Robot-Assisted Cardiovascular Interventions.

Robotic-Assisted PCI: The Future of Coronary Intervention?

R-One is a robotic percutaneous coronary intervention (PCI) system (CE mark 2019) designed to reduce operator radiation exposure, improve ergonomics, and accurately navigate, position, and deliver guidewires/devices during PCI. We aimed to evaluate the safety and efficacy of the R-One system for PCI. The European multicentre prospective R-EVOLUTION study included patients with a de novo coronary artery stenosis (length <38 mm, reference diameter 2.5-4.0 mm) undergoing stent implantation. Patients with recent ST-segment elevation myocardial infarction, ostial or left main lesion, bifurcation, severe tortuosity, or calcification were excluded. Clinical success was defined as the absence of major intraprocedural complications. Technical success was defined as the successful advancement and retraction of all PCI devices (guidewires/balloon/stents) without total manual conversion. Radiation exposure to patients, to a simulated manual operator, and to robotic PCI operators was measured. Sixty-two consecutive patients (B2/C lesions: 25.0% [16/64]) underwent robotic PCI. Radial access was used in 96.8% (60/62) of procedures. The mean robotic procedure duration was 19.9±9.6 min and the mean fluoroscopy time was 10.3±5.4 min. Clinical success was 100% with no complications at 30 days. Technical success was 95.2% (59/62). Total manual conversion was required in 4.8% (3/62) cases, with 1 case directly related to the robotic system. Operator radiation exposure was reduced by 84.5% under and 77.1% on top of the lead apron, compared to doses received on the patient table. This study suggests that robotic PCI using R-One is safe and effective with markedly lower radiation exposure to the operator. Further studies are needed to evaluate R-One in larger patient populations with more complex lesions. (ClinicalTrials.gov: NCT04163393).

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.

Robotic Percutaneous Coronary Intervention: Time to Focus on the Patient

Background: Advances in Percutaneous Coronary Inter-vention (PCI) techniques have improved patient outcome. However, occurrence of myonecrosis after elective PCI has been extensively debated.Aim of Study: We investigated the value of the ratio of early transmittal velocity to tissue Doppler mitral annular early diastolic velocity (E/E') in detecting the occurrence of peri-procedural myocardial injury in patients undergoing elective PCI.Patients and Methods: Sixty two patients undergoing elective PCI were recruited prospectively. All participants had EF% >50% and sinus rhythm. E/E' ratio was measured immediately before, and within 24 hours after PCI. CK-MB and cardiac troponin (cTn) were measured in the same day after successful PCI to diagnose myocardial injury.Results: The cohort age was 56.7±9.7 year, and consisted of forty four (71%) males, 49 (27.4%) had ³ two risk factors for CAD, 60% were symptomatic before PCI. Thirty (48.4%) patients had regional wall motion abnormalities (regional Wall Motion Score Index (WMSI): 0.74±0.29). Myocardial injury was diagnosed by elevated cTn in 39 (62.9%) patients. Patients with predilation showed reduction of LVEDP as estimated by D E/E' (8.9±2.9 Vs. 7.9±3.2, p<0.001). Pearson correlation analysis revealed that the E/E' correlated negatively with LV EF% (r=–26, p<0.03), positively with CK-MB and cTn level after PCI (r=.51, p<0.0001), NYHA functional class (r=.72, p<0.001), the number of risk factors, and number of vessel diseased and the number of vessel treated with PCI (r=36, pConclusion: These data suggest that the tissue Doppler derived-index of LV filling pressure (E/E') may be a useful indicator for predicting early myocardial injury after successful PCI. Patients with an elevated E/E' after PCI may need more careful and closer follow-up.

During the past decade, advances in device technology (eg, drug-eluting stents), development of safer anticoagulants (eg, bivalirudin), and refinement in procedural techniques have led to a dramatic improvement in the effectiveness and safety of percutaneous coronary intervention (PCI), despite increasing clinical and anatomic complexity of treated patients.1 As safety and effectiveness have been documented, the indications for PCI have expanded. In patients with ST-segment elevation myocardial infarction (STEMI), the superiority of primary PCI (when readily available) over thrombolytics is well established.2 More recently, PCI has also become a viable alternative to coronary artery bypass grafting in select patients with coronary artery disease.3 Article see p 14 As appreciation of the effectiveness of PCI has grown, there has been rapid diffusion of PCI capability into US hospitals. Dissemination of PCI has been further augmented by generous hospital and physician reimbursement, reductions in federal regulatory policies, and accumulating evidence that PCI can be performed safely at hospitals without on-site cardiac surgical backup.4,5 As a result, hospitals with PCI availability in the United States increased from 929 in 1993 to 1316 in 2004.6 Despite the growth in capacity, PCI is not available at all hospitals at all times. In fact, most patients with STEMI initially present to hospitals without PCI capability, where treatment options may include on-site thrombolytics or transfer to the nearest PCI-capable hospital for primary PCI. Based on demonstration of the superiority of primary PCI over thrombolytics,2 transfer to a PCI-capable hospital has been widely promoted as a treatment strategy for these patients.7 However, reperfusion in patients transferred for primary PCI is frequently delayed because <10% of these patients achieve the recommended door-to-balloon (D2B) time of <90 minutes.8 This is in sharp contrast to patients presenting directly to PCI-capable hospitals, where …

NP008 “LOOK, LISTEN and FEEL” What can the bedside nurse do to prevent vascular related complications post Percutaneous Coronary Intervention?

Alice K. Jacobs, MD, FACC, FAHA, Chair Jeffrey L. Anderson, MD, FACC, FAHA, Chair-Elect Nancy Albert, PhD, CCNS, CCRN, FAHA Mark A. Creager, MD, FACC, FAHA Steven M. Ettinger, MD, FACC Robert A. Guyton, MD, FACC Jonathan L. Halperin, MD, FACC, FAHA Judith S. Hochman, MD, FACC, FAHA

ST-segment elevation myocardial infarction (STEMI), cardiac arrest, and ischemic stroke are a diverse group of cardiovascular illnesses linked by the necessity for timely intervention in order to maximize patient outcomes. Despite the known efficacies of therapies, such as emergent percutaneous coronary intervention (PCI), rapid administration of tissue plasminogen activator, and induction of therapeutic hypothermia after cardiac arrest, translating these discoveries into standard practice nationwide has proven difficult to achieve. Significant regional variations in practice are commonplace, and facilities with higher patient volumes of STEMI, cardiac arrest, and ischemic stroke consistently have better outcomes compared with lower-volume facilities. Such disparities in emergency care led the Institute of Medicine in 2006 to describe the existing emergency care system as “at the breaking point,” and to call for “coordinated, regionalized, and accountable” systems of care. An effective and equitable regionalized emergency care system would resemble the existing US trauma system in some respects, with transparent and standard triage guidelines, cooperation between local and regional emergency medical service systems, and an integrated network of referring and receiving facilities. Emerging technologies, such as telemedicine, will likely play a significant role. Regionalized referral systems, such as designated PCI centers and designated stroke centers, are in existence, but have largely been reactive and local, and no mechanism is in place to ensure equitable distribution of such facilities across all geographic regions. As scientific advances in the treatment of these conditions continue to evolve, so too must the system of care that provides these therapies. Evidence suggests that regionalized systems of care for acute cardiovascular events may increase compliance with existing life-saving guidelines and improve patient outcomes.

Impact of high loading and maintenance dose of clopidogrel within the first 15 days after percutaneous coronary intervention on patient outcome

BackgroundCoronary heart disease (CHD) is one of the most common cardiovascular diseases, with its prevalence and mortality rates increasing annually. Percutaneous coronary intervention (PCI) serves as a crucial revascularisation method for CHD, effectively alleviating myocardial ischemia and improving patient outcomes. However, patients undergoing PCI often experience adverse events such as restenosis due to unhealthy lifestyles or behaviors. Therefore, conducting a comprehensive, multifaceted exploration of the factors influencing health promotion behaviors in post-PCI patients is crucial for enhancing these behaviors and preventing adverse cardiovascular events.ObjectiveBased on health ecology theory, this study aims to understand the current status of health promotion behaviors among post-PCI patients, analyze their influencing factors, and provide evidence for developing targeted interventions to improve these behaviors.MethodsThis cross-sectional study employed a convenience sampling approach. Between March and October 2024, 436 patients with PCI from the Cardiovascular Department of a Grade A tertiary general hospital in Sichuan Province, China, were enrolled. The study employed a general information questionnaire, the health promotion lifestyle scale, the health literacy scale, the psychological resilience scale, and the perceived social support scale for data collection. Univariate analysis, correlation analysis, and multiple stepwise linear regression were used to explore the factors influencing health promotion behaviors among these patients.ResultsThe mean health promotion behavior score among PCI patients was (84.55 ± 11.86). Correlation analysis revealed positive associations between health promotion behaviors and health literacy, psychological resilience, and perceived social support (r = 0.747–0.809, p < 0.01). Multivariate stepwise linear regression analysis revealed that age, occupational status, self-rated sleep quality, whether the patient or family members have worked in healthcare, receipt of chronic disease knowledge guidance, health literacy, psychological resilience, and perceived social support were significant factors influencing health promotion behaviors (p < 0.05), explaining 77.6% of the total variance.ConclusionHealth promotion behaviors among PCI patients post-surgery are at a moderate level. Influencing factors are multi-level and multidimensional, suggesting comprehensive interventions targeting individuals, families, and society are necessary to enhance health promotion behaviors.

2007 Focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention

Background: In-stent restenosis (ISR) remains a significant concern following percutaneous coronary intervention (PCI), particularly among diabetic patients who are at higher risk due to underlying vascular and metabolic factors. This research sought to establish the prevalence of ISR among diabetic patients with stable coronary artery disease and assess the relevant clinical and operative variables. Methods: A cross-sectional analytical study was conducted at Gajju Khan Medical College/Bacha Khan Medical Complex Swabi and Pak Welfare Cardiac Cath Lab, Peshawar, from February 2022 to January 2023. A total of 110 diabetic patients who underwent PCI for stable CAD and returned for follow-up coronary angiography were included. Clinical profiles, angiographic characteristics, and stent details were reviewed. ISR was defined as ≥50% narrowing within or near the stented segment. Statistical analysis was performed to identify associations between ISR and various risk factors. Results: ISR was detected in 25.4% of patients. Factors significantly associated with ISR included poor glycemic control (HbA1c ≥7%), longer duration of diabetes, dyslipidemia, triple vessel disease, long lesions, small vessel diameter, and use of longer or smaller stents. Symptom recurrence and the need for repeat revascularization were remarkably more prevalent among patients diagnosed with ISR. Conclusion: Diabetic patients remain at high risk for ISR despite the use of modern stent technologies. Recognizing clinical and angiographic predictors can help guide preventive strategies and improve patient outcomes following PCI. Keywords: ‘In-stent restenosis, diabetes mellitus, percutaneous coronary intervention, coronary artery disease, drug-eluting stents, angioplasty, risk factors’

Appropriate Coronary Artery Bypass Grafting Use in the Percutaneous Coronary Intervention Era: Are We Finally Making Progress?

Coronary angiography has an important role in invasive imaging of the coronary arteries. However, it has got limitations in the determination of physiologic significance of individual artery lesions. Coronary pressure derived FFR can be used to rapidly assess the hemodynamic significance of individual coronary artery lesions and can be easily performed in catheterization laboratory. FFR has been shown to effectively help coronary revascularization procedures with improved patient outcomes. FFR is a very important tool for determination of functional significance of coronary stenosis. It combines physiological and anatomical information which can be immediately followed by percutaneous coronary intervention (PCI) if required. The technique for FFR measurement is easy, safe and can be rapidly performed in the catheterization laboratory. PCI can be made more effective by proper and systemic use of FFR in dubious situations. The current clinical evidence for FFR is very encouraging for cardiologist to use this tool in the catheterization laboratory as and when required.