Part of the excitement of being in the medical field is keeping pace with advancements in technology and procedures. Finding new ways to provide better care and treatment, while improving patient safety and outcomes, is an ongoing initiative for physicians.
As an interventional cardiologist, I am always excited by new technologies that dramatically alter the way that we practice. One such innovation is a vascular robotic system for percutaneous coronary intervention (PCI) procedures, a technology that has piqued my interest and that of interventional cardiologists across the country.
I recently attended a medical conference at which I was able to “test drive” a new robotic system designed for the catheterization lab. PCI procedures, which typically utilize balloon angioplasty and stenting, are performed to restore blood flow in obstructed coronary arteries. Robotic-assisted systems allow physicians to perform the procedure from within a radiation shielded “cockpit,” rather than standing next to the patient in close proximity to the x-ray source. The cockpit contains monitors that are positioned much closer to the physician than those found in the cath lab.
This set-up enhances visualization of the procedure while a control console for the physician enables operation of the bedside-mounted robotic arm.
The robotic-assisted system that I “test drove” is called the CorPath Vascular Robotic System, from Corindus Vascular Robotics. There are multiple benefits to using a robotic-assisted system versus a traditional procedure done manually.
The CorPath System allows for measurement of coronary anatomy which the physician can use to select the optimal length stent. Such precision has been found to reduce the average number of stents per procedure by eliminating the occasional implantation of a stent that is too short to fully cover the diseased segment (thus requiring an additional stent).
Choosing a stent that is unnecessarily long can also be problematic due to inadvertent coverage of side branches, a problem that may also be avoided with the CorPath system.
The CorPath System can advance or retract guide wires and position balloons and stents with movements as small as a millimeter, a degree of precision difficult to replicate with “manual” control.
With such precision required, it’s no surprise that up to 47 percent of stents are sub-optimally placed using traditional methods, and these procedure variations can have a big impact, such as:
- Elevating the risk of target vessel revascularization in the patient, which may require a revised procedure in the future
- Increasing patient and physician radiation exposure during the placement of additional stents
- Decreasing procedure profitability, since reimbursement is the same whether one or two stents are used in the procedure.
Aside from the enhanced accuracy, an additional benefit of using the robotic-assisted system is that it dramatically reduces radiation exposure for the physician and potentially for the patient, as well.
In traditional PCI procedures, fluoroscopy is used to visualize the movements of guide wires, balloons and stents. A cardiologist might be exposed to 10 or 20 minutes (or more) of radiation per procedure, which certainly creates a significant lifetime occupational risk since a busy cardiologist may perform 10,000 or more PCI procedures during his / her career.
Also, the cockpit’s radiation shielding eliminates the need for physicians to wear the heavy and cumbersome lead aprons used in traditional PCI procedures to protect themselves from radiation exposure. Performing procedures from the cockpit reduces the physical fatigue that results from prolonged standing and leaning over the patient during the procedure.
Lower back problems are virtually indigenous to high volume interventional cardiologists often necessitating a reduction in procedure volume or even complete discontinuation of the performance of catheterization procedures.
It stands to reason that without the discomfort and weight of lead aprons, physicians using robotic technology will be able to focus more of their attention on performing the procedure perfectly while simultaneously avoiding fatigue, injury and exposure to radiation.
Corindus conducted a series of clinical trials of CorPath in 2010 and 2011. The CorPath PRECISE Study was sponsored by Corindus under Investigational Device Exemption approval from the FDA to obtain 510(k) clearance.
The study was a prospective, multicenter, non-randomized study which enrolled 164 patients at nine clinical trial sites. The study showed that robotic-assisted angioplasty can be performed safely and effectively.
Recently, data was published in a single-site study that compared the cases from the PRECISE trial to 80 cases performed on patients that would have qualified for inclusion in the trial but were treated using traditional methods.
This small study demonstrated strong trends suggesting that robotic PCI can decrease radiation to the patient along with reducing the volume of contrast media used. Reduced contrast media usage can decrease the risk of contrast-induced nephropathy, a worsening or cessation of renal function following contrast administration. CorPath’s ability to reduce contrast media usage would certainly be a welcome “side effect” of robotic system use.
In the future, I anticipate that the capabilities of the CorPath System and other robotic systems will evolve, making them progressively more and more useful for interventional procedures.
Although limited to coronary interventional procedures at present, I envision expanded use of such systems in the future for other types of procedures, including peripheral vascular and carotid stent procedures or even more complex procedures such as endovascular aneurysm repair procedures or percutaneous valve procedures.
Certainly, electrophysiology procedures, such as atrial fibrillation ablations, and complex peripheral vascular procedures, which often require very prolonged radiation times, will be prime targets for sophisticated robotic systems. It will be exciting to watch the development of such systems in the years to come.
Don’t be surprised if you walk into the cath lab one day and see your cardiologist sitting down at what looks like a video game console … performing a complex intervention in somebody’s heart!
References available upon request.
Dr Weinstock Bio
 Costa, MA. Impact of stent deployment procedural factors on long-term effectiveness and safety of sirolimus-eluting stents (final results of the multicenter prospective STLLR trial). Am J Cardiol. 2008 Jun 15;101(12):1704-11. Epub 2008 Apr 9.
 Smilowitz NR, Moses JW, Sosa FA, et al. Robotic-Enhanced PCI Compared to the Traditional Manual Approach. J Invasive Cardiol 2014;26(7):318-321
 Weinstock BS. Contrast Induced Nephropathy: How to Avoid a Life of CIN. Vascular Disease Management 2014; 11(3):E59-E66.
By Barry Weinstock, MD