Shaping the Future of Coronary Interventions by Highlighting Coronary Anatomy and Reducing Contrast Volume

Abstract

Coronary interventions, and specifically the number of percutaneous coronary intervention (PCI) procedures, are increasing, together with their complexity. Contrast media administration during those procedures assists in visualising vessels anatomy, but also increases the risk of contrast-induced nephropathy (CIN), which remains one of the most common complications, and has been associated with poor clinical outcomes. Dynamic Coronary Roadmap (DCR) is a technology that creates a dynamic, motion-compensated, real-time view of the coronary anatomy overlaid on a 2D fluoroscopic image, creating a coloured map that adjusts automatically, and providing continuous visual feedback on the positioning of wires and catheters. The technology, which is already being used in clinical practice, has posed the promise of not only assisting in navigating wires and catheters, but also reducing the use of contrast during PCI. DCR4Contrast was a randomised clinical trial conducted in the USA, Europe, and Israel that enrolled more than 356 patients. The primary endpoint for the study was the reduction in contrast administered with the use of DCR, compared with the control group. The secondary endpoint was the potential reduction in the number of cineangiography runs. In the trial, DCR reduced the total contrast volume per PCI procedure by an average of 28.8%, and reduced the number of contrast-enhanced cineangiography runs per procedure by 26.3%. It was also demonstrated that the more complex the PCI procedure, the larger the reduction in contrast with DCR. Here, interventional cardiology experts discussed the need for contrast reduction, and the evidence for DCR.