Awareness of the baseline creatinine clearance in order to target the contrast use not to exceed a volume-to-creatinine clearance ratio of 2. All measures should be employed to never exceed a ratio of 3, whenever possible.
Detailed analysis of the diagnostic coronary angiography in order to plan the interventional procedure (e.g. choice for best projections, selection of treatment strategies) and anticipate potential complications.
If the diagnostic coronary angiography is recent and of good quality, consider avoiding any baseline angiography during PCI. In this case, the diagnostic angiography, displayed in an auxiliary video monitor, should be used as baseline reference.
Extensive use of auxiliary video monitors with reference images of the target vessel anatomy during the procedure.
Extensive use of online X-ray (non-contrast) stent enhancement post-processing techniques
Small-diameter guiding catheters (5 or 6 French), with no side holes.
Small volume syringes for contrast injection (3 or 5 ml)
Extensive use of diluted contrast during the procedure (at least 1:1)
All contrast injections must be done during acquisition (not fluoroscopy), for better visualization of target segments and to allow for repeat video loops.
Avoid unnecessary “puff testing” of contrast.
Liberal use of high acquisition rates. Increased acquisition rates (i.e. > 15 frames per second) may be used during the procedure to improve angiographic image quality, particularly in patients with high heart rate or for fast moving target segments (e.g. mid right coronary artery or mid left circumflex artery).
Before insertion of any new interventional material into the guiding catheter (e.g. balloons, stents), caution must be taken to clean the lumen of the catheter free of contrast.
