Robotic PCI confers high rates of technical, clinical success
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The second generation of a robotic PCI system was associated with high rates of clinical and technical success, according to a presentation at the virtual Society for Cardiovascular Angiography and Interventions Scientific Sessions.
Ehtisham Mahmud, MD, MSCAI, FACC, Edith and William Perlman Chair in Cardiology and professor and division chief of cardiovascular medicine at the University of California, San Diego (UCSD), executive director of UCSD Cardiovascular Institute-Medicine and past president of SCAI, presented results from the PRECISION GRX registry of 980 patients (mean age, 65 years; 74% men) who underwent PCI with the second-generation robotic system (CorPath GRX, Corindus).
“If you work in the cath lab for more than 15 years, you have significant occupational hazards, both orthopedic-related as well as those associated with radiation,” Mahmud said during the presentation. “Robotic PCI is a change of how we do the procedure, with the operator sitting in a remote cockpit, where they can control the remote catheter, the remote guidewire and balloons and stents. They are protected from radiation and not wearing lead in this cockpit. Over time, there is potential for reduced risk.”
The co-primary endpoints were clinical success, defined as residual stenosis less than 30% and improved TIMI-3 flow without MACE, and technical success, defined as clinical success without unplanned conversion to manual PCI, he said.
In the cohort, the rate of clinical success was 98.2%, ranging from 98.9% in type A lesions to 97.9% in type C lesions, whereas the rate of technical success was 89.8%, ranging from 95.5% in type A lesions to 86.7% in type C lesions, Mahmud said.
He said there were no cases of in-hospital MACE, defined as cardiac death, MI or clinically driven target vessel revascularization. Among the cohort, 1.9% had residual stenosis of at least 30%, 0.9% had access-site complications, 0.1% had acute ischemic stroke, 0.1% had repeat PCI and 1.2% had acute kidney injury.
Some patients required manual assistance or conversion to manual PCI, Mahmud said, noting that inability to advance a guidewire, stent or catheter occurred in 4.5% of patients, inability to cross a guidewire, stent or catheter occurred in 4.6%, inability to retrieve a guidewire, stent or catheter occurred in 0.5%, inability to remotely manipulate a guidewire, stent or catheter occurred in 1%, robot malfunction occurred in 1.5% and other reasons for manual assistance or conversion occurred in 3.3%.
In high-risk lesions, defined as ostial, left main, moderately or severely calcified, bifurcation and chronic total occlusion lesions, clinical success ranged from 95.7% to 99.1% and technical success ranged from 77% to 96.2%, he said.
“These data support robotic PCI being a viable option for addressing both the orthopedic risks and radiation-associated risks for interventional cardiologists,” Mahmud said.
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Mahmud E, et al. Featured Clinical Research: Stable ischemic heart disease and TAVR. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; April 28-May 1, 2021 (virtual meeting).
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