At present, coronary angiography is one of the most reliable diagnostic methods for coronary heart disease. However, the use of contrast has certain risks, and some patients may experience allergic reactions or other adverse reactions after contrast use. Recently, a patient who was highly allergic to contrast was admitted to Department of Cardiovascular medicine ICU (CCU ward) of the First Affiliated Hospital (FAH) of Xi’an Jiaotong University (XJTU).
A 78-year-old male patient had severe allergic reactions to contrast medium. He was diagnosed with unstable angina pectoris due to precordial pain after physical activity, and stent implantation may be required. Nevertheless, coronary angiography is the gold standard for diagnosis. Considering the patient's severe allergic reaction to contrast medium, it is challenging and risky to perform surgery without contrast coronary angiography.
Consequently, Director Yuan Zuyi, Associate Chief Physician Liu Ping, Chen Tao, Ren Jie, Huo Jianhua and Attending Physician Yang Yanjie and other senior experts from FAH formed a CCU team. After comprehensive analysis and consultation, PCI surgery was considered as a necessary treatment for unstable angina pectoris.
To resolve the problem of contrast allergy, the surgical team proposed a protocol of IVUS (intravascular ultrasound)-guided contrast-free PCI. IVUS, as an advanced medical imaging technology, can display clear images of the interior of vessels without contrast use, and provide accurate information of lesion location and measurement for physicians.
After obtaining the consent of the patient's family, the surgical team started the surgery. With abundant surgical experience and exquisite skills, they successfully delivered the guide wire to the distal end of the lesion without contrast use. Subsequently, relying on the high-definition IVUS images, the patient's coronary artery lesions were accurately located and measured, and the stent implantation was successfully completed.
After several hours of intense and orderly operation, the surgery was successfully performed. Postoperatively, the patient was in good condition and his symptoms were significantly improved. IVUS not only solves the problem that patient cannot receive conventional treatment because of contrast allergy, but also provides novel treatment option for more patients with such conditions.
