EuroPCR 2023: Imaging technology reduces contrast use during PCI

Dynamic Coronary Roadmap in use for a PCI procedure

The use of an image-guidance system that overlays angiographic images on live fluoroscopic images has been shown to reduce the amount of contrast used during percutaneous coronary intervention (PCI), trial data shared at EuroPCR 2023 (16–19 May, Paris, France) indicate.

Dynamic Coronary Roadmap (DCR) is an imaging technology developed by Philips and is designed to reduce total iodinated contrast media volumes administered during PCI procedures. The software is intended to provide a real-time and dynamic angiographic roadmap of coronary arteries, which is automatically generated from previously acquired coronary angiograms during the same procedure.

Javier Escaned (Hospital Clinico San Carlos, Madrid, Spain) delivered results of the Dynamic Coronary Roadmap for Contrast Reduction—DCR4Constrast—trial during a late-breaking trial session at EuroPCR, where he revealed that the system reduced the use of contrast media on average by 28.8% compared to PCI using angiography alone (95% Confidence Interval: 18.9%, 38.2%).

Additionally, the trial found that the DCR system was able to reduce the number of angiograms per PCI procedure on average by three runs based on a PCI procedure with an average of 11 runs or 26.3% reduction (95% Confidence Interval: 16.8%, 35.1%).

Javier Escaned

Running in centres across the USA, Europe and Israel, DCR4Contrast randomised 371 patients undergoing both ad hoc and planned PCI procedures. Patients were stratified according to the number of vessels to be treated.

Patients within the DCR 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 following standard care.

Speaking to Interventional News, Escaned said that the DCR technology potentially has a particular benefit among patients undergoing complex PCI, as well as those with renal impairment.

“There is a great interest nowadays in so-called ultra-low contrast PCI, which is basically the skillset needed to reduce dependence of contrast administration particularly in complex patients during PCI,” said Escaned, highlighting that the issue features in a chapter in this year’s PCR-EAPCI textbook, published to coincide with the EuroPCR meeting.

“This feels like a very promising tool for this purpose, because it reduces radiation, the amount of contrast, and also it helps in transitioning from a culture of requiring the use of repeated vessel pacification with contrast, to something that relies more on a different technology.”

Escaned said that the system is relatively simple to use, given its use of existing techniques that most interventional cardiologists will be familiar with.

Speaking during a press conference at the EuroPCR meeting, William Wijns (Lambe Institute for Translational Medicine, Galway, Ireland) described the findings of the study as “really important” due to the potentially life-threatening impact of contrast induced necropathy and other side effects related to contrast usage.


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