AngioSupport: a novel and quantitative tool allowing clinical decision making for cardiac teams to plan coronary interventions

Every year, about 735.000 Americans suffer from Coronary Artery Disease (CAD); one of the leading causes of death in the United States. The Invasive Coronary Angiography (ICA) and the invasive Flow Fractional Reserve (FFR) are the ‘gold standard’ to assess CAD. The patients with a stenose, resulting to FFR ≤ 0.8, are assumed to have a significant stenose resulting in ischemia of the myocardium. Those patients receive treatment: either a Percutaneous Coronary Intervention (PCI) or a Coronary Artery Bypass Graft (CABG). The decision between PCI or CABG is based on the experience of the cardiac team, which consist of at least one intervention cardiologist and one cardiac surgeon. For about 20% of these patients discussed during the cardiac team meeting, the effect of PCI or CABG is hard to predict and the defined treatment plan will therefore vary between cardiac teams. Clinicians have no quantitative measurement that supports them with treatment planning for this specific group of patients. Therefore, this report represents a new product AngioSupport: a patient-specific model-based interactive tool to provide clinicians predictions of the post-operative FFR to plan coronary interventions and to support them in clinical decision making during a cardiac team meeting.
AngioSupport consists of three parts:
1) The segmentation of ICA images to generate the centreline and radii of the coronary arteries.
2) The physiological model that computes the blood pressure and flow throughout the coronary arteries.
3) The interface to allow clinicians to perform coronary interventions.
With a prototype of this new AngioSupport, a proof-of-concept has been shown that in principle could lead to a product that is able to support treatment planning for patients with challenging CAD (difficult vasculature, multiple stenoses, or diffuse disease) by allowing complicated interventions (multiple stents, jump-grafts, Y-grafts, and combinations of PCI and CABG).
This new prototype can treat one single occlusion, hence allows the clinician to place one stent (via PCI) or to perform a CABG connected to one location. Demo’s and presentations of the prototype have been given to receive feedback and to grow a reputation. The media messages and activities resulted in a user-friendly design and acceptance of AngioSupport as concluded from the conducted user survey. Although the backend (physiological model) of AngioSupport is not properly verified, the verification was good enough to gain trust of the clinicians that the pre-FFR and post-FFR could accurately be predicted. Finally, an first validation test has been performed of the complete prototype of AngioSupport, i.e. the interface at the frontend and the physiological model at the backend.
In summary, the further development of AngioSupport needs a long way to reach its full potential. Nevertheless, this proof-of-concept lifted confidence that it is technical possible to develop the product and that the product will be accepted by clinicians to support clinical decision making as well as an educational tool.