary stents under the live guidance of an intravascular ultrasound (IVUS) catheter which is positioned simultaneously, side by side to a stent. This technique takes advantage of all the benefits of IVUS based PCI without losing the precision in stent positioning when compared to traditional angiography. It simplifies the application of low contrast PCI by the interventional cardiology community, while maintaining the confidence in precise stenting. It has also the potential to decrease the incidence of contrast-induced nephropathy, hence procedural morbidity, while allowing for optimal long-term image based PCI outcomes. Obviously, it applies to moderate or larger coronary segments, without significant tortuosity. It also comes at the expense of slightly larger guide catheters, which is compensated for by the use of thin walled sheaths or sheathless catheter systems. Finally, radial access is still applicable depending on radial artery size and available equipment.

中文翻译：

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低对比度经皮冠状动脉介入术中实时 IVUS 引导下的冠状动脉支架定位：实时 IVUS 支架技术

在肾功能不全患者中，已经描述了实现超低对比度或零对比度经皮冠状动脉介入治疗 (PCI) 的先进技术。然而，这些技术在支架放置之前使用冠状动脉内成像来确定足够的着陆区，通过将它们与保存的荧光镜标志相关联。尽管如此，这仍使操作者对确切的病变覆盖范围存在一定程度的不确定性，这可通过支架后冠状动脉内成像进行检查。我们在此描述了一种新技术，它消除了对支架着陆区不确定性的担忧，并允许支架定位的最高精确度，甚至可以说比使用血管造影术更好。该技术涉及在血管内超声 (IVUS) 导管的实时引导下放置冠状动脉支架，该导管同时并排放置在支架上。与传统的血管造影术相比，该技术利用了基于 IVUS 的 PCI 的所有优点，同时又不会失去支架定位的精度。它简化了介入心脏病学界对低对比度 PCI 的应用，同时保持了对精确支架置入术的信心。它还可能降低造影剂肾病的发生率，从而降低手术并发症，同时实现基于 PCI 的最佳长期影像结果。显然，它适用于中等或较大的冠状动脉节段，没有明显的曲折。它还以稍大的引导导管为代价，这可以通过使用薄壁护套或无护套导管系统来补偿。最后，径向通路仍然适用，具体取决于桡动脉大小和可用设备。