Application of Intravascular Ultrasound-Guided Fluoroscopic Screen Marking in Zero-Contrast PCI

ZHANG Yiming; XING Erkun; ZHANG Bo; BAI Ming; ZHANG Zheng

doi:10.3639/j.issn.2095-3097.2025.06.016

Abstract：Objective To investigate the application value of intravascular ultrasound(IVUS)-guided fluoroscopic screen marking in zero-contrast percutaneous coronary intervention(PCI),assessing the safety,feasibility,and short-term effi-cacy of this strategy in patients with contrast allergy.Methods We retrospectively enrolled 28 patients with confirmed contrast allergy who underwent absolute zero-contrast PCI at the Department of Cardiology,First Hospital of Lanzhou University from January 2021 to March 2025.IVUS was used to real-time assess lesions,guide stent selection/optimization;for lesions iden-tified as borderline by IVUS,fractional flow reserve(FFR)measurement was performed(FFR<0.80 as intervention criterion).The IVUS-guided fluoroscopic screen marking technique was applied for lesion localization.Procedure success rate,intraop-erative allergic reactions,perioperative major adverse cardiovascular events(MACE),and follow-up outcomes were observed.Results All 28 patients(30 lesions)successfully underwent absolute zero-contrast PCI with 100.0%technical success rate and no intraoperative allergic reactions.Stents were implanted in 16 patients(57.1%);among 4 borderline lesions assessed by FFR,stents were implanted in 2 patients with FFR<0.80.All stents met IVUS optimization criteria post-procedure.No in-hospital MACE occurred.At a median follow-up of 12.8 months,no allergic reaction recurrence or MACE was observed,with alleviated angina symptoms.Conclusion For contrast-allergic patients,zero-contrast PCI guided by IVUS with fluoroscopic screen mark-ing is safe and effective,avoiding contrast-induced allergic reactions.This marking technique is a simple and practical navigation method.Combined IVUS and FFR assessment enables precise anatomical and functional coronary revascularization.