Detection of large LRP by NIRS at non-stented sites in a target artery was associated with an increased risk of future MACCE. These findings support ongoing prospective studies to further evaluate the ability of NIRS to identify vulnerable patients.

In a high-volume center, the incidence of pericarditis, cardiac perforation, tamponade, death, and lead dislodgement was significantly higher with the MR-conditional Medtronic 5086 lead when compared to the previous generation Medtronic 5076 lead.

Objectives This study was conducted to evaluate the association of geographic distance with robotic telestenting performance by comparing performance measures in transcontinental and regional pre‐clinical models of telestenting. Background Robotic telestenting, in which percutaneous coronary intervention (PCI) is performed on a remotely located patient, might improve PCI access, but has not been attempted over vast distances likely required to reach many underserved regions. Methods Telestenting performance was compared in regional (Boston to New York [206 miles]) and transcontinental (Boston to San Francisco [3,085 miles]) ex vivo models of telestenting, wherein a physician in Boston attempted robotic PCI on endovascular simulators in New York and San Francisco, respectively. PCI was attempted over both wired and fifth generation (5G)‐wireless networks. Outcome measures included procedural success, procedural time, and perceived latency. Results Procedural success was achieved in 20 consecutive target lesions in the regional model and in 16 consecutive target lesions in the transcontinental model. The transcontinental model had a greater latency than the regional model over both wired (121.5 ± 2.4 ms vs. 67.8 ± 0.9 ms; p < .001) and 5G‐wireless networks (162.5 ± 1.1 ms vs. 86.6 ± 0.6 ms; p < .001), but perceived latencies were graded “imperceptible” in all cases in both models. Transcontinental and regional models did not have significantly different procedural times over wired (4.1 ± 1.9 min vs. 9.0 ± 7.1 min; p = .051) or 5G‐wireless (3.0 ± 0.6 vs. 6.3 ± 1.2; p = .36) networks. Conclusions Transcontinental robotic manipulation of coronary devices is now possible and was not associated with adverse performance compared to robotic telestenting conducted regionally.

Background: Consistent with the increasing prevalence of obesity in the general population, obesity has become more prevalent among patients undergoing cardiac catheterization. This study evaluated the association between patient body mass index (BMI) and physician radiation dose during coronary angiography. Methods and Results: Real-time radiation exposure data were collected during consecutive coronary angiography procedures. Patient radiation dose was estimated using dose area product. Physician radiation dose in each case was recorded by a dosimeter worn by the physician and is reported as the personal dose equivalent (H p 10). Patient BMI was categorized as <25.0, 25.0 to 29.9, 30.0 to 34.9, 35.0 to 39.9, and ≥40. Among 1119 coronary angiography procedures, significant increases in dose area product and physician radiation dose were observed across increasing patient BMI categories ( P <0.001). Compared with a BMI <25, a patient BMI ≥40 was associated with a 2.1-fold increase in patient radiation dose (dose area product, 91.8 [59.6–149.2] versus 44.5 [25.7–70.3] Gy×cm 2 ; P <0.001) and a 7.0-fold increase in physician radiation dose (1.4 [0.2–7.1] versus 0.2 [0.0–2.9] μSv; P <0.001). By multiple regression analysis, patient BMI remained independently associated with physician radiation dose (dose increase, 5.2% per unit increase in BMI; 95% CI, 3.0%–7.5%; P <0.0001). Conclusions: Among coronary angiography procedures, increasing patient BMI was associated with a significant increase in physician radiation dose. Additional studies are needed to determine whether patient obesity might have adverse effects on physicians, in the form of increased radiation doses during coronary angiography.

The relatively simple approach of using accessory lead shields to protect staff members during cardiac catheterization was associated with a nearly two-thirds reduction in radiation exposure among nurses and technologists.

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Objective: This study evaluated the impact of network latency on telestenting performance.Background: The feasibility of long-distance robotic telestenting was recently demonstrated, yet the impact of network performance on telestenting remains unknown.Methods: Ex vivo and in vivo telestenting models were constructed by connecting a robotic drive over a wired network to a robotic control system up to 103 miles away.During consecutive attempts to robotically wire a coronary artery, investigators randomly added signal latencies from 0 to 1,000 ms. Outcomes included wiring success, wiring time (time to advance wire to preselected target landmark), and perceived latency score (5 = imperceptible; 4 = noticeable but minor; 3 = noticeable; 2 = noticeable and major; 1 = unacceptable). Results:Wiring success was achieved in 95 of 95 attempts in the ex vivo model and in 57 of 57 attempts in vivo. No significant difference in wiring time was observed across added latencies from 0 to 1,000 ms in the ex vivo (p = .64) or in vivo (p = .40) models. Compared to an added latency of 0 ms, perceived latency scores were not significantly different for added latencies of 150 and 250 ms (p = NS for both), but were significantly lower for latencies ≥400 ms (p < .001).Conclusions: Added latencies up to 250 ms were not associated with perceived latency, but latencies ≥400 ms were perceptible. Based on these findings, future telestenting studies should utilize networks with latencies ≤250 ms if perceived latency is to be avoided.

C oronary artery disease accounts for ≈1 in every 6 deaths in the United States, with acute ST-segment-elevation myocardial infarction (STEMI) contributing significantly to the overall morbidity associated with this disease. 1 Postmortem studies in patients dying of myocardial infarction consistently demonstrate that the majority of STEMIs are triggered by rupture of a thin-fibrous cap overlying a lipidrich necrotic core. 2-5Intracoronary near-infrared spectroscopy (NIRS) is a catheter-based imaging modality developed and validated to detect lipid-rich plaques (LRPs) in patients undergoing coronary angiography. 6,7 In an exploratory analysis in a small number of STEMI patients, NIRS demonstrated large, significant differences in the lipid content between culprit and nonculprit segments.8 A potential NIRS signature of STEMI culprit lesions was identified, defined by a maximum lipid core burden index within a 4-mm coronary section (maxL-CBI 4mm ) being >400. These initial observations were limited by a modest sample size, single-center enrollment, and post hoc selection of the maxLCBI 4mm ≥400 threshold. This study was designed a priori to confirm the ability of NIRS to discriminate STEMI culprit from nonculprit segments and to determine the sensitivity and specificity of the maxLCBI 4mm ≥400 threshold. Secondary aims were to evaluate the ability of the NIRS block chemogram to differentiate culprit from nonculprit segments and to evaluate the regional deposition of lipid within coronary segments adjacent to the angiographically defined culprit segment.© 2016 American Heart Association, Inc. Objective-In a previous exploratory analysis, intracoronary near-infrared spectroscopy (NIRS) found the majority of culprit lesions in ST-segment-elevation myocardial infarction (STEMI) to contain a maximum lipid core burden index in 4 mm (maxLCBI 4mm ) of >400. This initial study was limited by a small sample size, enrollment at a single center, and post hoc selection of the maxLCBI 4mm ≥400 threshold. This study was designed a priori to substantiate the ability of NIRS to discriminate STEMI culprit from nonculprit segments and to confirm the performance of the maxLCBI 4mm ≥400 threshold. Approach and Results-At 2 centers in the United States and Sweden, 75 STEMI patients underwent intracoronary NIRS imaging after establishing thrombolysis in myocardial infarction 3 flow, but before stenting. Blinded core laboratory analysis defined the culprit segment as the 10-mm segment distal to the proximal angiographic culprit margin. The remaining vessel was divided into contiguous 10-mm nonculprit segments.