Magnetic-guided percutaneous coronary intervention enabled by two-dimensional guidewire steering and three-dimensional virtual angioscopy: Initial experiences in daily clinical practice

Aims: Percutaneous coronary intervention (PCI) has been broadly established and often includes highly complex stenoses that require difficult navigation. The purpose of this study is to assess the feasibility of a new magnetic navigation system (MNS) to enable intracoronary guidewire deployment and PCI in daily clinical practice and to compare the 2D guidance to the virtual 3D angioscopy feature. Methods and Results: We included 30 consecutive patients (pt) in whom 36 coronary arteries were PCI targets. Patients were randomized to guidewire steering by either 2D guidance or virtual 3D angioscopy (33%). In 31/36 (86%) interventions the MNS guidewire successfully passed the culprit stenosis and the procedure was accomplished by PCI. In 5/30 pt an MNS multivessel intervention was performed. Three of 5 unsuccessful procedures failed due to an unsuccessful recanalization of a subtotal chronic occlusion including 1 pt who required surgical intervention. In 2/36 procedures the magnetic guided intervention was performed effectively after prior conventional failure related to complex anatomy. The contrast medium amount needed to position the magnetic guidewire was 60 ± 101 mL in 2D accomplished interventions vs. 14 ± 15 mL in 3D procedures (p < 0.05). In 3 pt the MNS did not harm the implanted pacemaker or defibrillator system. Conclusion: Magnetic guided PCI is useful in selected patients. In our experience, success is less likely in evidence of a subtotal occlusion.