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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Integration of Multislice Computed Tomography With Magnetic Navigation Facilitates Percutaneous Coronary Interventions Without Additional Contrast Agents

Steve Ramcharitar, BMBCh, DPhil^_*, Francesca Pugliese, MD, Carl Schultz, MBChB, DPhil^_*,, Jurgen Ligthart, BSc^_*, Pim de Feyter, MD, PhD^_*,, Huling Li, MD, Nico Mollet, MD, PhD, Martin van de Ent, MD, PhD^_*, Patrick W. Serruys, MD, PhD^_* and Robert Jan van Geuns, MD, PhD^_*,,_*

^_* Department of Cardiology, The Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Radiology, The Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands

Manuscript received June 25, 2008; revised manuscript received October 21, 2008, accepted October 26, 2008.

^_* Reprint requests and correspondence: Dr. Robert Jan van Geuns, Thoraxcenter, Ba585, Dr Molewaterplein 40, 3015-GD Rotterdam, the Netherlands (Email: r.vangeuns{at}erasmusmc.nl).

Objectives: We hypothesized that percutaneous coronary intervention (PCI) without additional contrast agents can be performed by directly integrating multislice computed tomography coronary angiography (CTCA) within the magnetic navigation system (MNS).

Background: Increasingly, CTCA is being used in the diagnostic work-up of patients with coronary disease. Its inherent 3-dimensional information should be exploited, as it potentially offers advantages over 2-dimensional radiography in guiding invasive diagnostic and therapeutic interventions.

Methods: CTCA-derived centerlines from 15 patients were coregistered and overlaid on real-time fluoroscopic images employing the MNS. Vessels were manually wired with a magnetically enabled guidewire assisted by variable local magnetic fields. Fractional flow reserve (FFR) determined the lesion severity, and the dimensions were quantified by intravascular ultrasound (IVUS). Locations of the IVUS catheter probe along the lesion were incorporated in software to facilitate stenting without contrast agents.

Results: The average crossing and fluoroscopic times were 105.3 ± 35.5 s and 83.4 ± 38.6 s, respectively, with no contrast agents used in 11 of 15 patients (73.3%). Contrast agents were used in only 1 of 10 patients (10%) in whom an IVUS was performed. In 4 patients, apart from a "blinded" safety check angiogram, the entire PCI (lesion crossing, stent sizing, positioning, and deployment) was performed without additional contrast agents following the coregistration of the IVUS probe position in the MNS.

Conclusions: The integration of pre-procedural CTCA within the MNS can facilitate PCI without additional contrast agents.

Key Words: multislice computed tomography • magnetic navigation • intravascular ultrasound • contrast agents

Abbreviations and Acronyms   CTCA = computed tomography coronary angiography   DS = diameter stenosis   FFR = fractional flow reserve   IVUS = intravascular ultrasound   MNS = magnetic navigation system   PCI = percutaneous coronary intervention   2D = 2-dimensional   3D = 3-dimensional

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