Percutaneous coronary intervention using iso-osmolar contrast agent in an end-stage renal failure patient: a case report

Abstract Background Managing acute myocardial infarction (AMI) in end-stage renal failure (ESRF) patients poses challenges, particularly the risk of contrast-induced nephropathy (CIN) during percutaneous coronary intervention (PCI). This case highlights the successful use of iodixanol, an iso-osmolar contrast agent, in an ESRF patient who declined dialysis with no renal function deterioration. It underscores the potential of iodixanol in safely managing high-risk patients, offering insights for clinical practice. Case presentation A 79-year-old male with non-ST-elevation myocardial infarction (NSTEMI) and end-stage renal failure (ESRF), who had declined dialysis, underwent PCI using iodixanol. Coronary angiography revealed significant left main and triple vessel disease, and coronary artery bypass grafting (CABG) was declined by the patient. A second intervention was performed one week later due to persistent symptoms. Post-procedural monitoring revealed stage 1 acute kidney injury (AKI), which was successfully managed with intravenous fluid therapy. Renal function stabilized after the second procedure, and the patient was discharged one week later. Conclusion The use of iodixanol in ESRF patients undergoing PCI without dialysis appears to be a favorable option. Further studies are needed to guide contrast agent selection in this high-risk group.