Demonstration of the Safety and Feasibility of Robotically Assisted Percutaneous Coronary Intervention in Complex Coronary Lesions

Mahmud, Ehtisham; Naghi, Jesse; Ang, Lawrence; Harrison, Jonathan S.; Behnamfar, Omid; Pourdjabbar, Ali; Reeves, Ryan; Patel, Mitul

doi:10.1016/j.jcin.2017.03.050

Cited by 128 publications

(108 citation statements)

References 14 publications

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“…1 Glimpsing to the future, the feasibility and technical success of robotically-assisted PCI for complex coronary lesions were investigated in 334 procedures from 315 patients included in the Complex Robotically Assisted Percutaneous Coronary Intervention (CORA-PCI) study. 2 In 108 procedures of robotically-assisted PCI, technical success was 91.7% and clinical success was 99. 1%.…”

Section: Myocardial Revascularization Percutaneous Coronary Interventmentioning

confidence: 99%

“…A propensitymatched analysis of 82 pairs showed that the procedures were longer in patients undergoing robotically-assisted PCI compared with patients undergoing standard PCI, but clinical success rates were similar. 2 Robotically-assisted PCI might find its niche sooner than expected, boosted by the opportunity to further reduce radiation burden to the operator and team.…”

Section: Myocardial Revascularization Percutaneous Coronary Interventmentioning

confidence: 99%

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The year in cardiology 2017: coronary interventions

Kristensen

Mæng

Capodanno

et al. 2018

European Heart Journal

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PreambleThe first balloon coronary angioplasty was performed in Zurich by Andreas Grüntzig in 1977. The patient, a 38-year-old man with severe angina and a tight stenosis on the left anterior descending artery, is still alive, is doing well, and he celebrated the 40-year anniversary of his percutaneous coronary interventions (PCI) in 2017 ( Figure 1). During the last decades, PCI techniques have undergone major improvements with the first real game changer being the introduction of bare metal stents, which made PCI safer and improved longer-term outcomes. Later on, drug-eluting stents (DESs) were introduced, which resulted in a major reduction in restenosis and also-with the newer generation DES-a low rate of stent thrombosis. Further, the introduction of intracoronary pressure measurements for assessment of severity of coronary stenoses [fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR)] and intracoronary imaging [intravascular ultrasound (IVUS) and optical coherence tomography (OCT)] for lesion assessment has refined lesion and procedure assessment. Improved outcomes were also fostered by development of better and safer adjunctive antithrombotic drugs and secondary prevention, optimizing drug-device synergy. Still, 40 years later the research in the coronary interventional field is very intense, and we aim here to summarize major developments in PCI published in 2017. Myocardial revascularization Percutaneous coronary intervention techniqueThe SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) II study investigated the impact of a contemporary PCI strategy on clinical outcomes of 454 patients with three-vessel disease. 1Characteristics of the SYNTAX II strategy that captures all components of today's 'best of PCI practice' are summarized in Figure 2. Following this approach systematically, the authors demonstrated major adverse cardiac and cerebrovascular events (MACCE) at 1 year to be much improved with respect to a matched historical PCI cohort from the SYNTAX I trial (10.6% vs. 17.4%; P = 0.006). The better result of the contemporary PCI strategy compared with the procedural technique followed at the time of the SYNTAX I trial was driven by a lower risk of myocardial infarction (MI) and revascularization, with a parallel reduction in stent thrombosis. Overall, the SYNTAX II study suggests that the combination of best practice components in PCI technique portends improved patient outcomes beyond what can be achieved by introducing one single new element. Because these results outperform PCI results obtained in the earlier SYNTAX I trial, the hypothesis was generated that a new randomized study of modern best PCI practice in patients with three-vessel disease might show non-inferiority vs. coronary artery bypass grafting (CABG). 1Glimpsing to the future, the feasibility and technical success of robotically-assisted PCI for complex coronary lesions were investigated in 334 procedures from 315 patients included in the Complex Robotically Assisted Percutaneous Coronary Intervention (...

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Section: Myocardial Revascularization Percutaneous Coronary Interventmentioning

confidence: 99%

Section: Myocardial Revascularization Percutaneous Coronary Interventmentioning

confidence: 99%

The year in cardiology 2017: coronary interventions

Kristensen

Mæng

Capodanno

et al. 2018

European Heart Journal

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“…Since then several reports have demonstrated the feasibility of robotic PCI for complex procedures including multi‐lesion CAD, allograft vasculopathy, vein graft PCI, unprotected left main (LM) PCI and ST elevation myocardial infarction (STEMI) . The Complex Robotically Assisted (CORA) PCI study reported the safety and feasibility of robotically assisted PCI in clinical practice with a high proportion of complex lesions (Figure ) . In this single center study, all patients undergoing PCI procedures performed by a single operator, either robotically or manually, over an 18‐month period were enrolled.…”

Section: The Systemsmentioning

confidence: 99%

Robotic technology in interventional cardiology: Current status and future perspectives

Mahmud

Pourdjabbar

Ang

et al. 2017

Cathet Cardio Intervent

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Robotic technology has been utilized in cardiovascular medicine for over a decade, and over that period, its use has been expanded to percutaneous coronary and peripheral vascular interventions. The safety and feasibility of robotically assisted percutaneous cardiovascular interventions has been demonstrated in studies including simple to complex coronary lesions, and both iliac and femoropopliteal lesions. These reports have shown that robotically assisted PCI significantly reduces operator exposure to harmful ionizing radiation without a detrimental effect on procedural success or clinical efficacy. Additionally, the use of robotics has the intuitive benefit of alleviating the risk of orthopedic injuries faced by interventional operators. In addition to the interventional operator benefits, robotically assisted intervention has the potential for patient level benefit by allowing more accurate lesion length measurement, precise stent placement, and lower patient radiation exposure. However, further investigation is required to fully elucidate these potential benefits.

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“…Since then several reports have demonstrated the feasibility of robotic PCI for complex procedures including multi-lesion coronary artery disease, allograft vasculopathy, vein graft PCI, unprotected left main PCI, and ST elevation myocardial infarction (STEMI) 28,29. The Complex Robotically Assisted (CORA) PCI study evaluated the safety and feasibility of robotically assisted PCI and compared clinical outcomes against manual PCI in an all-comers, real-world clinical practice 30. This study enrolled 334 patients, with 108 patients (157 lesions) in the robotic group and 226 patients (336 lesions) in the manual group.…”

Section: Corpath 200 and Coronary Interventionsmentioning

confidence: 99%

The Development of Robotic Technology in Cardiac and Vascular Interventions

Pourdjabbar¹,

Ang²,

Reeves³

et al. 2017

Rambam Maimonides Med J

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Robotic technology has been used in cardiovascular medicine for over a decade, and over that period its use has been expanded to interventional cardiology and percutaneous coronary and peripheral vascular interventions. The safety and feasibility of robotically assisted interventions has been demonstrated in multiple studies ranging from simple to complex coronary lesions, and in the treatment of iliofemoral and infrapopliteal disease. These studies have shown a reduction in operator exposure to harmful ionizing radiation, and the use of robotics has the intuitive benefit of alleviating the occupational hazard of operator orthopedic injuries. In addition to the interventional operator benefits, robotically assisted intervention has the potential to also be beneficial for patients by allowing more accurate lesion length measurement, stent placement, and patient radiation exposure; however, more investigation is required to elucidate these benefits fully.

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Demonstration of the Safety and Feasibility of Robotically Assisted Percutaneous Coronary Intervention in Complex Coronary Lesions

Abstract: This study demonstrates the feasibility, safety, and high technical success of R-PCI for the treatment of complex coronary disease. Furthermore, comparable clinical outcomes, without an adverse effect on stent use or fluoroscopy time, were observed with R-PCI and M-PCI.

Cited by 128 publications

References 14 publications

The year in cardiology 2017: coronary interventions

The year in cardiology 2017: coronary interventions

Robotic technology in interventional cardiology: Current status and future perspectives

The Development of Robotic Technology in Cardiac and Vascular Interventions

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