Virtual roadmap tool may improve safety during PCI, reducing contrast volume, radiation
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Key takeaways:
- A virtual roadmap tool may improve procedural safety during percutaneous coronary intervention.
- Roadmap guidance reduced iodinated contrast volume and angiogram radiation exposure vs. traditional PCI guidance.
A virtual PCI road mapping tool could increase procedural safety vs. conventional angiography by reducing contrast volume and the number of angiograms necessary, a speaker reported.
A real-world analysis of a roadmap tool (Dynamic Coronary Roadmap, Philips) for simple and complex PCI was presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
“Dynamic Coronary Roadmap is a PCI navigation support tool that may potentially facilitate PCI and increased procedural safety by projecting a virtual coronary roadmap onto the moving fluoroscopy, thus potentially decreasing the amount of contrast we need for PCI. We could potentially use this map to navigate and advance catheters, wires, balloons and position stents without needing to use contrast.,” John C. Messenger, MD, FSCAI, professor of medicine and director of interventional cardiology at the University of Colorado School of Medicine University of Colorado Hospital, said during a presentation. “While this has been FDA-approved as a tool, evaluation of the quality of the roadmap guiding simple and more complex PCI procedures has not been compared to standard PCI in a real-world setting, and that was the goal for the DCR4Contrast contrast study.”
DCR4Contrast was a multicenter, prospective, unblinded, randomized controlled trial that enrolled 371 patients undergoing PCI at six centers in the U.S, Belgium, Israel and Spain. Participants were randomly assigned to either the roadmap or conventional angiography.
For the secondary analysis of the DCR4Contrast trial, Messenger and colleagues evaluated utilization of roadmap during PCI, investigator-scored quality of coronary roadmap and contrast use based on roadmap quality.
Roadmap quality was scored based on adequate representation of the complete coronary artery tree with no missing relevant arteries and no significant artifacts. Accuracy was judged by comparing the roadmap location with interventional guiding catheter, guidewire or device location.
The roadmap was used in 98% of patients undergoing PCI assigned to the roadmap arm.
Messenger reported that approximately 79% of investigators described the quality and accuracy of the roadmap as very good or good.
Among cases with good roadmap quality, mean contrast volume was approximately 26% lower compared with conventional angiography and required fewer angiograms on average (P for all < .001), according to the presentation.
“The clinical implication of the DCR4Contrast study ... is that it generates roadmaps of high-quality in the real-world setting. The roadmap quality was definitely related to contrast volume. The better-quality roadmap we could get, the higher the contrast reduction,” Messenger said during the presentation. “In more complex PCI, the roadmap was an even higher quality because they were able to generate roadmaps from multiple vessels. This resulted in a 26% reduction in contrast during PCI ... and it was easy to implement in clinical practice in that we were able to get multiple investigators at all these centers to use this.”
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Messenger JC, et al. Late-Breaking Presentation I. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 18-20, 2023; Phoenix.
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