Initial clinical experience performing robotic percutaneous coronary intervention from the radial approach

1. 1
Initial Clinical Experience
Performing Robotic Percutaneous
Coronary Intervention from the
Radial Approach
J.D. Sheets, MS-IV
Michigan State University
College of Human Medicine
Frederik Meijer Heart & Vascular Institute

2. Disclosure Statement of Financial Interest
I, J.D. Sheets, DO NOT have a financial
interest/arrangement or affiliation with
one or more organizations that could be
perceived as a real or apparent conflict of
interest in the context of the subject of
this presentation.

3. Background: Robotic PCI
Frederik Meijer Heart & Vascular Institute
Weisz, et al. J Am Coll Cardiol 2013;61:1596–600

4. Frederik Meijer Heart & Vascular Institute
Wire Control
Forward/back
&
Torque
Balloon/Stent
Control
Forward/back
Background: Robotic Controls

5. Background: PRECISE Study
Frederik Meijer Heart & Vascular Institute
Weisz, et al. J Am Coll Cardiol 2013;61:1596–600

6. Background: PRECISE Study
Robotic PCI associated with:
• 97.6% procedural success rate
• 98.8% technical success rate
• 95.2% reduction in radiation exposure to the
operator
Frederik Meijer Heart & Vascular Institute
Weisz, et al. J Am Coll Cardiol 2013;61:1596–600
All robotic procedures in PRECISE were performed
using femoral arterial access.

7. Objectives
Frederik Meijer Heart & Vascular Institute
• Radial PCI has been shown to be associated with
lower rates of vascular complications, shorter
hospital stay, and enhanced patient comfort.
• This study was performed to describe the initial
clinical experience and procedural outcomes of
robotic-PCI performed using radial arterial access.

8. Methods
Frederik Meijer Heart & Vascular Institute
• Data were collected from
consecutive robotic-PCI
cases performed at a single
center using radial arterial
access.
• The primary measure of
interest was procedural
success:
- <30% residual stenosis after PCI
in the absence of associated
death or repeat revascularization
prior to hospital discharge
• We also assessed:
• Access site complications,
including bleeding or radial
artery occlusion
• Procedural duration
- time from sheath insertion
to removal of the guide
catheter

9. Results: Patient Characteristics
Frederik Meijer Heart & Vascular Institute
• Between March 2014 and
December 2014, we
identified 55 consecutive
patients undergoing robotic-
PCI using radial arterial
access.
• Robotic-PCI was attempted
on 62 lesions overall, with
varying baseline
angiographic complexities
(Type A 19%, Type B1 27%,
Type B2 34%, Type C 19%).
Characteristic N = 55
Age (years) 62 ± 11
Male 43 (78.2)
Hypertension 40 (72.7)
Smokers 16 (29.1)
Dyslipidemia 41 (74.5)
Diabetes 20 (36.4)
Clinical presentation
Myocardial infarction 17 (30.9)
Unstable angina 33 (60.0)
Stable symptoms 5 (9.1)

10. 56 year old
with unstable
angina
Frederik Meijer Heart & Vascular Institute
• Culprit lesion in mid-
LAD
• Bifurcation

11. Frederik Meijer Heart & Vascular Institute
• Radial
approach
• Prowater wire
into distal LAD
• Pre-dilation with
an undersized
balloon

12. Frederik Meijer Heart & Vascular Institute

13. Frederik Meijer Heart & Vascular Institute
• BMW wire into
diagonal branch
• 3.0 x 26 mm
Resolute DES
deployed in
LAD

14. Frederik Meijer Heart & Vascular Institute
• Re-wired the
side branch
• Post-dilated the
stent beyond
the bifurcation
with a 3.0 x 15
mm NC balloon

15. Frederik Meijer Heart & Vascular Institute
• Post-dilated
proximal portion
of stent with a
4.0 x 8 mm NC
balloon

16. Frederik Meijer Heart & Vascular Institute

17. Frederik Meijer Heart & Vascular Institute

18. Frederik Meijer Heart & Vascular Institute

19. Results: Procedural Success
Frederik Meijer Heart & Vascular Institute
• Robotic-PCI resulted in procedural success in 57 of 62
(92%) lesions.
• In 4 of 5 cases in which procedural success was not
achieved, lesions were classified as ACC/AHA Type C.
• None of the patients undergoing robotic-PCI experienced
death or repeat revascularization prior to hospital discharge
and there were no access site complications.

20. Results: Procedural Times
Frederik Meijer Heart & Vascular Institute
• Compared with 552 consecutive PCI cases performed
manually from the radial approach during the same time
period
• Robotic-PCI was associated with a 13-minute increase in
procedural duration (robotic 68 ± 22 minutes vs manual 55 ±
26 minutes, p<0.001).

21. Limitations
Frederik Meijer Heart & Vascular Institute
• Small single-center study
• Retrospective study design
• Procedural time definition is limited by:
• Inclusion of diagnostic portion of procedure
• Represents procedural time for the first 9 months of
robotics program from its inception

22. Conclusions
Frederik Meijer Heart & Vascular Institute
• The present observations represent preliminary evidence
that robotic-PCI using radial arterial access is feasible and
associated with acceptable clinical outcomes.
• Recent FDA approval
• Additional studies are needed to further evaluate the clinical
outcomes associated with robotic-PCI
• Further investigation is needed to determine if robotic-PCI
procedural duration, which we demonstrate to be longer
than the traditional manual approach in this early clinical
experience, will shorten as additional clinical experience is
gained