Novel Method for Real Time Co-Registration of Coronary Physiology and Angiography

Objectives: We present our experience with a novel method for real time co-registration of coronary physiology and angiography.

Background: A major limitation of the current practice of concomitant use of coronary angiography and physiology (FFR/iFR) is that the locations of the acquired pressure indices are not correlated with their exact locations on the vessel roadmap obtained by coronary angiography.

Methods: Phantoms simulating the coronary tree were used to test the accuracy and potential of co-registration. Subsequently we examined patients who underwent iFR pullback study during cardiac catheterization. Analysis and feasibility were performed in 40 arteries of 35 patients.

Results: The statistical validation in phantoms resulted in a co-registration accuracy of 2 mm. The length measurement on an angiogram resulted in an accuracy of 1.2 mm. Co-registration in patients was successful in all cases and four categories were assessed by 1(unacceptable) to 5 (Excellent) grading: Lesion characterization (4.3 ± 0.8), Treatment decision guidance (4.5±0.8), Stent position selection (4.4±0.9) and Stent length selection (4.2±0.9).

Conclusions: In this pilot study, we found that the novel physiology and coronary angiography co-registration method is a valid and accurate method to determine coronary artery lesions severity and to guide for an optimal treatment of these lesions, mainly in borderline and diffuse lesions.