By Chunjian Li
Magnetic navigation system (MNS)-assisted percutaneous coronary interventions (PCI) have been applied in clinical practice for several years. The major technical innovation of this procedure exists in the process of the guidewire placement, which can be guided by a roadmap extracted from the coronary artery angiography and navigated by the magnetic navigation system. Recently published studies have shown that MNS-assisted PCI may improve success rate in certain complex cases, reduce contrast usage and radiation exposure.
More recently, we have successfully extracted coronary arteries from the dual source computed tomography (DSCT) images and transferred them to the live fluoroscopic screen after reconstruction, which finally functioned as roadmaps to guide the MNS-assisted PCI. Compared to the roadmap extracted from the coronary artery angiography, the DSCT derived roadmap can be constructed not only for the stenotic arteries, but also for the total occlusions. However, the advantages of the MNS and CT roadmap-assisted PCI have not been fully investigated.
Our study was designed to compare the MNS and CT roadmap-assisted PCI versus conventional PCI regarding the difference of contrast usage, X-ray exposure, procedure success and the in-hospital expenses. As a result, we found that the median contrast usage for guidewire crossing was significantly lower in the MNS group than that in the conventional group [0.0 (0.0, 3.0) vs. 5.0 (3.1, 6.8) mL; P<0.001], with zero contrast usage in 25 of the 44 guidewire placements in the MNS group, but in none of the conventional group; the radiation dosage for guidewire crossing in the MNS group was also significantly lower than that in the conventional group [235.8 (134.9, 455.1) vs. 364.4 (223.4, 547.2) μGym2; P=0.033]. However, there were no significant differences between the two groups concerning the total contrast usage, total radiation dosage of the PCI, the procedural fees, or the overall in-hospital expenses.
We conclude that in PCI of simple lesions, the application of CT guidance and magnetic navigation had modest impacts on radiation dosage and contrast usage for wire crossing, but no impact on overall radiation dosage or contrast usage for the procedure. In addition, the use of CT roadmap and MNS was likely more expensive compared to PCI using conventional radiographic technique.
Magnetic Navigation System and CT Roadmap-Assisted Percutaneous Coronary Intervention: A Comparison to the Conventional Approach Ruina Hao, MD1,2*, Qiu Zhang, MD3*, Zhuowen Xu, MD4*, Lijun Tang, MD, PhD5, Zhijian Yang, MD, PhD1, Kejiang Cao, MD, PhD1, Chunjian Li, MD, PhD1 // From the 1Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China (PRC), 2Department of Cardiology, Fuping County Hospital, Weinan, Shanxi Province, PRC, 3Department of Cardiology, the Second People’s Hospital of Changzhou City, Changzhou, Jiangsu Province, PRC, 4Department of Cardiology, the Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, Jiangsu Province, PRC, and 5Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PRC.
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