Coronary Real-Time Navigation: From Emergence to Breakthrough

With continuous advances in medical technology and the growing demands of clinical practice, the development of coronary real-time navigation has been both long-standing and inevitable.

For a considerable period in the evolution of interventional therapy, its functionality remained relatively simple, relying mainly on angiographic images provided by DSA as rough references of vascular pathways. However, because angiography could not display the actual course of the guidewire inside the vessel, the concept of the "roadmap" was introduced.

In its early stage, the roadmap generally referred to a two-dimensional approach, in which fluoroscopic vascular images were superimposed on angiograms without contrast injection. This created inverted vascular pathways and provided visual feedback for guidewire positioning. The emergence of roadmap technology undoubtedly opened a new horizon for interventional treatment.

It is undeniable, however, that early roadmap technology had significant limitations in image quality, vascular extraction accuracy, and real-time performance. Vascular images were often blurred, making it difficult to assess fine details; extracted vascular pathways lacked precision, potentially misleading procedures; and conventional roadmaps failed to reflect vascular changes caused by respiration and heartbeat-serious challenges for coronary interventions, where precision is paramount.

With the advent of the digital era, continuous breakthroughs in computing, image processing, and artificial intelligence pushed roadmap technology forward. In 2017, dynamic roadmap technology was developed. This innovation accounted for the dual influences of respiratory and cardiac motion, overlaying real-time fluoroscopy on enhanced angiographic images to generate automatically adjusted color roadmaps. These provided continuous and efficient visual feedback for guidewire and catheter navigation.

However, as interventional technologies advanced, the integration of DSA created new opportunities. In clinical practice, the dual need to observe the coronary arteries in real time and track guidewire positioning simultaneously soon exceeded the capabilities of dynamic roadmaps. In this context, coronary real-time navigation technology emerged, opening a new path for safer and more precise interventional procedures.