Novel Dynamic Coronary Roadmap Technology is Feasible as Image Guidance for Percutaneous Coronary Interventions

Background
Dynamic Coronary Roadmap (DCR) is a novel technology that automatically overlays a dynamic, motion-compensated roadmap of the coronary arteries on live 2D fluoroscopy images (Figure 1). The roadmap is based on the latest angiogram acquired in the same angulation. DCR assists in device navigation, potentially minimizing the need for additional contrast puffs. The aim of this study was to evaluate the feasibility and clinical usefulness of DCR for Percutaneous Coronary Interventions (PCI).

Methods
For this single center study, 11 different physicians prospectively enrolled 52 patients undergoing ad hoc or elective PCI for stable Coronary Artery Disease using DCR. Chronic Total Occlusions were excluded. Feasibility was determined by subjective rating of accuracy, quality and clinical usefulness of the roadmap by the attending physician after each intervention.

Results
PCI was successful in all but one patient, who required follow-up rotational atherectomy for a heavily calcified lesion. Lesions were located in the LAD/diagonal (40%), LCX/marginal branches (37%), RCA (19%) or left main (4%). In 84% of procedures, the majority of sequences showed a good to excellent correlation between roadmap and guidewire, in 85% roadmap quality was deemed fair to very good and in 64% it was considered clinically useful for device navigation and/or guidance.

Conclusions
DCR use is feasible during PCI and rendered clinically useful information for device guidance in the majority of cases. More research is needed to determine the potential impact of DCR on procedural success, contrast volumes and radiation dose.