Magnetic navigation in percutaneous coronary intervention.
Magnetic navigation is the use of adjustable magnetic fields to precisely direct wires and equipment for clinical applications. It is a recently developed option that is now available for interventional cardiology. Procedures are based on the production of a three-dimensional reconstruction of the vessel lumen from standard angiographic images. Knowledge of the positions of the table and image intensifier during angiography allows calculation of the vessel coordinates in real space within the patient's chest. The applied magnetic field can be changed at any time to redirect the wire tip in order to improve navigation through complex and tortuous anatomy. The digital information of the coronary reconstruction can be used in further novel ways. Firstly, the integration of multislice computerized tomography images adds information about the path of the previous lumen of chronic total occlusions. Secondly, the computed center-line of the reconstructed vessel can be superimposed onto the live fluoroscopy images as a three-dimensional guide. The combination of improved navigation together with the other available system features may improve time, contrast, and material usage in a range of coronary lesions. Future potential developments include improvements in equipment and software, and potential therapeutic strategies under consideration include the use of equipment to perform remote control procedures, and the integration of the system to improve bone marrow-derived stem cell delivery.
Patterson
Mark S
MS
Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. markspatterson@doctors.net.uk
Schotten
Jeroen
J
van Mieghem
Carlos
C
Kiemeneij
Ferdinand
F
Serruys
Patrick W
PW
D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography / Q000295:instrumentation*; D023921:Coronary Stenosis / Q000628:therapy*; D055590:Electromagnetic Phenomena / Q000295:instrumentation*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D015641:Radiography, Interventional / Q000295:instrumentation / Q000379:methods; D014584:User-Computer Interface