Robotic Percutaneous Coronary Intervention Research Articles

Remote robotic percutaneous coronary intervention: An animal feasibility study.

The purpose of this study was to explore the feasibility and safety of robotic PCI performed using an off-siteremote-control system in an animal model. Access to primary percutaneous coronary intervention (PCI) remains a challenge in acute myocardial infarction management. The combination of telemedicine and robotic PCI allow the potential delivery of primary PCI to remote locations without the delay of transfer. This single-center prospective pilot preclinical feasibility study compared robotic PCI with remote PCI on swine across three stages (adjacent room, different floor of the same building, two different buildings). Latency up to 1,000 ms was introduced into the operating environment to simulate decreased network quality (blinded to operator). The primary outcome measures were technical success and acute safety. The secondary outcome measures included lesion wiring time, procedural time and qualitative scoring of the PCI experience by the operator. Across 52 experiments in 15 animals, technical success was 100%. No procedural complications occurred during the study. No significant difference in lesion treatment time was detected between stages (p = .11) and between time per target vessel when latency up to 1,000 ms was introduced (p = .58). Injected delay >250 ms had the greatest impact on procedure perceived lag. Longer procedure time was associated with lower procedure impact score, regardless of injected latency. Remote robotic PCI was feasible and safe in an animal model. Procedural duration was acceptable and unaffected by network latency. Future studies are needed to determine the safety and feasibility of remote PCI in humans.

Feasibility and safety of robotic PCI in China: first in man experience in Asia.

ObjectivesTo evaluate the feasibility and safety of a second generation robotic percutaneous coronary intervention (R-PCI) system in China.BackgroundRobotic PCI has been shown to be an effective method for conducting coronary interventions. It has further benefits of more accurate lesion measurement, improved stent deployment, reduced incidence of geographic miss and reduction of operator radiation exposure.MethodsThis single center evaluation enrolled 10 consecutive patients who had been selected for PCI. Clinical success was defined as residual stenosis < 30% and no in-hospital major adverse cardiovascular events. Learning curve effect was assessed by comparing efficiency metrics of early vs. later cases.ResultsEleven lesions were treated all successfully without manual interruption or MACE events. Most lesions (63%) were ACC/AHA class B2 and C. Mean procedure time was 57.7 ± 26.4 min, however two procedures were part of live demonstrations. Excluding the two live cases, the mean procedure time was 51.8 ± 23.7 min. Procedural efficiency tended to improve from early cases to later cases based on PCI time (48.3 ± 32.9 vs. 25.5 ± 13.0 min, P = 0.27), fluoroscopy time (20.3 ± 8.2 vs. 12.5 ± 4.6 min, P = 0.16), contrast volume (145.0 ± 28.9 vs. 102.5 ± 17.1 mL, P = 0.05) and Air Kerma dose (1932 ± 978 vs. 1007 ± 70 mGy, P = 0.31).ConclusionsSecond generation robotic PCI was safe, effective and there were trends toward improvements in procedural efficiency during this early experience in China.

Shields and garb for decreasing radiation exposure in the cath lab

ABSTRACTIntroduction: Decreasing radiation exposure of the cardiac catheterization laboratory staff is critical for minimizing radiation-related adverse outcomes and can be accomplished by decreasing patient dose and by shielding.Areas covered: protection from ionizing radiation can be achieved with architectural, equipment-mounted, and disposable shields, as well as with personal protective equipment.Expert commentary: Radiation protective aprons are the most commonly used personal protective equipment and provide robust radiation protection but can cause musculoskeletal strain. Use of a thyroid collar is recommended, as is use of ‘shin guards’, lead glasses and radioprotective caps, although the efficacy of the latter is being debated. Alternatives to lead aprons include shielding suspended from the ceiling and robotic percutaneous coronary intervention. Radiation protective gloves and cream can be used to protect the hands, but the best protection is to not directly expose them to the radiation beam. Devices that provide real time operator radiation dose monitoring can enable real time adjustments in positioning and shield placement, reducing radiation dose. Shielding can be achieved with architectural, equipment-mounted, and disposable shields. Equipment-mounted shielding includes ceiling-suspended shields, table-suspended drapes, and radioabsorbent drapes. Personal protective equipment and shielding should be consistently and judiciously utilized by all catheterization laboratory personnel.

First‐in‐human robotic percutaneous coronary intervention for unprotected left main stenosis

The safety and feasibility of robotically-assisted percutaneous coronary intervention (PCI) for simple coronary lesions has been demonstrated. The CorPath robotic system (Corpath 200, Corindus, Waltham, MA) consists of a robotic arm mounted on the cardiac catheterization table that consists of a drive housing a single-use sterile cassette, which is connected to the guiding catheter. While sitting in the nonsterile, radiation-shielded cockpit, the operator remotely controls delivery and removal of coronary guidewires, angioplasty balloons, and stents. The database for the ongoing PRECISION registry was queried at a single center and results of unprotected left main robotic PCI procedures are reported. Of 102 robotic PCI procedures performed at this center, 6 were unprotected left main lesions (age 69 ± 14 years; 67% male). All 6 subjects underwent successful PCI (fluoroscopy time 26.8 ± 11.4 min;1.8 stents and 2.2 vessels treated/patient) with three requiring hemodynamic support (two with percutaneous left ventricular assistance using the Impella 2.5 (Abiomed, Danvers, MA) and one with intraaortic balloon pump counterpulsation). This report demonstrates the feasibility of performing robotically assisted unprotected left main PCI with or without hemodynamic support. © 2016 Wiley Periodicals, Inc.

COMPLEX ROBOTICALLY-ASSISTED PERCUTANEOUS CORONARY INTERVENTIONS: REASONS FOR PARTIAL MANUAL ASSISTANCE OR MANUAL CONVERSION

Robotic percutaneous coronary intervention (R-PCI) (CorPath 200, Corindus, Boston, MA) is safe and feasible for simple coronary lesions. This study was designed to determine the frequency and reasons for partial manual assistance or manual conversion during complex R-PCI. Consecutive R-PCI

CRT-200.63 Robotic Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction: Initial Clinical Experience and Procedural Outcomes

A robotic system for performing remote-controlled angioplasty and stent placement is now in clinical use in the US. This robotic system allows the operator to perform percutaneous coronary intervention (PCI) while seated in a lead-lined cockpit, thereby minimizing radiation exposure and eliminating

TCT-402 Feasibility of Robotic Percutaneous Coronary Intervention for Unprotected Left Main Stenosis in the Presence and Absence of Left Ventricular Hemodynamic Support with Impella

Robotic PCI can potentially address the occupational hazards associated with interventional cardiology, addressing both the orthopedic and radiation associated risks. The safety and feasibility of robotically assisted percutaneous coronary intervention (PCI) for simple coronary lesions has been

TCT-435 Feasibility And Success of Radial-Access Robotic Percutaneous Coronary Intervention: Insights From The PRECISION Registry

TCT-435 Feasibility And Success of Radial-Access Robotic Percutaneous Coronary Intervention: Insights From The PRECISION Registry

TCT-108 Initial Clinical Experience Performing Robotic Percutaneous Coronary Intervention from the Radial Approach

TCT-108 Initial Clinical Experience Performing Robotic Percutaneous Coronary Intervention from the Radial Approach

TCT-148 Feasibility of Complex Robotic Percutaneous Coronary Intervention

TCT-148 Feasibility of Complex Robotic Percutaneous Coronary Intervention

Safety and Feasibility of Robotic Percutaneous Coronary Intervention

The aim of this study was to evaluate the safety as well as the clinical and technical effectiveness of robotic-assisted percutaneous coronary intervention. Robotic systems have been suggested to enhance the performance of cardiovascular procedures, as well as to provide protection from the occupational hazards that are associated with interventional practice. Patients with coronary artery disease and clinical indications for percutaneous intervention were enrolled. The coronary intervention was performed with the CorPath 200 robotic system, which consists of a remote interventional cockpit and a bedside disposable cassette that enables the operator to advance, retract, and rotate guidewires and catheters. The primary endpoints were clinical procedural success, defined as <30% residual stenosis at the completion of the robotic-assisted procedure without major adverse cardiovascular events within 30 days, and device technical success, defined as the successful manipulation of the intracoronary devices using the robotic system only. A total of 164 patients were enrolled at 9 sites. Percutaneous coronary intervention was completed successfully without conversion to manual operation, and device technical success was achieved in 162 of 164 patients (98.8%). There were no device-related complications. Clinical procedural success was achieved in 160 of 164 patients (97.6%), whereas 4 (2.4%) had periprocedural non-Q-wave myocardial infarctions. No deaths, strokes, Q-wave myocardial infarctions, or revascularization occurred in the 30 days after the procedures. Radiation exposure for the primary operator was 95.2% lower than the levels found at the traditional table position. This pivotal multicenter study with a robotic-enhanced coronary intervention system demonstrated the safety and feasibility of the system. The robotic remote-control procedure met the expected technical and clinical performance, with significantly lower radiation exposure to the operator. (Evaluation of the Safety and Effectiveness of the CorPath 200 System in Percutaneous Coronary Interventions [PCI] [PRECISE]; NCT01275092).

Robotic-Assisted Angioplasty: Current Status and Future Possibilities

Percutaneous coronary intervention (PCI) has seen steady technological progress over the past 3 decades. Despite improved patient safety and efficacy, modern interventionalists continue to face significant occupational hazards, including radiation exposure, cataracts, and orthopedic injuries. Robotic remote navigation systems have been developed to address risks and procedural challenges associated with conventional PCI. The first in-human experience using a modern robotic system for PCI yielded excellent results, with an overall technical success rate of 97.9%. A larger multicenter prospective registry with this system is currently underway. Robotic PCI technology holds promise to reduce operator radiation exposure and musculoskeletal complaints. Postulated benefits to patients include more accurate lesion length calculations, precise stent placement, and reductions in radiation exposure and contrast-media delivery. The development of novel robotic remote control navigation systems represents the dawn of a new era of interventional cardiology.

Closed chest hybrid coronary revascularization for multivessel disease ??? current concepts and techniques from a two-center experience

Hybrid coronary revascularization combining minimally invasive coronary surgery and percutaneous coronary intervention (PCI) allows sternal preserving treatment of multivessel coronary disease. The main principle of the technique includes placement of mammary artery graft to the left anterior descending coronary artery (LAD) and performance of PCI in non-LAD target vessels. This principle is based on increasing data showing equivalent results of PCI with coronary revascularization using saphenous vein grafts in selected patients. Providing that perioperative and long-term results are as good as the results of conventional surgical revascularization, this option seems to be quite appealing for patients and referring cardiologists. This concept has been designed to allow rapid rehabilitation and minimize periprocedural pain under concomitant preservation of the patient's body integrity. Robotically assisted endoscopic approaches for hybrid coronary revascularization set the pace for a closed-chest treatment of multivessel coronary disease. The time point of PCI, the use of different anticoagulation protocols as well as the stent selection are some of the variables, which affect outcome. We additionally report on the midterm results of 130 after-closed-chest hybrid-coronary procedures in two institutions. Hybrid procedures using robotic technology and PCI allow closed chest treatment of multivessel coronary artery disease. Single- and double-bypass grafts are feasible and simultaneous interventions can be performed. The overall safety of the procedure seems to be adequate and perioperative clinical results are satisfactory. Intermediate term survival and freedom from angina are excellent.