Robotically-assisted percutaneous coronary intervention: Reasons for partial manual assistance or manual conversion

Background: Robotically-assisted percutaneous coronary intervention (R-PCI) is feasible for simple coronary lesions. Objectives: To determine the frequency and reasons for partial manual assistance or manual conversion during RPCI in clinical practice. Methods: The CorPath 200 System (Corindus, Waltham. MA) enables the operator to sit in a radiation-shielded cockpit and remotely control intracoronary devices including guidewires, balloons, and stents. Consecutive RPCI procedures performed over 18 months were analyzed to identify reasons for planned or unplanned manual assistance or manual conversion, and categorized as due to 1) adverse event: 2) technical limitation of the robotic platform: or 3) limited guide catheter/wire support. Results: During the study period, 108 R-PCI procedures (68.1 +/- 11.0 years. 77.8% men, 69.4% elective PCI, 783% type B2/C lesions, and 503% left anterior descending/left main target lesion segment) were performed. High robotic technical success (91.7%) and clinical procedural success (99.1%) were achieved. Twenty procedures (18.5%) required either planned partial manual assistance (3.7%), unplanned partial manual assistance (7.4%), or manual conversion (7.4%). Among these procedures, manual assistance/conversion was required in 3 procedures for an adverse event (15%), 8 for technical limitation of the robotic platform (40%), and 9 for guide catheter/wire support issues (45%). Conclusions: High clinical success with R-PCI for a complex lesion cohort is possible with only occasional partial manual assistance or manual conversion. The majority of procedures requiring manual assistance/conversion were due to limited guide catheter/wire support or robotic platform limitations, rather than occurrence of adverse events. (C) 2017 Elsevier Inc. All rights reserved.