Accurate and Safe Directional Coronary Atherectomy Using the X-Ray Detector's Calculated Optimal Angular View

Area of Science:

• Cardiovascular Interventions
• Medical Imaging
• Surgical Navigation

Background:

• Directional coronary atherectomy (DCA) is effective for treating bifurcation lesions.
• Procedural risks include coronary perforation due to geographical and recognition errors during catheter alignment.
• Accurate alignment of the DCA catheter with target plaque is crucial for safety and efficacy.

Purpose of the Study:

• To evaluate whether viewing DCA housing from frontal or lateral angles, compared to oblique angles, reduces cutting errors.
• To determine the impact of viewing angle on the accuracy of DCA catheter alignment.

Main Methods:

• A bench test was conducted with 15 physicians and 5 medical staff.
• Directional coronary atherectomy (DCA) catheters were rotated to frontal (0°), lateral (90°), and oblique (45°) views under fluoroscopy.
• Error angles were measured and compared across different viewing positions.

Main Results:

• The frontal view demonstrated significantly fewer error angles (4.4° ± 3.4°) compared to lateral (10.1° ± 4.6°) and oblique (13.6° ± 7.5°) views.
• Statistical analysis confirmed the significance of these differences (p < 0.0016 for lateral, p < 0.0001 for oblique).
• No significant difference in error rates was found between physicians and medical staff.

Conclusions:

• Recognizing DCA housing from frontal or lateral views significantly reduces recognition errors in plaque cutting.
• This improved visualization enhances procedural safety and effectiveness, even for less experienced operators.
• Optimizing viewing angles has the potential to improve overall outcomes in DCA procedures.