T-trendz Issue 2 / 2021

Explore the benefits of Robotics in Vascular Interventions with Corindus

Since the introduction of Percutaneous coronary intervention (PCI) 40 years ago, there has been an astonishing amount of advancement in the technology and devices used in the procedure, however the way the procedure is performed has remained virtually unchanged. Now, robotics has the potential to overcome some of the current limitations of the traditional manual approach to vascular interventions.

Corindus, A Siemens Healthineers Company, is a global technology leader in robotic-assisted vascular interventions. The Company’s CorPath® platform is the first FDA-cleared medical device to bring robotic precision to Percutaneous coronary (PCI) and Peripheral vascular (PVI) interventions.

CorPath GRX is the second-generation robotic-assisted technology offering enhancements to the platform by adding important benefits of Robotic precision, Remote procedural control and Improved radiation safety to minimally invasive endovascular procedures.

The CorPath GRX system is intended for use in the remote delivery and manipulation of Guide wires and rapid exchange balloon/stent catheters, and remote manipulation of guide catheters during percutaneous intervention procedures. The platform is designed to assist minimally invasive procedures that have the potential to reduce treatment times, increase precision during treatment, raise standardization levels in clinical procedures and ultimately improve clinical outcomes.

Patients

• Robotic precision
• 1-milimeter positioning and sub-mm measurement of anatomy
• Potential to reduce radiation exposure

Physicians

• Reduction in radiation exposure up to 95%
• No need to wear lead protective equipment, potential to reduce orthopedic burden
• Procedural control

Hospitals

• Robotic precision and procedural automation aimed at improving patient outcomes
• Radiation protection for physicians and staff
• Market differentiation

Primary operator⁶

PRECISE trial demonstrated 95% Reduction in Radiation Exposure⁷

• Radiation-shielded cockpit enables working from a seated position without wearing lead
• Widescreen monitor enhances visualization
• Device fixation enables technologist to step away while imaging is in process

Background

Robotic assisted PCI is becoming an increasingly popular technique in Interventional Cardiology. While type A & B lesions are done easily by Robotic assisted technique, type C lesions are increasingly being addressed. We report a case of type C lesion in LAD with subtotal occlusive Instent Restenosis (ISR) with an abnormal acute angle origin of LAD.

Case history

A 32-year-old male with no coronary risk factors, presented with NYHA class III angina. He underwent PCI with DES to LAD (3mm x 20mm Xience Prime) 2 years back. Physical examination and blood investigations were unremarkable. ECG showed T wave inversion in V1-V5 leads. Diagnostic coronary angiography showed abnormal acute angle origin of LAD (90 degree from LMCA) with near-total instent occlusion and TIMI II distal flow.

Robotic assisted PCI

XB 3.0 guide catheter (Cordis) was used to engage Left main coronary artery manually, via femoral access. The guide catheter tip was crossing beyond the LAD ostium and on withdrawing the guide, it was flipping back into the aorta. A BMW guide wire and 2.5 mm x 15 mm semi compliant balloon (Maverick) were loaded into the CorPath cassette. Then using the controls at the robotic interventional cockpit, the wire maneuvering was done to enter LAD. The guide catheter position and the acute angulation of LAD made the wire enter into the ramus repeatedly. The first BMW wire was left in the ramus and guide catheter was withdrawn into the proximal LMCA using Robotic control. The ramus guide wire gave stability to the guide catheter and prevented it from flipping back into the aorta.

Then another BMW wire with bigger tip curve was used to enter LAD using ROR (Rotate On Retract) technique, which is a special feature of robotic technology, and this easily facilitated the wire entry into LAD. Then, using the joystick control, 2.5x15mm Maverick Balloon (BSL) was placed across the lesion and dilated. A 3mm x 38mm Resolute Onyx stent (Medtronic) was deployed successfully. Final completion angiogram showed well deployed stent with TIMI III distal flow, no residual stenosis or dissection.

Challenges in this case

1. Acute angle origin of LAD (90°) with the wire entry propensity towards ramus artery
2. XB 3.0 guide catheter going past the LAD ostium on LMCA engagement
3. Diffuse near total occlusive ISR of LAD

Conclusion

This case is published to highlight that vascular robotic procedure can be used to perform PCI of type C coronary lesions even in an unfavourable anatomy with ease and high success. The ease of doing the procedure and precision in the procedure is a special feature with vascular robotic technique which is beneficial to both the patient and the operator.

Why Robotic PCI for this case?

• Long diffused lesion needed to be assessed accurately: In-built measuring tool helped in measuring the lesion length accurately.
• Based on the measurement, 60 mm long stent was chosen to avoid more than one stent to cover the lesion. Delivering 60 mm stent to the lesion needed stable guide catheter position which was provided by robotic guide catheter control.
• Robotic sub mm. movement helped in precise placement of the stent from proximal to distal RCA.

Conclusion

Robotic assisted PCI helps achieve precision and safety for patients, in complex coronary artery disease.

Technological innovations spur new clinical applications. This gives healthcare providers an edge in detection and treatment of diseases at an early stage with minimally invasive techniques. This in turn will help in expanding precision medicine, transforming care delivery and improving patient experience. These are the primary objectives with which we developed T-trendz. We would like to know how we can make this initiative more valuable for your practice and the wellbeing of patients.

© Siemens Healthcare GmbH, 2021
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