The first PCI in Germany took place at University Hospital Giessen.
Defusing mines? Possible. Building cars? Sure. But using robots to assist in heart interventions? Even in 2020, many people think that sounds a lot like science fiction and the idea generally inspires fear rather than excitement. Below, we provide key facts about using robotics during a coronary intervention. Find out how today’s physicians are using the technology to work more accurately and gently – and why, for Siemens Healthineers, bringing Corindus into its portfolio was not just something close to their heart.
Photos: Marco Leibetseder
Coronary heart disease is one of the most common cardiovascular diseases in Western industrialized nations. Its consequences, which include acute myocardial infarction, are among the leading causes of death globally. When it comes to treating coronary heart disease percutaneous coronary intervention (PCI) with stenting has become established as the gold standard. Nevertheless, PCI presents challenges for both the patient and the medical team working in the cath lab.
Working at a distance from radiation
During a coronary intervention, precise imaging is crucial for identifying vascular structures in detail. To achieve this, the patient is injected with a contrast agent that shows up on X-ray imaging. This means that patients are briefly exposed to radiation during their procedure. The operators, however, are exposed to it every day. To protect themselves from the constant exposure, they wear lead aprons throughout the procedure. After a while, the aprons start to feel as heavy as their name implies. Wearing the protective clothing puts strain on the bones, spine, and muscles – and it doesn’t even protect every organ and part of the body. This is reason enough to test methods that will allow the physicians to permanently keep their distance from the radiation source while working.
“The procedure allows you to move the stent forward and backward by very small degrees and place it in exactly the right position.”
Robot enables more accurate stent placement
Nowadays, remote-controlled robots for coronary interventions are so advanced that they can be used as standard. However, “robotics alone don’t lead to success,” says Doris Pommi, who leads Cardiovascular Care at Siemens Healthineers and is coordinating the global commercial scale-up of Corindus. She explains that robots can only bring about a “revolution” when used in combination with detailed imaging, appropriate information from the system, and the expertise of a seasoned cardiologist. The robot is used in combination with an angiography system to guide the catheter and place the stent. Angiography imaging gives the physician an accurate view of the patient’s vascular structures throughout the procedure. Using a control module, the cardiologist can operate the robot in the cath lab remotely, and precisely steer the catheter, the guidewire, and the balloon or stent. This level of precision is crucial to the success of the procedure and to the long-term outcome – and since a machine never has any “off days” and can perform movements of a millimeter over and over again, robots can provide the consistently high precision that the cath lab needs.
Enabling access to optimal healthcare
With a view to meaningfully expanding its own portfolio, Siemens Healthineers bid USD 1.1 billion for Corindus Vascular Robotics, the U.S. company that was one of the first to develop robotic-assisted systems for minimally invasive vascular interventions. “Our aim is to shape medical technology and be a front runner,” says Pommi. This, she explains, is why Siemens Healthineers invests in growth markets with large potential for the future. The robotic system will both bring improvements for physicians and create a real opportunity for the healthcare system. Plans to incorporate artificial intelligence are expected to simplify the PCI procedure, meaning it is high time that this futuristic technology becomes standard. In the long term, the idea is that, as well as protecting patients and medical teams, the robots will also minimize the need for follow-up interventions, increase efficiency, and give more people access to optimal healthcare. The technology’s potential lies in optimizing processes.
Technology in use nationwide by 2025
Robotic-assisted procedures are already being carried out in a variety of medical fields, but they are new to cardiology in Germany. A successful intervention in Giessen (see background info) shows that these types of systems can become reliable copilots for cardiologists. The machine helps the operator to work more efficiently. The system cannot replace physicians; instead, it will be a useful aid that can help avoid complications and optimize processes. In the future, the technology might also allow top-flight physicians to deploy their abilities for patients in different regions at short notice. As part of a clinical study, PCI was performed on five patients by using telerobotics and CorPath GRX platform*. Albrecht Elsässer of the German Cardiac Society believes that it will be possible to use the technology “universally and nationwide” in five to ten years’ time. Interventions will change rapidly because humans and machines can achieve more if they work together than separately, and because visible successes are more powerful than human fear
Physicians at University Hospital Giessen used a robotic system to help them insert a stent in a heart patient. “The intervention worked well,” says Holger Nef, MD, an interventional cardiologist and one of Germany’s leading specialists in the field. Nef used a joystick and controller to steer a wire with a stent attached. To guide the catheter and place the stent accurately, the team in Giessen used the CorPath GRX robotic system in combination with an Artis angiography system from Siemens Healthineers.
“Particularly with more complex procedures, such as those for multivessel diseases (…), the precision provided by robotic assistance and the reduction in radiation exposure can be of fundamental importance.”
Facts & figures
One benefit that speaks for itself is that the mechanical precision of a robotic system makes it possible to position a stent or balloon in steps of 1 mm. Now, however, the robot’s safety, applicability, and effectiveness have also been compared with conventional PCI. Clinical procedural success was achieved in 160 of 164 patients (97.6%). The interventional cardiologists’ radiation exposure dropped by 95 percent compared to conventional PCI.
About the Author
Andrea Lutz is a journalist and business trainer specialized on medical topics, technology, and healthcare IT. She lives in Nuremberg, Germany.