Adoption of transradial access (TRA) for Percutaneous Coronary Intervention (PCI) continues to grow in the United States. In 2013, the rate of PCIs done transradially was estimated to account for 16% of all US PCI procedures, but more recent reports put the estimates at closer to 30%. Transradial access is associated with lower vascular and bleeding complication rates, is preferred by patients and is cost-effective compared with transfemoral access.1 The benefits of transradial access, however, don’t come without a cost. The REVERE trial found that the primary operator receives up to 50% more radiation exposure when performing coronary angiographic and interventional procedures from the left radial approach as compared to the femoral approach.1
This abstract, presented at the 2015 Transcatheter Cardiovascular Therapeutics (TCT) Conference, was designed to compare the clinical and technical outcomes of radial access versus femoral access for robotic-assisted PCI. We, and our customers, see robotics as a solution to help minimize the radiation exposure to the operator during transradial PCIs.
The PRECISION Registry is a multicenter post-market registry for the evaluation of the CorPath System effectiveness in percutaneous coronary interventions. The aim of this on-going study is to collect data on the routine use of the CorPath System. One of the many data points collected under the PRECISION Registry is the clinical and procedural data of robotic-assisted radial PCI procedures. The authors of this study sought to compare the technical and clinical outcomes of Robotic PCI via the transradial approach vs. the transfemoral approach (TFA) among the patients in the PRECISION Registry.
Technical success was achieved when Robotic-PCI treated lesions had a residual stenosis of <30%. Clinical success was achieved with a residual stenosis of <30% and absence of MACE at hospital discharge or 72 hours post-procedure, whichever came first. There were 9 clinical sites enrolled with 273 patients; 156 patients were treated transradially and 117 patients were treated via transfemoral access (TFA). Although lesion locations were similar among the two groups, statistically, the lesion types were different as the TRA group had a greater percentage of Class B2 lesions while the TFA group had a greater percentage of Class C lesions.
Results & Conclusion
In this study, Robotic-PCI was more commonly performed via radial access than via femoral access. Overall, the technical success rate of the TRA group was higher than that of the TFA group, 93.7% vs. 85.7%, respectively (P=0.02). Clinical success rates were similar; 99.4% and 97.4% respectively (P=0.32). This study demonstrated the ability of the CorPath System to successfully perform robotic-assisted PCIs via transradial access. CorPath allows the physician to work from a radiation protected Interventional Cockpit which has been shown to reduce radiation exposure to the primary operator by up to 95%.2 CorPath may be a great solution for the operator who is discouraged by the increased radiation exposure associated with transradial access.
1 Pancholy SB, Joshi P, Shah S, et al. Randomized evaluation of vascular entry site and radiation exposure: the REVERE trial. J Am Coll Cardiol Intv. 2015; Epub ahead of print.
2 Weisz G, et al. Safety and Feasibility of Robotic Percutaneous Coronary Intervention. J American College of Cardiol, 2013, Vol 61, No. 15: 1596-1600