Google Glass Used to Assist CTO Recanalization in Proof-of-Concept Study

A wearable computer used to visualize 3-dimensional coronary CT angiography (CTA) images was successfully employed during recanalization of a chronic total occlusion (CTO), according to a case report. Although the technology used—Google Glass—is no longer being made, the case shows the potential of wearable technology to improve operator comfort and make procedures more efficient, the authors say.

“Of particular interest, mobile technology is easily accessible and offers an incremental opportunity to expand the existing open platform for mobile applications, which might in turn overcome the economic and capacity limitations of most advanced angiography systems with dedicated monitors for projection of CTA data sets,” Maksymilian Opolski, MD, of the Institute of Cardiology (Warsaw, Poland), and colleagues write in their Canadian Journal of Cardiology paper, published online November 19, 2015.

“Furthermore, wearable devices such as Google Glass might be potentially equipped with filter lenses that provide protection against X-radiation,” they continue. “We believe wearable computers have a great potential to optimize percutaneous revascularization, and thus favorably affect interventional cardiologists in their daily clinical activities.”

Use of wearable computers, which display and capture images and videos while allowing the user to continue interacting with the surrounding environment, has gained increased attention in the medical community. Doctors were among those who tried out such technology as part of Google’s Glass Explorer Program. That program ended in January, but new devices by Google and others are in development.

The Case

To explore the potential for wearable technology in the cath lab, Opolski’s team performed percutaneous revascularization of a chronic CTO in the RCA of a 49-year-old hypertensive man with a history of CABG and PCI in the LCX. The patient presented with persistent Canadian Cardiovascular Society class III angina and preserved LVEF. The LCX stent and left internal mammary artery graft to the LAD were both patent, with a medial chronic occlusion of the RCA with incomplete filling of the distal coronary vessel.

CTA reconstructions of the RCA showing the complete course of the distal RCA with severe calcification proximal to the occlusion were transmitted to Glass using syngo.via software (Siemens Healthcare). Two DES were successfully implanted in the proximal to distal segments—achieving TIMI 3 flow—based on the projected images.

“In our case, we have demonstrated the novel application of a wearable computer … for display of CTA data sets in the catheterization laboratory that enabled us to clearly visualize the distal CTO and verify the direction of the guidewire advancement relative to the course of the blocked vessel segment,” Opolski told TCTMD in an email.

Potential Exists, But Issues Remain

Opolski said that “the number of potential applications of wearable devices appears to be indefinite and can be constrained by the imagination of the physicians only.”

The most promising use includes the planning and guiding of structural interventions, such as atrial septal defect or left atrial appendage closure, based on 3-dimensional CT data, he said. “Furthermore, given the high penetration of mobile devices in low- and middle-income countries, health-related mobile applications might bypass traditional barriers to health information worldwide.”

Jordan G. Safirstein, MD, of Morristown Medical Center (Morristown, NJ), who was part of the Glass Explorer Program and tested the device in the cath lab, said that he sees the potential for wearable devices in interventional cardiology but that the technology is not quite ready.

The most useful function Glass had, Safirstein told TCTMD, was to allow operators to record procedures or broadcast them live as a teaching tool. A major limitation, however, was difficulty integrating advanced imaging technology.

Moving forward, a successful wearable device will likely have to be industry specific, according to Safirstein, who said that a device designed for general use could not be used in a hospital setting because of issues surrounding privacy and connectivity.

“Once that exists and it can integrate with the hospital’s imaging systems, or the hospital’s [electronic medical records], then I think that that does have applicability in the hospital setting and a procedure setting,” Safirstein said. He added that more “augmented reality” features would allow clinicians to walk into a room with a patient and automatically have demographics, vital signs, and past medical history available on the display. 

Source: 
Opolski MP, Debski A, Borucki BA, et al. First-in-man computed tomography-guided percutaneous revascularization of coronary chronic total occlusion using a wearable computer: proof of concept. Can J Cardiol. 2015;Epub ahead of print.

Disclosures:

• The study was supported by a statutory grant of the Institute of Cardiology.
• Opolski reports no relevant conflicts of interest.
• Safirstein reports serving on the Google Health Advisory Board.

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