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

BACKGROUND

Directional coronary atherectomy (DCA) is effective for bifurcation lesions but carries a risk of coronary perforation, due to geographical and recognition errors during the procedure. Geographical errors involve incorrect targeting of plaque-free areas, whereas recognition errors stem from the misinterpretation of visual information during catheter alignment. To minimize these risks and improve procedural safety and efficacy, it is crucial to align the DCA catheter accurately with the target plaque by utilizing the morphological characteristics of the housing.

AIMS

This study aimed to determine whether visual recognition of DCA housing from the front or side, as opposed to an oblique angle, reduces cutting errors.

METHODS

Fifteen physicians and five medical staff members performed a bench test in which a DCA catheter was rotated 0° (frontal view), 45° clockwise (oblique view), and 90° clockwise (lateral view) under fluoroscopy. The error angles at each position were compared (p < 0.05).

RESULTS

Error angles were 4.4 ± 3.4° (frontal view), 10.1 ± 4.6° (lateral view), and 13.6 ± 7.5° (oblique view). The frontal view showed fewer errors than the lateral and oblique views (p = 0.0016 and p < 0.0001, respectively). No significant differences were observed between the physicians and medical staff.

CONCLUSION

Recognizing DCA housing from the frontal or lateral view calculated from intravascular ultrasound (IVUS) significantly reduces recognition errors in plaque cutting, enables safer and more effective procedures, even for less experienced operators, and has the potential to improve the safety and outcomes of DCA procedures.