MRCA Combined With Zero-Contrast IVUS-Guided PCI in a Patient With NSTE-ACS and Severe Contrast Allergy

BACKGROUND: The management of acute coronary syndrome in patients with severe hypersensitivity reactions to iodine-based contrast media (ICM) remains a considerable clinical challenge, particularly when coronary anatomy is undetermined. CASE SUMMARY: A 50-year-old man with non-ST-segment elevation acute coronary syndrome and severe hypersensitivity reactions to ICM was referred for revascularization without coronary anatomic information. Magnetic resonance coronary angiography (MRCA) and zero-contrast intravascular ultrasound (IVUS) were integrated for the first time to evaluate coronary artery lesions and guide percutaneous coronary intervention. DISCUSSION: This case demonstrates that combining MRCA with IVUS-guided percutaneous coronary intervention presents a promising direction for managing patients with coronary artery disease who experience hypersensitivity reactions to ICM. This is especially beneficial for high-risk patients who require revascularization. TAKE-HOME MESSAGE: Multimodality imaging strategy, which integrates MRCA and IVUS, provides a viable solution to such clinical challenges, thereby enabling revascularization in patients with coronary artery disease and specific contraindications to conventional imaging.