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Iodinated contrast media are required in all cases who undergo coronary angiography and percutaneous coronary interventions (PCI). Though the modern contrast media (both low-osmolar and iso-osmolar) have lesser adverse effects than the older generation contrast media, they may lead to life threatening complications in few cases. Contrast induced acute kidney injury (CI-AKI) is one such complication where the presentation may vary from asymptomatic mild elevation in serum creatinine to life threatening uremia. Various pre-procedural and procedural steps are followed commonly to prevent CI-AKI and reducing the contrast volume is one of the most important steps. Indeed, multiple studies have proven that reducing the contrast volume during PCI reduces the risk of CI-AKI. More recently, intra-coronary imaging guided zero-contrast PCI has emerged as an important method to prevent CI-AKI. Though randomised controlled trials comparing low-contrast PCI and zero-contrast PCI are lacking, this technique is being used widely by experienced operators. Technical expertise in complex PCI and meticulous analysis of intra-coronary imaging, particularly intravascular ultrasound (IVUS), are mandatory for this procedure.
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