Utilizing Mixed Reality Technology to Facilitate Coronary Chronic Total Occlusion Antegrade Wiring: A Pilot Study

Abstract

Background: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is technically demanding. This pilot study evaluated the feasibility and safety of mixed reality technology to assist antegrade wiring during CTO PCI.

Methods: We developed a workflow using HoloLens mixed reality goggles to assist antegrade wiring by integrating coronary computed tomography angiography images. Two strategies-overlay and side-by-side display-were tested. Feasibility and safety were assessed using semi-qualitative scoring and confirmation of intraluminal wire position by intravascular ultrasound (IVUS).

Results: Five patients underwent CTO PCI with mixed reality guidance during the antegrade wiring phase, all achieving procedural success. Antegrade wiring was successful in 4 cases; 1 case required retrograde wiring. Operator-reported feasibility and safety scores were high, and IVUS confirmed intraluminal wire passage in 4 cases.

Conclusions: This pilot study reports initial experience from the first 5 cases of mixed reality-guided CTO PCI. The technology enhanced operator confidence and safety in achieving intraluminal wiring.

Keywords: coronary chronic total occlusion; mixed reality; percutaneous coronary intervention.