Philips Azurion, ultra-low contrast percutaneous coronary intervention solutions.
Royal Philips has presented at EuroPCR (Paris, France) innovations that may enable clinicians to perform percutaneous coronary intervention with ultra low contrast use with greater confidence and clarity. Philips solutions co-record instantaneous blood flow measurements and/or intravascular ultrasound (IVUS) images along with real-time fluoroscopy to help interventionists diagnose, decide, guide, treat and confirm PCI success, with the potential to limit the use of iodinated contrast media.
Integrated into Philips’ image-guided therapy system, Azurion, ultra-low-contrast percutaneous coronary intervention solutions provide clinicians with tools to help reduce the use of contrast media in PCI procedures.
The ability to perform these procedures using a very small amount of contrast allows PCI to be offered to more patient groups, particularly patients who have both a Coronary artery disease (CAD) such as chronic kidney disease (CKD), who are at high risk of contrast-induced nephropathy (CIN), a life-threatening form of hospital-acquired acute kidney injury (AKI) caused by contrast media toxicity. A 2020 US study concluded that AKI after PCI resulted in a mean increase in duration of hospital stay of 3.6 days.
Innovations to improve quality of life
“Innovation in interventions based on the use of catheters and wires to treat stenosed cardiac arteries – the so-called percutaneous coronary interventions – continues to contribute to Improve Life Quality and the prognosis of millions of patients around the world,” said Javier Escaned, head of the Interventional Cardiology Section at Hospital Clínico San Carlos in Madrid. “As a result, more complex patients can now undergo PCI, including those with old age and frailty, chronic renal failure and associated heart conditions. In many of these patients, in whom the injection of radiological contrast used to guide PCI can have deleterious effects, the technologies developed by Philips allow clinicians to drastically reduce contrast administration during the procedure, contributing both to the safety of the patient as well as the quality of PCI,” added
During a conventional PCI procedure, contrast media are injected into the patient’s coronary arteries to acquire an angiogram, and additional fluoroscopy is used during the procedure to help the interventionalists navigate their guidewires and catheters. To maintain the visibility of the arteries, this guidance often requires repeated injections of contrast media, which increases the toxic load on the patient’s kidneys. The Dynamic Coronary Roadmap software Philips eliminates the need to inject additional contrast media by overlaying the pre-operative angiogram on real-time motion compensated 2D fluoroscopic images. This provides interventionists with continuous visual feedback on the position of guidewires and catheters. In many cases, the use of additional contrast for navigation is not necessary.
While Philips’ Dynamic Coronary Roadmap software helps interventional physicians direct guidewires and catheters to the injury site, the company’s IntraSight Series 7 precision guidance system streamlines injury assessmentsimplifies assessment of vessel size and enables precise treatment delivery.
As an alternative or complement to IVUS co-registration, the IFR that occurs during a period of diastole known as the “wave-free period” adds valuable physiological data to anatomical images. Unlike fractional flow 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 efficacy of treatment. using a simple pressure guide wire removal technique.
On the other hand, the IVUS co-registration function of IntraSight Series 7 is to merge the intravascular ultrasound imaging and real-time angiogram, with information on the precise location of the ultrasound images derived during manual removal of the ultrasound catheter under continuous fluoroscopy. As a result, interventionists can simultaneously view reconstructed cross-sectional ultrasound images of the vessel lumen, including its precise position on the angiogram. This level of accuracy significantly reduces the risk of a “geographical failure,” which has been estimated to occur in more than 60 percent of PCIs. IntraSight Series 7 Angio+ Quantitative Coronary Analysis Software automatically calculates lumen dimensions and stenosis in real time, helping to accurately assess the size of the stent needed.
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