The link between percutaneous coronary interventions (PCI) and coronary angiography is a fundamental one: at the time balloon angioplasty was born, selective coronary opacification was the only way to establish a diagnosis and to plan and guide balloon angioplasty. More than 40 years later, the current scenario for planning and guidance of PCI is entirely different, with multiple invasive and non-invasive coronary imaging and physiology tools. So has changed the kind of patients undergoing PCI: patient risk profile has markedly increased, particularly over the last decade not only to a change in demographics and mean patient age, but also to a more frequent treatment of patients with longstanding cardiac disease, more advanced atherosclerosis and prior coronary revascularisation, challenging anatomical scenarios, and concomitant systemic conditions. All this results in an increased risk of cardiac and non-cardiac complications of PCI which not seldom stems from the need to use iodinated contrast in large volumes because of PCI complexity or in patients highly susceptible of developing contrast-induced nephropathy (CIN).
This is the context for the growing interest of interventional cardiologists in the field of ultralow contrast (ULC) coronary interventions. Reducing the dependence on contrast injections is an important aspect of complex high-risk and indicated percutaneous intervention (CHIP) procedures. Also, for launching our first dedicated course on ULC PCI in which, over two days, we aim to provide a structured and practical approach to this important PCI skill.
The curriculum of the course will address fundamental aspects of PCI. Contrary to what many colleagues may think, ULC PCI is not intended solely for patients with pre-existing chronic kidney disease: it is a compendium of tools and skills aiming to improve procedural safety and the quality of coronary revascularisation in complex patients by reducing operator´s dependence on vessel opacification during PCI. In that regard, one of the first tasks of the course will be generating awareness of the many clinical situations in which ULC PCI may be helpful. We shall discuss in depth the importance of a change in mindset in ULC PCI. Be ready to learn features of your angiographic equipment that you were unaware of and that are very helpful in ULC PCI. We shall analyse how to best use available material (pre-existing coronary CT or angiography) in planning the intervention. And, of course, the use of dedicated tools and techniques during the intervention, including intracoronary ultrasound and physiology, dynamic coronary road mapping, along with many tips and tricks that do not require special equipment and that will increase your confidence as an operator during PCI.
This essential guide is an educational activity intended for an international audience, specifically interventional cardiologists and cardiologists. However, other healthcare professionals involved in the care of coronary artery disease (CAD) patients will also find this topical.
