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Review
. 2025 Feb 24;18(4):409-424.
doi: 10.1016/j.jcin.2024.11.043.

Ultra-Low-Contrast PCI: A Structured Approach to Reducing Dependence on Contrast Vessel Opacification in PCI

Asad Shabbir  1 , Ziad Ali  2 , Giuseppe Colletti  3 , Dariusz Dudek  4 , Roberto Garbo  5 , Farrel Hellig  6 , Jeffrey Moses  7 , Abdul Mozid  8 , Sunao Nakamura  9 , Billal Patel  10 , Gabor G Toth  11 , Nattawut Wongpraparut  12 , Nieves Gonzalo  1 , Javier Escaned  13
Affiliations
Free article
Review

Ultra-Low-Contrast PCI: A Structured Approach to Reducing Dependence on Contrast Vessel Opacification in PCI

Asad Shabbir et al. JACC Cardiovasc Interv. .
Free article

Abstract

Since its inception, percutaneous coronary intervention (PCI) has relied upon vessel opacification with iodinated contrast to plan, guide, and assess the results of the procedure. Yet revisiting this fundamental concept is important in contemporary PCI practice, especially in patients with high-risk clinical or anatomical profiles. In addition to decreasing the probability of acute kidney injury during PCI, limiting the volume of iodinated contrast allows the operator to perform more thorough interventions by relying on intracoronary imaging and physiology, ultimately contributing to more complete revascularization and improving the efficacy and durability of the intervention. Ultra-low-contrast PCI (ULCPCI) may thus be useful in performing PCI not only in patients with chronic renal dysfunction but also in those with multivessel coronary artery disease, impaired left ventricular function, and many other scenarios. The aim of this review is to highlight contemporary PCI scenarios in which a ULCPCI approach may be beneficial. The authors provide a structured approach to address the challenges faced by operators in transitioning from conventional contrast-based interventions to ULCPCI, with practical solutions that are accessible to most interventionalists. The reader will learn that ULCPCI is feasible in contemporary practice as a result of technological innovation, the implementation of dedicated skills, and redefining the role of angiography as the cornerstone of contemporary PCI.

Keywords: CHIP; CTO; complex PCI; contrast-induced nephropathy.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Shabbir has received honoraria and speaking fees from Philips, Abbott, and iVascular. Dr Ali has received institutional grant support from Abbott, Abiomed, ACIST Medical Systems, Amgen, Boston Scientific, CathWorks, Canon, Conavi, Chiesi, HeartFlow, Inari, Medtronic, the National Institutes of Health, Nipro, Opsens Medical, Medis Medical Imaging, Philips, Shockwave Medical, Siemens, SpectraWAVE, and Teleflex; has received consulting fees from Abiomed, AstraZeneca, Boston Scientific, CathWorks, HeartFlow, Opsens, Philips, and Shockwave Medical; and holds equity in Elucid, Lifelink, SpectraWAVE, and VitalConnect. Dr Colletti has received consulting fees from Boston Scientific and Philips; and has received honoraria for educational events from Cordis outside the submitted work. Dr Garbo is a consultant for Philips, Boston Scientific, Asahi Intecc, Terumo, Medtronic, and iVascular. Dr Hellig has received honoraria and speaking fees from Philips and Boston Scientific. Dr Moses has reported equity with Orchestra BioMed and Covanos; and holds equity in Xenter. Dr Mozid has received honoraria and speaking fees from Abbott, Biotronik, Philips, and Shockwave Medical. Dr Patel has received speaking fees for Philips. Dr Toth has received consulting fees from Abbott, Biotronik, Boston Scientific, Medtronic, and Terumo. Dr Wongpraparut has received honoraria and speaking fees from Philips, Abbott, Medtronic, and Boston Scientific; and has received a research grant from Abbott. Dr Gonzalo has received consulting fees from Philips and Boston Scientific. Dr Escaned has received speaking and advisory board fees from Abbott, Boston Scientific, and Philips; and is supported by the Intensification of Research Activity project (INT22/00088) of the Spanish Instituto de Salud Carlos III. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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