Minimizing Contrast Use in High-Risk Patients: A Case Report of Optical Coherence Tomography-Guided Percutaneous Coronary Intervention

Contrast-induced nephropathy (CIN) is a concerning complication following percutaneous coronary intervention (PCI), particularly in patients with preexisting renal impairment, diabetes, hypertension, and heart failure. Intravascular imaging with optical coherence tomography (OCT) requires contrast flushes for clearing blood and can cause CIN. We present a patient at high risk for developing CIN who underwent PCI with minimal contrast use, aided by OCT with saline flushes and a parallel wire technique to visualize plaque morphology and guide stent placement, while avoiding excessive contrast exposure. The patient had no worsening of kidney function after the procedure. Despite the absence of intravascular ultrasound, the parallel wire technique facilitated accurate stent positioning, contributing to a successful PCI outcome. This case underscores the importance of minimizing contrast use in high-risk patients and highlights the efficacy of OCT with saline flushes as an alternative imaging modality in reducing the risk of CIN during PCI.