Remote robotic percutaneous coronary intervention: An animal feasibility study

Abstract

Objectives 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. Background 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. Methods 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. Results 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. Conclusions 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.

Effect of the hospital transfer of STEMI patients through the remote emergency consultation system on the emergency department length of stay and survival at hospital discharge: a single center retrospective cohort study

“…The median age of the participants was 70.5 years, which was consistent with the demographic characteristics of previous studies, which reported the highest incidence of STEMI in the 50-90 year age group [19].…”

Robotically performed diagnostic coronary angiography

“…Furthermore, telerobotic PCI has been demonstrated to be technically feasible in an ex vivo model spanning the distance between Boston and San Francisco 17 . Despite being conducted over >3000 miles, network latency was <200 ms on both wired and 5 G wireless networks, which is below the 400‐ms threshold at which latencies become perceptible to physicians performing telerobotic PCI 15,18 . Based on the results of these prior studies showing that PCI is technically feasible over long distances, we believe the results of the present study warrant future studies to evaluate telerobotic performance of diagnostic coronary angiography over long distances.…”

“…The successful performance of robotic diagnostic coronary angiography, controlled from the same procedure room housing the patient in this study, suggests diagnostic coronary angiography may also be possible if performed remotely over long distances. This notion is supported by prior research demonstrating telerobotic PCI to be successful in animal models over short distances and those exceeding 100 miles, 14,15 as well as in five humans over a distance of approximately 20 miles 16 . Furthermore, telerobotic PCI has been demonstrated to be technically feasible in an ex vivo model spanning the distance between Boston and San Francisco 17 .…”

“…17 Despite being conducted over >3000 miles, network latency was <200 ms on both wired and 5 G wireless networks, which is below the 400-ms threshold at which latencies become perceptible to physicians performing telerobotic PCI. 15,18 Based on the results of these prior angiography in 50% and PCI in only 42% of cases, rates which were both significantly lower than those at urban hospitals. 19 The geographic disparities in access to coronary angiography and PCI, although profound, do not seemingly approach the level of disparity that exists in access to catheter-based therapies for acute stroke.…”

Robotics, imaging, and artificial intelligence in the catheterisation laboratory

“…While the majority of interventional procedures are set up with the control station placed within a protected cockpit in the catheterisation laboratory next to the patient table, some operators prefer performing PCI with the console placed in the control room. The concept of a remote procedure, during which the operator is outside and potentially distant from the patient procedure room was initially tested in a swine model within the Mayo Clinic, using local communication 76 with full success in 52 experiments. Latency effects for up to 1,000 ms were tested; a detrimental effect was observed only for a latency greater than 250 ms.…”