As measured one year after the procedure, coronary stenting for multivessel disease is less expensive than bypass surgery and offers the same degree of protection against death, stroke, and myocardial infarction. However, stenting is associated with a greater need for repeated revascularization.

Integrating humans and robotic machines into one system offers multiple opportunities for creating assistive technologies that can be used in biomedical, industrial, and aerospace applications. The scope of the present research is to study the integration of a human arm with a powered exoskeleton (orthotic device) and its experimental implementation in an elbow joint, naturally controlled by the human. The Human-Machine interface was set at the neuromuscular level, by using the neuromuscular signal (EMG) as the primary command signal for the exoskeleton system. The EMG signal along with the joint kinematics were fed into a myoprocessor (Hill-based muscle model) which in turn predicted the muscle moments on the elbow joint. The moment-based control system integrated myoprocessor moment prediction with feedback moments measured at the human arm/exoskeleton and external load/exoskeleton interfaces. The exoskeleton structure under study was a two-link, two-joint mechanism, corresponding to the arm limbs and joints, which was mechanically linked (worn) by the human operator. In the present setup the shoulder joint was kept fixed at given positions and the actuator was mounted on the exoskeleton elbow joint. The operator manipulated an external weight, located at the exoskeleton tip, while feeling a scaled-down version of the load. The remaining external load on the joint was carried by the exoskeleton actuator. Four indices of performance were used to define the quality of the human/machine integration and to evaluate the operational envelope of the system. Experimental tests have shown that synthesizing the processed EMG signals as command signals with the external-load/human-arm moment feedback, significantly improved the mechanical gain of the system, while maintaining natural human control of the system, relative to other control algorithms that used only position or contact forces. The results indicated the feasibility of an EMG-based power exoskeleton system as an integrated human-machine system using high-level neurological signals.

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Complete revascularization was more frequently accomplished by bypass surgery than by stent implantation. One year after bypass, there was no significant difference in event-free survival between surgically treated patients with complete revascularization and those with incomplete revascularization, but patients randomized to stenting with incomplete revascularization had a greater need for subsequent bypass surgery.

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