The Development of Robotic Technology in Cardiac and Vascular Interventions

Abstract

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.

Figure 1

The CorPath 200 Vascular Robotic System. (A) Robotic PCI platform—robotic console and tableside drive (CorPath 200, Corindus, Waltham, MA) and robotic cassette. ➀ Robotic arm and cassette; ➁ interventional cockpit; ➂ control console. (B) Robotic cassette demonstrating the placement for the guidewire (red) and the balloon/stent (blue). ➃ Driver for rapid-exchange catheters; ➄ driver for 0.014” guidewires; ➅ mechanical torque system for 0.014” guidewires.

Figure 2

Exemplary Procedures of Complex Robotic PCI Showing Pre- and Post-PCI Angiograms in a Patient with Multi-vessel Disease. (A) Angiogram of the right coronary artery (RCA) demonstrating a tortuous artery with severe obstructive lesions in the mid and distal segments. (B) Demonstrates the use of a buddy wire and a Wiggle wire, both advanced robotically for the delivery of a stent to the mid and distal RCA. (C) Final angiogram after stenting of the mid and distal RCA. (D) Right anterior oblique (RAO) caudal view of the left coronary system demonstrating severe distal left anterior descending (LAD) and distal left main lesions. (E) Stent delivery and deployment within the distal left main into the proximal LAD. (F) Final angiogram of the left coronary artery after stenting of the distal left main into the LAD and the distal LAD.

Figure 3

Right Lower Extremity below the Knee Robotic Revascularization. (A) Preprocedural angiogram demonstrating a focal stenosis within the tibioperoneal (TP) trunk, a focal lesion in the proximal peroneal artery, and occluded anterior and posterior tibialis arteries. (B) Follow-up angiography after robotically assisted balloon angioplasty of the peroneal and TP trunk (3.0×20 mm Maverick RX balloon, Boston Scientific, Marlborough, MA, USA) revealing elastic recoil. (C) Additional balloon angioplasty of both target lesions (3.5×20 mm Maverick RX balloon, Boston Scientific, Marlborough, MA, USA). (D) Final angiogram demonstrating <30% residual stenosis and no flow-limiting dissections. From Behnamfar et al. J Invasive Cardiol 2016 Nov; 28(11): E128–E131, used with permission.