Clinicians in India have teamed up to demonstrate the feasibility of having a physician remotely perform percutaneous coronary intervention (PCI) procedures, reports Medgadget.
Using the CorPath GRX, an FDA cleared cath lab robot that lets physicians stay away from the radiation produced by fluoroscopes, the team from the Apex Heart Institute in Ahmedabad positioned the control mechanism in a building 20 miles away from where the patients were to be treated.
They were then able to perform five separate procedures, including dilation with angioplasty balloons and positioning stents within the treated area. All of the procedures were completed successfully and no complications or adverse events occurred.
It seems like everything went as though there was no significant procedural differences compared with the same treatments performed in proximity.
This capability may allow physicians to serve patients in remote regions while maintaining the freedom to remain closer to home.
Long Distance Tele-Robotic-Assisted Percutaneous Coronary Intervention: A Report of First-in-Human Experience
EClinical Medicine, 3 September 2019
Background: Robotic-assisted percutaneous coronary intervention (R-PCI) has been successfully employed in the United States since 2011. Performing R-PCI from a remote location has never been reported but if feasible would extend availability of treatment to many patients with coronary artery disease (CAD) who would otherwise go without.
Objective: To assess the feasibility of remote tele-R-PCI with the operator 20 miles away from the patients.
Methods: Five patients with single, type A coronary artery lesions treatable by PCI consented to participate. The primary endpoint was procedural success with no major adverse cardiac events (MACE) before discharge.
Procedural success was defined as achieving <10% diametric stenosis of the occluded target vessel utilizing tele-R-PCI balloon angioplasty and stent deployment (CorPath GRX®, Corindus Vascular Robotics, USA) without converting to in-lab manual PCI by an on-site standby team. Procedural, angiographic, and safety data were collected as were questionnaire scores from the remote operator evaluating the robot-network composite, image clarity, and overall confidence in the procedure.
Results: The primary endpoint was achieved in 100% of patients. No procedural complications or adverse events occurred, and all patients were discharged the following day without MACE. The operator scores were favorable with the operators rating the procedure as equivalent to an in-lab procedure.
Conclusions: Performing long distance tele-R-PCI in patients with CAD is feasible with predictably successful outcomes if reliable network connectivity and local cardiac catheterization facilities are available.
Tejas M Patel, Sanjay C Shah and Samir B Pancholy.