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‘Telestenting’ may be feasible with robotic PCI
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“Telestenting,” which involves a combination of telecommunications and a robotic system for PCI, may one day allow interventional cardiologists to perform stenting remotely.
In REMOTE-PCI, a single-center, prospective, observational study, researchers sought to determine whether physician operators were capable of performing robotic PCI from a physical location separate from the patient. For all procedures, the interventional cockpit was moved outside the procedure room, and all communications with the patient and cath lab personnel were conducted via telecommunication devices that wirelessly provided real-time audio and video connectivity. Robotics were used for all manipulations of guidewires, balloons and stents.
Twenty patients with severe stenosis requiring PCI, as demonstrated on invasive angiography, and with a lesion deemed suitable for robotic PCI were included in the analysis. Six patients had MI, 13 had unstable angina and one had stable symptoms. The researchers also used propensity score matching to select a control group from a pool of 50 consecutive patients undergoing standard bedside robotic PCI.
Total procedural time was 29 minutes, and total fluoroscopy time was 15.5 minutes. The fluoroscopy time of control patients (18.5 minutes) was not significantly different in the propensity-matched analysis (P = .22). Total air kerma was lower among patients undergoing telestenting vs. controls in the propensity-matched analysis (1,263 mGy vs. 1,826 mGy; P = .01).
Technical success, defined as successful intracoronary advancement and retraction of guidewires, angioplasty balloons and stents by the robotic system without conversion to manual operation, was achieved in 19 of 22 lesions (86.4%). Procedural success, defined as less than 30% of residual stenosis after completion of the procedure without death or repeat revascularization before hospital discharge, was attained in 19 of 20 patients (95%), which was not significantly different from that of controls (95%) in the propensity-matched analysis.
No deaths or repeat revascularizations occurred before hospital discharge.
“Additional studies will determine if future advancements in robotics will facilitate the successful performance of telestenting over longer geographic distances,” the researchers wrote. “If developed into a procedure capable of being performed over long distances, telestenting could be applied to improve access to stenting in medically underserved regions and might represent a novel alternative to inter-hospital transfer for primary PCI in patients with STEMI.” – by Melissa Foster
Disclosure: One researcher reports receiving research support from Corindus Vascular Robotics Inc.
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