Coronary artery stent implantation is one of the effective methods for treating coronary heart disease. During the surgical process, vascular contrast agents are needed to enhance vascular imaging. This not only better displays the location of the lesion and the degree of stenosis, but also helps guide the wire forward, assist in stent positioning, and assess stent effectiveness.

In other words, coronary stent implantation without guidance from contrast agents is almost impossible, but what if there is an allergy to the contrast agent?

Recently, the intervention team from the Cardiovascular Department of the First Hospital of Hebei Medical University encountered such a challenge.

A month ago, Aunt Li underwent emergency intervention surgery at a hospital in her hometown due to a sudden acute myocardial infarction. A stent was implanted in the right coronary artery to open the occluded blood vessel. The doctor told Aunt Li that there was another blood vessel with severe stenosis that needed to be treated at a scheduled time, but refused to give her another surgery.

The reason is that after Aunt Li’s first intervention surgery, she developed a serious allergic reaction to contrast agents, with skin rash and facial edema all over her body. It took a long time to recover after treatment.

Aunt Li came to the Cardiovascular Department of the First Hospital of Hebei Medical University for treatment. Director Qi Guoqing’s intervention team carefully studied the intervention CD and case data brought by the patient and found that the patient’s right coronary stent was unobstructed, and 95% of the middle segment of the anterior descending artery was severely narrowed, requiring treatment for severe stenosis of the anterior descending artery. But the patient is allergic to contrast agents, and if they are allergic to contrast agents again, the reaction will be even more severe and even life-threatening!

After careful preoperative discussions with the intervention team and thorough communication with the patient and their family, Director Qi Guoqing and Deputy Director Wei Liye finally decided to break the norm and use intravascular ultrasound guidance to perform coronary stent implantation with "no contrast media" for the patient.

Intravascular ultrasound is simply understood as the installation of a miniature ultrasound probe on a catheter to display the cross-sectional morphology and blood flow patterns of the cardiovascular system. It largely compensates for the shortcomings of relying solely on the naked eye to analyze the severity of the lesion, and is also known as the "third eye of coronary artery fluoroscopy.".

However, the use of zero contrast agents still makes the surgery almost "blind", making it difficult to see the "path" of blood vessels in a three-dimensional and complete manner. This requires the surgeon to have a deep understanding of coronary anatomy and intravascular ultrasound images, as well as rich experience in guidewire catheter operation, which requires extremely high demands from doctors and surgical teams.

The surgery was jointly completed by Director Qi Guoqing and Deputy Director Wei Liye, leading a team. During the operation, the skilled guidewire operation technique was first used to smoothly deliver the guidewire to the distal end of the anterior descending branch. However, since contrast agents cannot be used, how can the stent be positioned in the ideal position?

The intraoperative team cleverly inserted another guide wire into the branch blood vessel as a landmark for stent positioning, and then skillfully operated intravascular ultrasound (IVUS) by technician Sun Xiansheng from the interventional therapy department to accurately measure the diameter of the blood vessel, the nature and length of the lesion, and assist in guiding stent positioning and selecting stent models.

(Preoperative and postoperative ultrasound imaging display)

(Comparison of preoperative and postoperative angiography)

After the release of the stent, another intravascular ultrasound examination showed that the stent adhered well to the wall and expanded well, completely covering the lesion, and there was no dissection of the blood vessels at both ends of the stent. In less than 40 minutes, a perfect zero contrast agent coronary intervention surgery was successfully completed without using a single drop of contrast agent throughout the process.

After the surgery, Aunt Li recovered well without any complications or special discomfort reactions.