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Abstract Review: Longitudinal Geographic Miss (LGM) in Robotic-Assisted vs Manual Percutaneous Coronary Interventions

Posted by Corindus Staff
December 02, 2015
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Background: Prevalence of LGM & current status of robotic-assisted PCI

In interventional cardiology, Longitudinal Geographic Miss (LGM) is defined as a situation where the entire length of an injured segment or the entire length of a stenotic segment of a vessel is not fully covered by the total length of a stent. In the STLLR trial, comprised of 1,557 patients undergoing percutaneous coronary intervention (PCI), nearly half showed an incidence of LGM which was correlated  to increased rates of target vessel revascularization by 2.3 times. More recent studies have shed light on the issue of inaccuracy in visual assessment of lesions, which may lead to high rates of LGM.

 

Robotics has created a new level of precision during PCI procedures by enabling physicians to measure anatomy to the sub-mm and to position stents with 1mm accuracy. In an abstract presented at the 2015 Transcatheter Cardiovascular Therapeutics (TCT) conference, the authors evaluated the incidence of LGM in manual (M-PCI) vs. robotic-assisted PCI (RA-PCI).

 

Study Methods

Study authors evaluated all 1,509 patients* enrolled in the STLLR Trial and compared outcomes with the 164 patients enrolled in the PRECISE Trial. The angiograms were evaluated by a core laboratory and were classified first in accordance with the modified ACC/AHA lesion characteristics and secondarily into 2 subsets: simple lesions (A, B1) and complex lesions (B2, C).

 

Results & Conclusion

Overall, there was a significant reduction in LGM across the board with robotic-assisted vs. manual PCI procedures.

 

Lesion Characteristics

RA-PCI (n=164)

M-PCI (n=1509)

P value

All Lesions

20/164 (12.2%)

650/1509 (43.1%)

<0.0001

Simple Lesions

12/112 (10.7%)

105/366 (28.7%)

0.0002

Complex Lesions

8/52 (15.4%)

539/1124 (48.0%)

<0.0001

 

Further utilization of propensity scoring showed continued significance in reduction of LGM with the robotic-assisted group. This study highlights how robotics may be able to improve clinical outcomes by leveraging the unique features that enable precise measurement and positioning of PCI devices.

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* A total of 1509 M-PCI patients had a determination of LGM and at least one stent placed during the index procedure.

 

  

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