Integration of multislice computed tomography with magnetic navigation facilitates percutaneous coronary interventions without additional contrast agents.
OBJECTIVE
We hypothesized that percutaneous coronary intervention (PCI) without additional contrast agents can be performed by directly integrating multislice computed tomography coronary angiography (CTCA) within the magnetic navigation system (MNS).


BACKGROUND
Increasingly, CTCA is being used in the diagnostic work-up of patients with coronary disease. Its inherent 3-dimensional information should be exploited, as it potentially offers advantages over 2-dimensional radiography in guiding invasive diagnostic and therapeutic interventions.


METHODS
CTCA-derived centerlines from 15 patients were coregistered and overlaid on real-time fluoroscopic images employing the MNS. Vessels were manually wired with a magnetically enabled guidewire assisted by variable local magnetic fields. Fractional flow reserve (FFR) determined the lesion severity, and the dimensions were quantified by intravascular ultrasound (IVUS). Locations of the IVUS catheter probe along the lesion were incorporated in software to facilitate stenting without contrast agents.


RESULTS
The average crossing and fluoroscopic times were 105.3 +/- 35.5 s and 83.4 +/- 38.6 s, respectively, with no contrast agents used in 11 of 15 patients (73.3%). Contrast agents were used in only 1 of 10 patients (10%) in whom an IVUS was performed. In 4 patients, apart from a "blinded" safety check angiogram, the entire PCI (lesion crossing, stent sizing, positioning, and deployment) was performed without additional contrast agents following the coregistration of the IVUS probe position in the MNS.


CONCLUSIONS
The integration of pre-procedural CTCA within the MNS can facilitate PCI without additional contrast agents.
Ramcharitar
Steve
S
Department of Cardiology, The Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
Pugliese
Francesca
F
Schultz
Carl
C
Ligthart
Jurgen
J
de Feyter
Pim
P
Li
Huling
H
Mollet
Nico
N
van de Ent
Martin
M
Serruys
Patrick W
PW
van Geuns
Robert Jan
RJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008280:Magnetics; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018084:Ultrasonography, Interventional
D003287:Contrast Media