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Philips showcases ultra-low contrast PCI solutions at EuroPCR 2022

The ability to peorm PCI procedures using a very small amount of contrast media enables PCI to be offered to more patient groups, notably patients presenting with both coronary aery disease (CAD) and chronic kidney disease
(CKD), who are at high risk of suffering contrast-induced nephropathy (CIN) – a life-threatening form of hospital-acquired acute kidney injury (AKI) caused by contrast media toxicity

Royal Philips, a global leader in health technology, recently showcased innovations at EuroPCR (May 17-20, Paris, France) that can enable interventionists to perform ultra-low contrast percutaneous coronary intervention (ULC-PCI) procedures with greater condence and clarity. Philips’ ULCPCI solutions coregister instantaneous blood ow measurements and/or intravascular ultrasound (IVUS) images onto real-time uoroscopy to help interventionists diagnose, decide, guide, treat and conrm the success of PCI, with the potential to limit the use of iodinated contrast media.

Seamlessly integrating into Philips’ Image Guided Therapy System – Azurion – the company’s unique ULC-PCI solutions provide physicians with tools to help reduce the use of contrast media throughout PCI procedures.

The ability to perform PCI procedures using a very small amount of contrast media enables PCI to be offered to more patient groups, notably patients presenting with both coronary artery disease (CAD) and chronic kidney disease (CKD), who are at high risk of suffering contrast-induced nephropathy (CIN) – a life-threatening form of hospital-acquired acute kidney injury (AKI) caused by contrast media toxicity. A 2020 study in the USA concluded that AKI after a PCI procedure resulted in an average increase in length of hospital stay of 3.6 days and an additional healthcare cost of 9,448 USD per patient.

Innovation in catheter-based interventions to treat narrowed heart arteries – so-called percutaneous coronary
interventions – continuous to contribute to improving the quality of life and prognosis for millions of
patients around the world, said Javier Escaned, MD, PhD, Head of the Interventional Cardiology Section at Hospital Clinico San Carlos, Madrid, Spain.

As a result, more complex patients can now undergo PCI, including those with advanced age and frailty, chronic renal failure, and associated heart conditions. Inmany of these patients, where the injection of radiological contrast used to guide the PCI can have deleterious effects, technologies developed by Philips that enable physicians to dramatically decrease contrast administration during the procedure is contributing to both the safety and quality of PCI.

Dynamic Coronary Roadmap

During a conventional PCI procedure, contrast media is injected into the patient’s coronary arteries to acquire an angiogram, with additional uoroscopy used during the procedure to help interventionists navigate their guide wires and catheters. To maintain visibility of the arteries, this guidance typically requires repeated contrast media injections, increasing the toxic load on the patient’s kidneys. Philips’ Dynamic Coronary Roadmap software removes the need for additional contrast media injection by overlaying the preoperative angiogram onto real-time motion-compensated 2D uoroscopic imaging to provide interventionists with continuous visual feedback on the positioning of guide wires and catheters. In many cases, no additional contrast media injection is required for wire navigation.

While Philips’ Dynamic Coronary Roadmap software helps interventionists navigate guide wires and catheters to the site of a lesion, the company’s IntraSight Series 7 precision guidance system streamlines lesion assessment,
simplies vessel sizing, and enables precise therapy delivery.

iFR Co-registration

As an alternative or adjunct to IVUS co-registration, spatially accurate instantaneous wave-free ratio (iFR) pullback measurements can be coregistered onto the angiogram, adding valuable physiological data to the anatomical imaging. Unlike fractional ow reserve (FFR) measurements, iFR measurements do not require the use of hyperemic drug injection and can be used to assess both the degree and length of vessel stenosis and the effectiveness of therapy using a simple pressure wire pullback technique.

IVUS Co-registration

IntraSight Series 7’s IVUS co-registration facility merges real-time intravenous ultrasound and angiogram images, with information on the precise location of the ultrasound images derived during manual pull-back of the ultrasound catheter under continuous uoroscopy. As a result, interventionists can simultaneously view reconstructed cross-sectional ultrasound images of the vessel lumen, including their precise position on the angiogram. This level of precision signicantly reduces the risk of a ‘geographic miss’, which has been estimated to occur in over 60% of PCIs [3]. IntraSight Series 7’s Angio+ quantitative coronary analysis software automatically calculates lumen dimensions and stenosis in real time, helping accurate assessment of the required stent size.

Tri-registration

IntraSight Series 7’s Tri-registration function aids stent selection by co-registering IVUS and iFR information with the angiogram to help choose a stent that optimally supports meeting a procedure’s objectives. Coupled
with IntraSight Series 7’s enhanced live stent visualization capabilities, which help to immediately verify correc t stent positioning and deployment, the ability to enhance stent choice and size means more right-rst-time procedures and better patient outcomes.