Objective To investigate the feasibility of substituting iodinated contrast with intravenous ultrasound (IVUS) during the procedure of percutaneous coronary intervention (PCI) in chronic renal insufficiency patients suffering from angina pectoris. Methods A total of 51 angina pectoris patients with chronic renal insufficiency admitted in our hospital from January 2018 to December 2019 were enrolled in the study. They were randomly divided into conventional treatment group (n=30) and IVUS guidance group (n=21). Iodinated contrast was used in the conventional treatment group, and PCI was performed conventionally. For the IVUS guidance group, PCI was performed according to the results of IVUS examination, and iodine contrast was disallowed in the procedure. The primary end point was the success rate of procedure in 2 groups, and the secondary end point was the changes of renal function, incidence of complication and relief of angina pectoris. SPSS statistics 18.0 was used to analyze the data.Results PCI was successfully performed in both groups, and no significant differences were seen in the PCI and procedure success rates between them. Before the treatment, there were no statistical differences in estimated glomerular filtration rate [eGFR, (46.3±20.4) vs (39.7±13.2)L/(min·1.73m²), P=0.201] and serum creatinine [(SCr, (167.2±57.4) vs (156.3±44.3)μmol/L, P=0.469] between the two groups. In 24h after the treatment, the conventional treatment group had obviously increased SCr level [(210.3±100.9) vs (167.2±57. 4)μmol/L, P=0.002] and higher incidence of contrast-induced nephropathy (CIN) when compared with the IVUS guidance group (37% vs 0%, P<0.001). The SCr level was notably lower in the IVUS guidance group in 24h after treatment than the conventional treatment group [(144.6±41.9) vs (210.3±100.9)μmol/L, P=0.007]. Conclusion In angina pectoris patients with chronic renal insufficiency, it is feasible to use IVUS instead of iodine contrast during the procedure of PCI if indications are suitable.