Zero-Contrast PCI in a Patient With Recurrent Anaphylaxis to Contrast

Background: Iodinated contrast media (ICM) are important for percutaneous coronary intervention (PCI) but can trigger life-threatening reactions in sensitized patients. Alternative strategies are needed for safe revascularization. Case Summary: A 59-year-old woman with heart failure, diabetes, and prior ICM-induced anaphylactoid reaction presented with stable angina. Angiography showed severe left anterior descending and left posterior descending artery stenosis. She declined coronary artery bypass grafting and experienced recurrent severe anaphylactoid reactions during PCI attempts despite premedication. After desensitization, she underwent successful zero-contrast PCI using intravascular ultrasound and previous imaging as a guide. Discussion: This case highlights the limitations of premedication alone in preventing ICM reactions and supports the use of zero-contrast PCI. The literature demonstrates its safety and feasibility, even in complex lesions, offering a valuable alternative for high-risk patients. Take-Home Message: Zero-contrast PCI is a safe and effective option for patients with ICM hypersensitivity.