Dynamic Coronary Roadmap paves the way for contrast reduction during PCI procedures
Article ∙ By Philips Healthcare ∙ May 16, 2023 ∙ 2-3 min read
Across the globe, the number of high-risk patients undergoing percutaneous coronary intervention (PCI) has increased significantly. Awareness of the importance of the need to reduce contrast volume to minimize periprocedural renal injury, a complication that is not infrequent in patients with high-risk clinical profiles and its prognostic implications, has led to the proposal of an ultra-low dose contrast approach to PCI.
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About Dynamic Coronary Roadmap
Since contrast-induced nephropathy (CIN) can significantly impact prognosis, clinicians are seeking ways to minimize the contrast volumes used during PCI, thereby increasing procedural safety. To support these aims, Philips has developed Dynamic Coronary Roadmap (DCR), a PCI navigation support tool that is the only one of its kind currently available on the market.
DCR is a commercially available (CE-labeled, FDA 510(k)-cleared) software medical device intended to provide a real-time dynamic angiographic roadmap of the patient’s coronary arteries. Used in tandem with a Philips interventional X-ray system, the tool automatically generates a highlighted coronary angiogram which is overlaid on a 2D fluoroscopy image. This colored roadmap compensates for vibrations of the heart and respiratory motions and is generated from previously acquired coronary angiograms during the PCI procedure.
To better understand how DCR can deliver real-world benefits, the Dynamic Coronary Roadmap for Contrast Reduction trial (DCR4Contrast) has investigated DCR’s ability to reduce total contrast volumes administered during PCI, compared to PCI performed without DCR guidance. The study has found that DCR reduces contrast agent by 28.8% - offering clear potential to support and protect patient health.
“Dynamic Coronary Roadmap is a great asset to add to the interventional toolkit" said Dr Strobel. "It is an easy to use tool which reduces the contrast exposure to patients. It is very useful in patients with low GFR or patients with branch vessel disease. I use it very frequently to assist in decreasing contrast use. “
Dr Strobel Baptist Health, Little Rock, US
About the DCR4Contrast trial
This multi-center, prospective, unblinded, stratified, 1:1 randomized controlled trial was designed to assess whether using DCR can reduce the total iodinated contrast volume used during PCI procedures. A secondary objective was to assess the total number of contrast-enhanced cine angiographic X-ray runs (angiograms) related to PCI. The study population comprised a total of 394 patients requiring PCI, recruited from a total of six centers – three in Europe, one in Israel and two in the United States. Patients were randomized and stratified within each type of PCI (ad hoc or elective), according to the number of vessels to be treated. Patients within the experimental group underwent PCI procedures where DCR was used to guide the advancement of coronary wires, balloons, stents and other PCI diagnostic or therapeutic devices. Patients assigned to the control group underwent PCI without DCR support.
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