Successful stent implantation with the use of non contrast whole-heart coronary magnetic resonance angiography and intra
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IMAGES IN CARDIOVASCULAR INTERVENTION
Successful stent implantation with the use of non contrast whole‑heart coronary magnetic resonance angiography and intravascular ultrasound in patient with allergy to iodinated contrast media Shingo Kato1 · Kazuki Fukui2 Received: 25 August 2020 / Accepted: 20 September 2020 © Japanese Association of Cardiovascular Intervention and Therapeutics 2020
A 50-year-old male with a history of anaphylactic shock by iodine contrast was referred to our hospital for the examination of coronary artery disease. Serum creatine level was 0.66 mg/dL. On a coronary magnetic resonance angiography (MRA), significant coronary artery stenosis was clearly depicted in the middle segment of left anterior descending (LAD) artery (Fig. 1a–c). Myocardial single photon emission computed tomography (SPECT) detected exercise induced myocardial ischemia in the anteroseptal wall (Fig. 2a). Fortunately, LAD artery was very straight on coronary MRA, so that it seems not so difficult to cross the wire to LAD stenosis. Therefore, we decided to perform percutaneous coronary intervention (PCI) to LAD stenosis with the use of MRA and intravascular ultrasound (IVUS) without injection of iodine contrast. We obtained the approval by institutional review board of our hospital and the written informed consent was obtained from the patient to perform PCI. At the time of PCI, prophylactic corticosteroid was administered to prevent allergic reaction to gadolinium contrast. We inserted a 6-french sheath via right radial artery and engaged a 5-french guiding catheter (Heartrail II, BL3.5, Terumo, Shibuya, Tokyo, Japan) at left coronary artery ostium. After the engagement, we crossed a guide wire (SION blue, ASAHI INTECC, Nagoya, Aichi, Japan) to LAD very carefully to avoid wire perforation. IVUS was performed for measuring the length and vessel diameter, deciding the proximal edge and distal edge for * Shingo Kato sk513@yokohama‑cu.ac.jp 1
Departments of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3‑9 Fukuura, Kanazawaku, Yokohama, Kanagawa 236‑0004, Japan
Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
2
stent deployment (Fig. 1d, e). After IVUS, we implanted drug eluting stent (XienceExpedition, 3.0 × 23 mm, Abott labolatories, Lake Bluff, Illinois, United State) (Fig. 1f, g). We used gadolinium contrast even in the indeflator, because small amount of contrast media may be injected into the coronary artery if a balloon ruptures during stent implantation. Right before the stent implantation, we injected 2 mL of gadolinium contrast media (Magnevist, Bayer, Whippany, New Jersey, USA) to left coronary artery just checking if coronary stent was properly covering LAD stenosis. After stent deployment, IVUS was performed again for evaluating sufficient stent expansion and ruling out the stent edge dissection. After IVUS, we injected gadolinium contrast to left coronary artery again to ruling out coronary perforation. Total dose of gadolinium inj
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