Periprocedural and 30-day outcomes of robotic-assisted percutaneous coronary intervention used in the intravascular imaging guidance

Abstract

In recent years, there have been several reports on robotic-assisted percutaneous coronary intervention (R-PCI), but few studies have been conducted on R-PCI performed under intravascular imaging guidance. To elucidate the periprocedural and postoperative 30-day outcomes of intravascular imaging-guided R-PCI, we performed a retrospective observational study on all patients in 102 consecutive cases who underwent R-PCI under intravascular imaging guidance at a single center in Japan from June 12, 2019 to February 18, 2021. The primary end point was 30-day survival, and the secondary end point was the incidence of complications. Intravascular imaging-guided R-PCI was performed 110 times in total on 125 lesions. The medians of procedural time, fluoroscopy time, contrast volume, patient entrance skin dose, and radiation exposure to the main operator were 49 min, 16 min, 67 mL, 0.62 Gy, and 0 μSv, respectively. Furthermore, 60.0% of target lesion branches were American College of Cardiology Foundation/American Heart Association classification type B2 or type C. However, in all cases, lesion dilatation was successful, and the final Thrombolysis in Myocardial Infarction flow grade was 3. The combination of manual operation was required in 12.7% of all cases, but 30-day survival was confirmed in all cases. There were two problems at the puncture site. One small distal branch artery dissection occurred due to manual operation, but no cardiovascular events (myocardial infarction, stroke) occurred and no target lesion restenosis was observed within 30 days of R-PCI. Hence, R-PCI using intravascular imaging demonstrated highly satisfactory treatment outcomes, and no complication caused by robotic operation was observed.

Prognostic Factors of In-Hospital Mortality in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock

“…Given that the relative prevalence of NSTEMI versus STEMI has been increasing globally, the prognostic impact of NSTEMI presentation may be even more important in the current era. Indeed, it is conceivable that the present study population represents a contemporary PCI population, with the use of intravascular ultrasound, drug-eluting stents, and MCS in 98.0%, 87.2%, and 56.6%, respectively, which is in line with current clinical practice patterns in Japan [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

Robotic-assisted percutaneous coronary intervention: experience in Switzerland

“…Similarly, in the CORA-PCI registry, guiding catheter or wiring support issues and robotic platform limitations were the leading causes (85%) for manual assistance or conversion and adverse events accounted for 15% ( 15 ). Rare cassette or system errors were also reported from a Japanese registry ( 16 ). Predictors for the need of manual inputs in other studies were lesion complexity and higher-graded pre-PCI stenosis ( 12 , 15 ).…”

“…Current robotic systems do not support most intracoronary imaging devices, which therefore must be operated manually ( 12 , 16 ). Aiming for completely robotic procedures should not be a reason to refrain from use of intracoronary imaging, which will be increasingly used in routine clinical PCI practice.…”

“…Aside from intracoronary imaging catheters, additional devices are not compatible with the current robotic platform. Guide catheter extensions, which may be required to overcome limited guiding catheter support ( 15 , 16 , 21 ), microcatheters and rotational ablation devices must be used manually. However, a newer robotic cassette, inspired by the neurovascular CorPath system, features an adaptor to be connected to a microcatheter broadening the spectrum of lesions potentially eligible to RA-PCI.…”

Robotic percutaneous coronary intervention (R-PCI): Time to focus on the pros and cons

“…However, the CorPath GRX cannot control all types of intravascular imaging catheters, which were manually controlled in this study. 18 More recently, Arif A. Khokhar and colleagues evaluated the key technological advancements in the most recent robotic CorPath GRX system and reported that IVUS was carried out robotically using the Eagle Eye Platinum catheter (Philips) in a complex left main to the left anterior descending (LAD) artery lesion. 19 The robotic system is not capable of manipulating rotational IVUS systems but can do phased array IVUS; however, phased array generally operates at a lower frequency and therefore has lower resolution.…”