Dynamic coronary roadmap assisted PCI: early experience and feasibility

Background
The novel Dynamic Coronary Roadmap (DCR; Philips, Netherlands) software takes a diagnostic angiogram loop and overlays it on a live fluoroscopy image, synchronised to the cardiac cycle. Despite an early learning curve, it is hoped that the use of DCR for guidewire advancement and device positioning will reduce percutaneous coronary intervention (PCI) contrast use. We sought to explore the impact of DCR on contrast use, procedure time and radiation dose in the early learning phase.

Methods
All patients in a single tertiary centre who underwent PCI after DCR installation (DCR group) were retrospectively compared 1:1 with consecutive patients who had PCI before DCR installation (control group). Patients undergoing PCI to chronic total occlusions and coronary bypass grafts were excluded. Outcome measures analysed included total contrast volume, procedure time, fluoroscopy time and radiation dose.

Results
67 pts in each group were compared. Baseline characteristics between control and DCR groups were similar including age, vessel(s) wired and arterial access site. Lesion characteristics were similar, namely presence of at least moderate vessel tortuosity (i.e. ≥2 bends >75° or ≥1 bend >90° between guide catheter tip and final guidewire position) and presence of radio-opaque prior stent or at least moderate vessel calcification (i.e. readily apparent densities in the target vessel wall before contrast injection). Outcome measures were similar between control and DCR groups. There were no differences in total contrast volume, procedure time, fluoroscopy time and radiation dose.

Conclusions
In this retrospective study of the initial experience of DCR, there was no increase in procedure time, fluoroscopy time or radiation dose associated with this early learning phase. Although there was no reduction in contrast use, a difference may be seen in time with greater operator experience. A prospective randomised study is underway.