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.

Keywords: Intravascular ultrasound; Optical coherence tomography; Optimal stenting.

Fig. 1

Flowchart for inclusion and exclusion criteria. Exclusion criteria were “acute myocardial infarction,” “culprit lesion in left main trunk,” “culprit lesion in coronary bypass graft,” “with transcatheter aortic valve replacement,” “using debulking device,” “using mechanical circulatory support,” and “without intravascular imaging”

Fig. 2

Graphs of each factor. Graphs of each factor in (Table 2). It was observed that 77.3% of all R-PCIs had a procedural time of < 60 min, 86.4% had a fluoroscopy time of < 30 min, 81.8% had an entrance skin dose of < 1.00 Gy, 83.6% had 0 μSv radiation exposure to the main operator, and 86.4% had an iodine contrast volume of < 100 mL

Fig. 3

Major causes and details of manual operations besides intravascular imaging device. Manual operations used in combination in addition to intravascular imaging were mostly related to guide wire operations. System error was recovered without any issue following rebooting after R-PCI was completed. Single-use cassette failure was solved after cleaning the connection part of the robotic drive of the adhered contrast agent and rebooting