Rethinking Percutaneous Coronary Intervention: The Era of Ultra‐Low‐Contrast Intervention

ABSTRACT

Iodinated contrast remains a key component of percutaneous coronary intervention, yet it poses a significant risk for contrast‐associated acute kidney injury (CA‐AKI), particularly in patients with chronic kidney disease (CKD). This review summarizes the evidence, procedural workflow with stepwise approach including clinical implications of ultra‐low‐contrast PCI (ULC‐PCI). We reviewed recent literature describing strategies for contrast reduction, imaging and physiology‐guided PCI, and subsequent clinical outcomes. ULC‐PCI incorporates techniques such as intravascular imaging (IVUS/OCT), fractional flow reserve (FFR/iFR), and dynamic coronary roadmap imaging to safely reduce contrast exposure while maintaining procedural quality. It, thus, represents a paradigm shift toward a safer, precision‐guided revascularization. Broader implementation requires structured training in this aspect and further outcome validation.