Dynamic coronary roadmapping during percutaneous coronary intervention: a feasibility study

Abstract

Background: A novel software ("Dynamic Coronary Roadmap") was developed, which offers a real-time, dynamic overlay of the coronary tree on fluoroscopy. Once the roadmap has been automatically generated during angiography it can be used for navigation during percutaneous coronary interventions (PCI). As a feasibility study, we aimed to investigate the feasibility of real-time dynamic coronary roadmapping and consecutive coronary overlay during elective PCI.

Methods and results: We studied 936 overlay runs, created following the same amount of angiographies, which were generated during 36 PCIs. Feasibility of dynamic coronary roadmapping was analyzed using a dedicated software tool. Roadmap quality (correct dynamic imaging of the vessels without relevant artefacts or missing parts) was distinguished from overlay quality (congruence of dynamic coronary roadmapping and coronary anatomy). Additionally, we assessed procedural success and the occurrence of major cardiac and cerebrovascular events (MACCE). Roadmap quality was defined as "fit for use" in 99.5%. In 97.4% of runs overlay quality was deemed "fit for use". Overall, we observed low inter and intra observer variability (ICC R = 0.84 for roadmap quality and R = 0.75 for overlay quality). Procedural success rate was 100%. MACCE occurred in two (5.6%) patients during post-interventional in-hospital stay and were not software-related.

Conclusions: Dynamic coronary roadmapping provides in > 98% of cases sufficient roadmap quality with an anatomically correct overlay of the coronary vessels with good inter and intra observer variability. Future randomized studies are warranted to test possible advantages like procedure time reduction and less consumption of contrast medium.

Keywords: Dynamic coronary roadmap; Imaging guided technique; Percutaneous coronary intervention; Real-time overlay.

Fig. 1

Cardiac roadmapping technology. a Cine loop is analyzed on contrast density. b Angiography is converted into a mask. c A heart cycle of masks is stored in a library, each one defined by its C-arm position. d If a corresponding C-arm position is accomplished, the software analyses guide catheter and wire shape (fixed curvatures, arrows). e Library search for mask with similar fixed curvatures (arrows) and f Superimposed real-time image of the mask and the fluoroscopy image through attachment of the coronary tree to fixed curvatures

Fig. 2

Simultaneous display of dynamic coronary roadmap, static coronary roadmap and standard angiography. a Dual plane Angio A, b dual plane Angio B, c hemodynamics, d dynamic coronary roadmap, e reference B, f reference A

Fig. 3

Examples of insufficient roadmap and overlay quality. a “Hole“in the map: Some parts of the vessel tree are missing from the roadmap (arrow). b “Blinking“vessel: The coronary artery is displayed discontinuously(circles). c False device tracking: an ICD lead is falsely displayed as a vessel (arrow). d “Jumpy“registration: Exact overlay of the wire and the coronary artery and in the next heartbeat the wire “jumps” and is now displayed next to the vessel (arrows)