Guidewire Manipulation Based on Establishment of Stereo Perception in Percutaneous Coronary Intervention

Traditional percutaneous coronary intervention (PCI) relies on two-dimensional X-ray imaging, but this does not allow depth perception and complicates precise manipulation of the guidewire. Our purpose was to develop a novel method for guidewire manipulation by establishing stereoscopic perception in coronary angiography (CAG), as described in our previous study, and thereby improve the precision and success rate of PCI.

Based on establishment of stereo perception in CAG, we used digital subtraction angiography (DSA) with gantry rotation and simulation with UG NX software to determine the orientation of the guidewire tip and the relative positions of the true lumen and false lumen. We then performed verification using a highly realistic 3D-printed transparent silicone model of the human heart and coronary arteries. By manipulating the guidewire in various branches of the model of the coronary artery, we identified the directional torque of wire rotation and simulated this using UG NX software. A preliminary trial with unidirectional rotation was conducted in which one interventionist performed 60 guidewire manipulations (30 before and 30 after training) in a 3D-printed heart model to quantify changes in directional accuracy.

The results confirmed that the orientation of the distal tip of the guidewire and the relative positions of the true and false lumens were accurately determined using DSA with gantry rotation and simulation with UG NX software. We also validated the consistency of rotational torque within the coronary artery lumen, irrespective of vessel twisting and deformation. The preliminary trial demonstrated a higher success rate (93.3% vs. 60%, p < 0.01) after training.

Our novel method significantly improved the accuracy of guidewire manipulation in an in vitro model. This method therefore has the potential to enhance PCI outcome, and warrants further examination by clinical trials.