Intraprocedural Strategies

Intraprocedural strategies for patients with CKD largely depend on (1) the choice of contrast agent, (2) minimizing the volume that is used, and (3) avoiding use of potentially nephrotoxic medications. However, this must be done without sacrificing the operator's ability to adequately and safely perform the procedure, which always requires a careful balance. Appropriate visualization of the lesion and adjacent coronary anatomy is essential for success during PCI and should not be sacrificed.

General strategies to consider include the use of smaller guiding catheters whenever possible, because they are associated with lower volumes of contrast agents. It is also important to minimize the use of contrast agents during the diagnostic portion of the case if ad hoc PCI is performed. This can be done by avoiding left ventriculograms and using noninvasive tests such as echocardiography to evaluate systolic wall motion and function. The use of biplane coronary angiography, which allows the operator to obtain two simultaneous views with one injection during cineangiography, is another commonly used tool.

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