Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Shiwa-gun, Yahaba-cho, Iwate, 028-3695, Japan.
Faculty of Software and Information Science, Iwate Prefectural University, Takizawa, Japan.
Cardiovasc Interv Ther. 2023 Jan;38(1):39-48. doi: 10.1007/s12928-022-00864-0. Epub 2022 May 5.
In recent years, there have been several reports on robotic-assisted percutaneous coronary intervention (R-PCI), but few studies have been conducted on R-PCI performed under intravascular imaging guidance. To elucidate the periprocedural and postoperative 30-day outcomes of intravascular imaging-guided R-PCI, we performed a retrospective observational study on all patients in 102 consecutive cases who underwent R-PCI under intravascular imaging guidance at a single center in Japan from June 12, 2019 to February 18, 2021. The primary end point was 30-day survival, and the secondary end point was the incidence of complications. Intravascular imaging-guided R-PCI was performed 110 times in total on 125 lesions. The medians of procedural time, fluoroscopy time, contrast volume, patient entrance skin dose, and radiation exposure to the main operator were 49 min, 16 min, 67 mL, 0.62 Gy, and 0 μSv, respectively. Furthermore, 60.0% of target lesion branches were American College of Cardiology Foundation/American Heart Association classification type B2 or type C. However, in all cases, lesion dilatation was successful, and the final Thrombolysis in Myocardial Infarction flow grade was 3. The combination of manual operation was required in 12.7% of all cases, but 30-day survival was confirmed in all cases. There were two problems at the puncture site. One small distal branch artery dissection occurred due to manual operation, but no cardiovascular events (myocardial infarction, stroke) occurred and no target lesion restenosis was observed within 30 days of R-PCI. Hence, R-PCI using intravascular imaging demonstrated highly satisfactory treatment outcomes, and no complication caused by robotic operation was observed.
近年来,有几项关于机器人辅助经皮冠状动脉介入治疗(R-PCI)的报告,但很少有研究涉及血管内成像指导下的 R-PCI。为了阐明血管内成像指导下 R-PCI 的围手术期和术后 30 天结果,我们对日本一家单中心 2019 年 6 月 12 日至 2021 年 2 月 18 日期间 102 例连续接受血管内成像指导下 R-PCI 的患者进行了回顾性观察研究。主要终点为 30 天生存率,次要终点为并发症发生率。总共对 125 个病变进行了 110 次血管内成像指导下的 R-PCI。手术时间、透视时间、造影剂用量、患者入射皮肤剂量和主操作辐射暴露的中位数分别为 49 分钟、16 分钟、67 毫升、0.62 戈瑞和 0 微希弗。此外,60.0%的目标病变分支为美国心脏病学会/美国心脏协会(ACC/AHA)分类 B2 或 C 型。然而,在所有病例中,病变扩张均成功,最终心肌梗死溶栓分级(TIMI)血流分级达到 3 级。所有病例中 12.7%需要手动操作辅助,所有病例均确认 30 天生存率。穿刺部位出现两个问题。由于手动操作,一个小的远端分支动脉夹层发生,但无心血管事件(心肌梗死、中风)发生,在 R-PCI 后 30 天内无目标病变再狭窄。因此,使用血管内成像的 R-PCI 显示出非常满意的治疗结果,并且未观察到机器人操作引起的并发症。