Evaluation of the R-One robotic system for percutaneous coronary intervention: the R-EVOLUTION study.

Robotic-Assisted PCI: The Future of Coronary Intervention?

A Randomized Comparison of the Transradial and Transfemoral Approaches for Coronary Artery Bypass Graft Angiography and Intervention: The RADIAL-CABG Trial (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention)

Robotic-assisted percutaneous coronary intervention (PCI) is a novel technology that permits remote operation of interventional devices. However, little is known about the safety and effectiveness of introducing a robotic PCI program in a hospital already experienced in traditional coronary angioplasty. Prospective single-arm survey to assess the safety and effectiveness of robotic-assisted PCI in comparison to pre-defined performance goals. The study cohort comprised all consecutive cases treated with robotic PCI since its introduction. The safety primary endpoint was a composite of (I) overall death or (II) non-fatal adverse events related to target vessel complications (stent thrombosis, myocardial infarction, vessel perforation or cardiac tamponade, or repeat invasive treatment) during the index hospitalization. The efficacy primary endpoint was robotic-assisted procedural success, a composite of (I) successful dilatation of the target lesion and (II) successful robotic assistance, defined as absent non-planned manual conversion. A total of 83 patients and 112 lesions were prospectively enrolled. The rate of angiographic success was 99.1%. From these, 97 lesions (86.6%) were treated with only robotic PCI or with hybrid according to the pre-interventional plan. The rates of efficacy and safety primary endpoints were 85.7% and 2.4% respectively (P<0.01 for non-inferior to the pre-defined performance threshold). Introduction of robotic-assisted PCI in a tertiary center was associated with safe and effective results, comparable to pre-defined goals of optimal performance.

Impact of Complex Lesions on Radiological Exposure during Percutaneous Coronary Intervention

Single-Use versus Reusable Endoscopes for Percutaneous Biliary Endoscopy with Lithotripsy: Technical Metrics, Clinical Outcomes, and Cost Comparison

Radial artery access for coronary angiography or percutaneous coronary intervention (PCI) reduces the risk of death, bleeding, and vascular complications and is preferred over femoral artery access, leading to a class 1 indication by clinical practice guidelines. However, alternate upper extremity access such as distal radial and ulnar access are not mentioned in the guidelines despite randomized trials. We aimed to evaluate procedural outcomes with femoral, radial, distal radial, and ulnar access sites in patients undergoing coronary angiography or PCI. PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized clinical trials that compared at least 2 of the 4 access sites in patients undergoing PCI or angiography. Primary outcomes were major bleeding and access site hematoma. Intention-to-treat mixed treatment comparison meta-analysis was performed. From 47 randomized clinical trials that randomized 38 924 patients undergoing coronary angiography or PCI, when compared with femoral access, there was a lower risk of major bleeding with radial access (odds ratio [OR], 0.46 [95% CI, 0.35-0.59]) and lower risk of access site hematoma with radial (OR, 0.34 [95% CI, 0.24-0.48]), distal radial (OR, 0.33 [95% CI, 0.20-0.56]), and ulnar (OR, 0.50 [95% CI, 0.31-0.83]) access. However, when compared with radial access, there was higher risk of hematoma with ulnar access (OR, 1.48 [95% CI, 1.03-2.14]). Data from randomized trials support guideline recommendation of class 1 for the preference of radial access over femoral access in patients undergoing coronary angiography or PCI. Moreover, distal radial and ulnar access can be considered as a default secondary access site before considering femoral access. URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: 42024512365.

Background Currently available evidence suggests that outcomes are less favorable when left main (LM) bifurcation lesions are treated with 2-stent techniques compared with a single-stent technique. We aimed to evaluate the long-term outcomes of the 2-stent techniques for treating unprotected LM bifurcation lesions in Chinese patients. Methods We enrolled 301 consecutive patients treated with drug-eluting stents (DES) implantation using 2-stent techniques for unprotected LM bifurcation lesions (MEDINA 1, 1, 1, 70.5%). The 2-stent techniques included crush technique, V stenting, T stenting, and Culottes stenting. After stenting, both vessels were redilated at a high pressure before final kissing balloon (FKB). Clinical and angiographic data were analyzed. The primary endpoints were major adverse cardiac events (MACE), which included death, myocardial infarction, and target lesion revascularization. Results Immediate procedural success was obtained in all cases with a FKB success rate of 95.3%. Follow-up data were available for all patients. The overall incidence of angiographic in-stent restenosis (ISR) rate was 20.3% and most ISRs were of the focal type. During long-term follow-up (mean duration, (54±22) months), the cumulative incidence of MACE was 11.0%, with 8 (2.7%) deaths, 7 (2.3%) myocardial infarctions, and 18 (6.0%) repeated lesion revascularization. MACEs in high SYNTAX score terciles were significantly higher compared with those in low and intermediate SYNTAX score terciles (P=0.001). Conclusions Although percutaneous coronary intervention (PCI) with 2-stent technique for unprotected LM bifurcation lesions was accompanied with a slightly high incidence of ISR, the long-term clinical follow-up is acceptable. Technical modifications and stent innovations may further improve both the angiographic and clinical outcomes for patients with LM bifurcation disease treated by PCI.

Innovation has been the cornerstone of progress in the field of percutaneous coronary intervention (PCI) since its inception. Refinements in procedural technique and interventional tools have improved patient outcomes and overall safety. Despite this progress, however, the health risks posed to operators and staff remain undeniably high. Robotic PCI (R-PCI) offers a new era in coronary revascularization poised to address this dilemma. To date, R-PCI procedures have been widely performed in clinical practice for over a decade and multiple novel endovascular robotic systems are currently under development. This review serves as an up-to-date understanding of R-PCI, focusing on the origins, clinical evidence, current state, and future targets of robotic therapy.

Distal radial approach treating a left main lesion during hemostasis of the forearm radial artery on the same side in a case of unstable angina

Introduction: Robotics in percutaneous coronary intervention (R-PCI) has been one such area of advancement where potential benefits may include reduction in radiation exposure, improved outcomes and reduced rate of adverse events. Robotic assistance may offer many potential benefits to both the operator and the patient. Limited data exist about the benefits of R-PCI vs. conventional manual PCI (M-PCI). Hypothesis: The aim for our meta-analysis is to evaluate the procedural measures and clinical outcomes between R-PCI and M-PCI. Methods: A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant clinical studies. Summary effects were calculated using a DerSimonian and Laird random effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. All studies adhering to the inclusion criteria of direct comparisons between R-PCI and M-PCI were evaluated. Results: Seven studies with a total of 2,230 patients were identified. There was significant decrease in the chest-level operator radiation exposure (OR= -442.32; 95% CI = -675.88 to -208.76), fluoroscopy time (OR = -1.46; 95% CI -2.92 to 0.00) and amount of contrast used (OR= -18.28; 95% CI -24.16 to -12.41) in the robotic group as compared to the manual group. PCI time (OR = 2.41; 95% CI -3.95 to 8.76) and procedural success rate (OR 1.26; CI 0.19-8.22) was not statistically different between the two groups. In terms of clinical outcomes, there was no difference between R-PCI and M-PCI in terms of major adverse cardiac events (OR 0.90; CI 0.45-1.79), all-cause mortality (OR 0.95; CI 0.21-4.30), and myocardial infarction (OR 0.88; CI 0.41-1.89). Conclusions: Robotic PCI is associated with reduced operator radiation exposure, fluoroscopy time and amount of contrast used. While there is a significant reduction in the procedural characteristics with robotic PCI, the clinical outcomes are not different compared to manual PCI. Use of robotics in PCI appears to be safe and potentially favorable to the patients, in addition to its benefits of improved ergonomics. More randomized studies looking at the use of R-PCI, especially in complex lesions, are needed before consideration for widespread implementation.

Introduction: Percutaneous coronary interventions (PCI) remain a debatable choice of access site. Procedural success, complications, and recovery outcomes in terms of the impact of complications were shown to be lower for radial access when compared to femoral access. However, comparative outcomes in terms of procedural success require further evaluation. Objective: To compare the outcomes of radial and femoral access in PCI settings with respect to procedural success, complications, and patient recovery. Materials and Method: This retrospective cohort study conducted at Department of Cardiology, Hayatabad Medical Complex, Peshawar from July, 2022 to December, 2022. Five hundred patients undergoing PCI were analyzed, and data were compared regarding procedural success, complications, and recovery outcomes between radial and femoral access. Results: Fewer complications, such as bleeding and hematoma, and shorter hospital stays were found with radial access. However, the groups had no significant differences in major adverse cardiac events. Conclusion: Femoral access is safer and more convenient for PCI, but it has more complications and slower recovery compared to radial access.

BackgroundData on radial access (RA) as an independent risk factor for acute kidney injury (AKI) in myocardial infarction (MI) patients are conflicting. Our aim was to assess how RA influences the incidence of AKI in MI patients undergoing percutaneous coronary intervention (PCI).MethodsData from 3842 MI patients undergoing PCI at our institution from January 2011 to December 2016, of which 35.8% were performed radially, were retrospectively analyzed. A propensity-matched analysis was performed to adjust for differences in the baseline characteristics between the RA and femoral access (FA) groups. The effect of RA on the incidence of AKI was observed.ResultsIn the unmatched cohort, AKI occurred less often in the RA group [77 (5.6%) patients in the RA group compared to 250 (10.1%) patients in the FA group; p = 0.001]. After propensity-matched adjustment, the incidence of AKI was similar in the two groups.After adjustment for potential confounders, RA was not identified as an independent predictive factor for AKI in either the unmatched or the propensity-matched cohort. Bleeding, heart failure, age ≥ 70 years, renal dysfunction, and the contrast volume/GFR ratio predicted AKI in both cohorts. Additionally, diabetes, contrast volume, and hypertension were predictive of AKI in the unmatched cohort.ConclusionThe access site was not independently associated with the incidence of AKI in patients with MI in both a non-matched and a propensity-matched cohort. Our study result suggests that the lower incidence of AKI in patients treated with RA in an unmatched cohort might be substantially influenced by confounding factors, especially bleeding.

Impact of heart failure on outcome after percutaneous coronary intervention: is it the patient or the intervention?

Radial versus femoral access for elderly patients with acute coronary syndrome undergoing coronary angiography and intervention: insights from the RIVAL trial

Reduction of Operator Radiation Dose by a Pelvic Lead Shield During Cardiac Catheterization by Radial Access: Comparison With Femoral Access