title: Magnetic positioning system in coronary angiography and percutaneous intervention: a feasibility and safety study.
abstract: OBJECTIVE
  This study sought to evaluate the safety and feasibility of a magnetic medical positioning system (MPS) to determine the three-dimensional (3D) position and orientation of intracoronary wires and catheters and to guide angiography and percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Coronary angiography relies on fluoroscopy for catheter navigation and often fails to accurately portray vessel tortuosity, overlap, and length because of complex anatomy and foreshortening of curved coronary segments.
  
  
  METHODS
  Forty adult participants underwent coronary angiography and/or PCI with MPS guidance. Two interventional cardiologists independently scored (1-5) the accuracy of MPS catheter tracking projected on live fluoroscopy, recorded cine loops, and 3D vessel reconstructions. Measurements from MPS reconstructions were compared to conventional two-dimensional (2D) quantitative coronary angiography (QCA) measurements. Device procedural success was defined as the ability of the MPS-enabled catheter to reach the target vessel, perform the intended operations, and be retrieved without major adverse cardiac events.
  
  
  RESULTS
  Diagnostic coronary angiography was performed in 19 (47.5%) and PCI in 21 patients (52.5%). MPS procedural success was achieved in 36 (90%) of the cases. MPS accuracy was highest with the MPS superimposed on live fluoroscopy (4.9 ± 0.2/5) and the 3D vessel reconstruction (4.7 ± 0.5/5). MPS length measurements were more accurate than conventional QCA.
  
  
  CONCLUSIONS
  This study demonstrates the feasibility and safety of magnetic catheter tracking with 3D positional data during diagnostic angiography and PCI. Catheter position was accurately projected on real-time fluoroscopy, recorded cine loops, and 3D reconstructions. An MPS may serve as a platform for device navigation and positioning during PCI.
authors.affiliation: Center for Interventional Vascular Therapy, NewYork Presbyterian Hospital, Columbia University Medical Center, New York, NY.
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Smilowitz
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: LeRoy E
authors.initials: LE
authors.lastname: Rabbani
authors.forename: Michael B
authors.initials: MB
authors.lastname: Collins
authors.forename: Adrian
authors.initials: A
authors.lastname: Herscovici
authors.forename: Andreas
authors.initials: A
authors.lastname: Jeron
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Andreas
authors.initials: A
authors.lastname: Luchner
mesh_terms: D000368:Aged; D062906:Cardiac Catheters; D017023:Coronary Angiography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D005858:Germany; D006801:Humans; D021621:Imaging, Three-Dimensional; D008280:Magnetics / Q000295:instrumentation / Q000379:methods*; D059346:Magnets; D008297:Male; D008875:Middle Aged; D009519:New York City; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000295:instrumentation / Q000379:methods*; D013813:Therapy, Computer-Assisted / Q000295:instrumentation / Q000379:methods*
keywords: catheter; coronary vessels; fluoroscopy; image reconstruction; magnetic