Rupture of sinus of Valsalva

Catheterization and Cardiovascular Interventions 2014;84:1184-89.

Li Zhong et al.

Transcatheter closure of ruptured sinus of Valsalva aneurysm.

n=22

From...To:

Non-coronary sinus to RA 11

Non-coronary sinus to RVinflow 1

Right coronary sinus to RVOT 8

Right coronary sinus to RA 2

Devices used: 

Amplatzer duct occluder 19

Amplatzer muscular VSD device 1

Outcome:

Successful in 20.

No residual shunt in 18, Small residual shunt in 2.

Complications:

Two patient needed urgent AVR because of procedure-related aortic valve regurgitation.

PDA closure: Ductal Spasm

Catheter Cardiovasc Interv. 2014 Apr 1;83(5):762-7. doi: 10.1002/ccd.25120. Epub 2013 Nov 9.

Ductal spasm during performance of transcatheter ductal occlusion.

Batlivala SP1, Glatz AC, Gillespie MJ, Dori Y, Rome JJ.

Author information

Abstract

OBJECTIVES:

Transcatheter patent ductus arteriosus (PDA) occlusion is a staple of pediatric catheterization laboratories. We present the phenomenon of significant PDA spasm to prevent failure to occlude a hemodynamically significant duct.

BACKGROUND:

Transcatheter techniques have evolved, allowing safe and effective occlusion of PDAs in younger and smaller patients. Neonatal care is evolving with increasing survival at younger gestational ages. Premature infants often have PDAs, so the proportion of formerly premature children referred for transcatheter ductal occlusion will likely rise.

METHODS:

We reviewed all transcatheter PDA occlusions performed at our institution since 2001 (N = 331). Retrospective data included: gestational age, age at catheterization, precatheterization echocardiographic parameters, PDA size (after spasm relief), device specifications, and most recent follow-up data.

RESULTS:

Seven cases were identified. Median age was 12 months, median gestational age was 28 weeks. All were born prematurely. All PDAs were restrictive and six had left-heart volume overload. All patients were examined by the interventional cardiologist and had ductal murmurs. When reauscultated (three of seven), murmurs were absent during spasm. Once spasm relieved, PDA diameters ranged from 1.5 to 8 (median 2) mm. All patients accommodated a 6-mm-or larger-Amplatzer device. No significant complications occurred and all patients were well at follow-up.

CONCLUSIONS:

Ductal spasm occurs during transcatheter occlusion and may be an unrecognized cause of procedural failure. The phenomenon seems to occur in children born prematurely, and can occur after infancy. Loss of a continuous murmur confirms the diagnosis. Care should be taken to avoid device under-sizing when spasm occurs.

Balloon Pulmonary Valvuloplasty - Safety & Efficacy

Catheter Cardiovasc Interv. 2012 Oct 1;80(4):663-72.

Safety and efficacy of balloon pulmonary valvuloplasty: A Multicenter Experience.

Holzer RJ, Gauvreau K, Kreutzer J, Trucco SM, Torres A, Shahanavaz S, Bergersen L.

METHODS: Prospective data collection. C3PO Registry. Cases performed between 02/07 and 06/10 at eight institutions. The registry was queried for cases of isolated BPV.


RESULTS:
211 cases were included (45%, Less than 1 month old).

Procedural success was achieved in 91% procedures, being defined as one of the following:
   (i) post-BPV peak systolic valvar gradient to < 25 mm Hg (88%),
   (ii) decrease in gradient by 50% (79%), or
   (iii) reduction of RV/systemic pressure ratio by 50% (45%).

Procedural success was more common in neonates, when compared to older patients (96% vs. 87%, P = 0.03).

Procedure failure - Risk factors included (i) moderate or severe pulmonary valve thickening (OR 2.9, CI 1-8.3), and (ii) presence of supravalve PS (OR 9.6, CI 2.7-33.8).

Adverse events:
Low severity AEs (levels 1-2) occurred in 9% of patients.
Higher severity AEs (levels 3-5) occurred in 3% of patient.
No deaths.
Risk factors for any AE (levels 1-5) were (i) age below 1 month (OR 3.5, CI 1.3-8.9) and (ii) operator experience of less than 10 years (OR 3.8, CI 1.5-9.9).

CONCLUSIONS: Procedural success is common and AEs, especially higher severity AEs, are rare for BPV in patients with isolated PS. Results have improved considerably when compared to historical data.

© 2012 Wiley Periodicals Inc.

Scoring system to determine need for LA decompression

J Heart Lung Transplant. 2003 Aug;22(8):883-8.


Scoring system to determine need for balloon atrial septostomy for restrictive interatrial communication in infants with hypoplastic left heart syndrome.

Mulla NF, Osher AP, Beeson WL, Kuhn MA, Larsen RL.

SourceDepartment of Pediatrics, Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, California 92534 , USA. nmulla@ahs.llumc.edu



Abstract

BACKGROUND: Restrictive interatrial communication (IAC) causes morbidity and mortality in infants with hypoplastic left heart syndrome awaiting cardiac transplantation. We sought to create a scoring system, based on echocardiographic and clinical findings, to serve as a guide for determining the need for balloon atrial septostomy (BAS).



METHODS: We retrospectively reviewed echocardiograms of 44 infants with hypoplastic left heart syndrome. Infants were studied from the time of admission to the final end-point of transplantation, Norwood procedure, or death. Seventeen infants underwent BAS for clinical indications of oxygen saturation <80% in room air. Data collected included age at BAS, maximum velocity (V(max)), and IAC diameter throughout the clinical course. We assigned higher IAC scores to smaller IAC diameter, greater V(max) through the IAC, and lower oxygen saturation value. The minimum score was 3, and the maximum score was 9.



RESULTS: Only 10% of infants with a score <6 at presentation required BAS, whereas 67% of those with scores > or =6 required BAS. Higher IAC scores at presentation were associated with earlier need for BAS (p = 0.04).



CONCLUSIONS: The IAC scoring system can serve as a reliable clinical guide for identifying infants with hypoplastic left heart syndrome who are likely to require BAS for relief of critically restrictive IAC while awaiting cardiac transplantation.

Biodegradable stents are equivalent to metal stents

Link

Cath: Balloon Pulmonary Valvuloplasty

Predictors of reintervention in neonates with critical PS or PA-IVS.

Ghassan Shaath et al.

Cath Cardiovasc Interv 2012;79:659-664.

n=43 babies.

Mean f-up 19 mo.

36% required reintervention after at mean age of 7.4 mo.

Predictors of reintervention were the following:

1) Diagnosis of PA-IVS

2) Hospital stay > 7.5 days

3) TR gradient > 43 mmHg on the day after intervention

All were statistically-derived parameters. No good clinical explanation in the paper.

From discussion secton:

Humpl et al.Circ 2003;108:826-32 reported reintervention was more likely if TV z-score was < -5.

Fedderly et al. JACC 1995;25:460-5 reintervention was less likely if TV annulus > 11 mm and PV annulus > 7 mm.

Alwi et al. Cardiol Young 2005;15:141-7. PDA stenting is suggested if if small RV and TV z-score between -2.5 and -4.5.

Diabolo Stent - Fontan Fenestration Creation, Creation of Dumbell shape

Catheter Cardiovasc Interv. 2010 Nov 15;76(6):860-4.
Novel technique to reduce the size of a Fontan Diabolo stent fenestration.
Anderson B, Bhole V, Desai T, Mehta C, Stumper O.
Source
The Birmingham Children's Hospital, Birmingham, United Kingdom.

Abstract
OBJECTIVES:
To develop an effective catheter technique to reduce the size of a Diabolo stent fenestration in the failing Fontan circulation.

BACKGROUND:
Diabolo stent fenestration is employed by many centers in the treatment of the failing Fontan patient. With subsequent recovery, exercise tolerance may be impaired by significant desaturation secondary to the right to left shunt across the fenestration. Complete fenestration closure carries the risk of recurrence of the initial symptoms and, hence, reduction of the size of fenestration should be the preferred technique.

METHODS:
Twenty-eight patients with failing Fontan circulations (16 early and 12 late) underwent Diabolo stent fenestration for relief of symptoms. Five of these patients remained very limited by severe desaturation even at rest, after complete recovery from symptoms. Further cardiac catheterization with crimping/reduction of the size of the waist of the stent was carried out using a technique whereby a snare catheter was placed over the waist of the stent aided by an arterio-venous guidewire loop and a balloon catheter placed within the stent.

RESULTS:
All 5 patients had successful stent reduction with improvement in saturations, whilst still maintaining a small residual fenestration. No complications were encountered.

ONCLUSION:
This novel technique of reduction of a diabolo stent fenestration, in a failing Fontan circulation, offers the advantages of avoidance of implanting further devices in the circulation and the ability to redilate the stent should symptoms recur.

Copyright © 2010 Wiley-Liss, Inc.

Bifurcation stenting - RVOT. Branch PA, Coarctation

Catheter Cardiovasc Interv. 2011 Sep 1;78(3):419-24. doi: 10.1002/ccd.23025. Epub 2011 Mar 30.
A novel technique for stenting pulmonary artery and conduit bifurcation stenosis.
Stumper O, Bhole V, Anderson B, Reinhardt Z, Noonan P, Mehta C.
SourceHeart Unit, Birmingham Children's Hospital, United Kingdom. oliver.stumper@bch.nhs.uk

Abstract
BACKGROUND: Distal conduit obstruction is a recognized complication after surgery for congenital heart disease requiring implantation of a conduit from the right ventricle to the pulmonary arteries. Endovascular stenting of distal conduit obstruction can be challenging due to the proximity to the pulmonary artery bifurcation.

OBJECTIVE: A technique is described, whereby a single stent is mounted onto two balloon angioplasty catheters in tandem. This ensemble was delivered to the distal conduit/pulmonary artery via a large Mullins sheath on two guidewires, one placed in each of the branch pulmonary arteries. The aim was to assess safety and efficacy of this novel technique.

MATERIALS AND RESULTS: Seven patients (mean age 13.4 (6.7-23.4) years, mean weight 44.2 (23-69) kg were treated with this method. The pressure gradient was reduced from 36 (26-52) mm Hg to 11 (8-15) mm Hg [P< 0.05]. RV/LV pressure ratio decreased from 0.85 (0.6-0.95) to 0.42 (0.35-0.5) [P < 0.05]. There were no significant complications. During follow-up over a median of 2.6 (0.3-6.7) years no patient required re-intervention or surgery.

CONCLUSION: This novel technique appears to be safe and effective for stenting stenoses just proximal to pulmonary artery bifurcation.

Copyright © 2011 Wiley-Liss, Inc.



Catheter Cardiovasc Interv. 2011 Sep 1;78(3):425-7.



Dual wire technique for aortic coarctation stent placement.
Lampropoulos K, Budts W, Gewillig M.
SourceCongenital, University Hospitals Leuven, Belgium.

Abstract
A young adult presented for percutaneous treatment of a narrow aortic coarctation. A very large left subclavian artery originated immediately proximal to the coarctation. In order not to exclude or jail the left subclavian artery with a stent, a double wire technique was used. From a femoral approach, two guide wires were positioned, one in the aortic arch and another in the subclavian artery. A stent crimped over a 16-mm balloon and a 4-Fr catheter was advanced over the two wires within a 14-Fr long introducer sheath. The stent was successfully deployed and molded within the bifurcation by a kissing balloon technique, relieving the obstruction and leaving a guaranteed passage to the subclavian artery. The double wire technique is an elegant way to deliver a stent safely across a narrowing with guaranteed access to important side branches.

Copyright © 2010 Wiley-Liss, Inc.

Figure-8 stitch - For Hemostasis of femoral vein access

Catheter Cardiovasc Interv. 2011 Jul 1;78(1):155-60.

Technique of temporary subcutaneous "Figure-of-Eight" sutures to achieve hemostasis after removal of large-caliber femoral venous sheaths.

Cilingiroglu M, Salinger M, Zhao D, Feldman T.
SourceNorthShore University HealthSystem, Evanston, Illinois, USA.

Abstract
Over the last decade, significant advances have been made in percutaneous treatment of structural heart diseases. Many of these interventions require insertion of large caliber sheaths in the femoral veins. Manual compression, compression devices, and various closure devices have been used for removal of large-sized venous sheaths. Here, we describe the use of a temporary subcutaneous "Figure-of-Eight" suture technique for venous access site closure after removal of large-caliber sheaths.

Copyright © 2011 Wiley-Liss, Inc.

Cath: Hybrid Procedure - Aortic stent placement for recoarctation after Norwood Procedure

1. Hybrid aortic reconstruction for treatment of recurrent aortic obstruction after stage 1 single ventricle palliation. Medium-term outcomes and results of redilataion.

1. Shelby Kutty MD¹,
2. Redmond P. Burke MD²,
3. Robert L. Hannan MD²,
4. Evan M. Zahn MD, FSCAI^2,*

Catheterization and Cardiovascular Interventions

Volume 78, Issue 1, pages 93–100, 1 July 2011

Catheterization and Cardiovascular Interventions

Volume 78, Issue 1, pages 93–100, 1 July 2011

Abstract

Objective:

We describe a hybrid approach to the treatment of aortic obstruction after stage 1 palliation (S1P) of hypoplastic left heart syndrome.

Background:

Recurrent aortic obstruction is a common problem after S1P of hypoplastic left heart syndrome. Even mild aortic obstruction is poorly tolerated so early and definitive therapy is desirable. Although stent implantation is an effective treatment for aortic obstruction in older children and adults, technical issues due to small vessels and concerns regarding future potential for expansion have generally precluded the use of stents in this setting.

Methods:

Six patients underwent hybrid aortic reconstruction (HAR) in the operating room or catheterization laboratory, with the interventional cardiologist and cardiac surgeon working in cooperation.

Results:

Patients had a mean weight of 5.8 kg (2.9–7.7) and a mean age of 5.6 months (0.5–12.9) at the time of HAR. Five patients had undergone prior balloon angioplasty at a mean age of 2.8 months (2.1–3.5), and five had moderately depressed single ventricular function prior to HAR. The balloons used had a diameter of 7–10 mm and introducer sheath size ranged from 6 to 10 F. There were no immediate or late procedure related complications. Stent redilation was performed in 5 patients for relief of recurrent obstruction or to keep pace with somatic growth. At a median follow up of 4.8 years (0.2–7.9), there were 3 patients progressing well after Fontan palliation and 3 deaths.

Conclusions:

HAR allows for placement of stents that can ultimately reach adult size in small infants who have recurrent aortic obstruction after balloon angioplasty following S1P. Advantages include freedom from delivery sheath constraints when determining stent type/size, facilitation of precise stent position, and avoidance of vascular damage or hemodynamic compromise during the procedure. Longer follow-up and larger experience are required to determine if this therapy will provide a long-term solution to this difficult problem. © 2011 Wiley-Liss, Inc

Cath: Melody Valve in Contegra Graft - Animal Study

Circulation. 2010;122:A19333

Abstract 19333: Transcatheter Delivery of Melody Valves (MelV) Larger Than Contegra Conduit (CC)

Core 3. Genetics, Genomics and Congenital CV Disorders Session Title: Cardiac Catheterization and Electrophysiology in the Young

Prakul Chanthong; Luis Quinonez; Patty Boylen; Jon Timinsky; James Y Coe

UNIVERSITY ALBERTA HOSPITAL, Edmonton, Canada; Medtronic Canada, Missisauga, Canada; UNIVERSITY ALBERTA HOSPITAL, Edmonton, Canada

Transcatheter replacement of pulmonary valves is used in failed right ventricular to pulmonary artery (RV-PA) homografts (H) or prosthetic valves (PV). The former calcify and the latter have metal rings ± struts, both providing secure landing spots for MelV. The MelV expansion is limited by the H or PV size, and H may rupture if expanded beyond its original diameter. CCs often do not calcify, yet may become aneurysmal with increased intraluminal pressure. We tested the hypothesis that transcatheter MelV replacement is possible in a hypertensive, supported CC. Under general anesthesia, supported 18 mm CCs were placed as descending aortic jump grafts via a left thoracotomy in sheep (n=6). After a recovery period, 22 mm MelVs (n=4) were delivered via a carotid artery into the CCs. 56-82 (mean 72) days after aortic placement, the 18 mm CC dilated to 36-37 mm under systemic pressure, while the ring diameter remained at 18 mm. Deploying the MelV at 22 mm expanded the CC rings to 22 mm. without CC rupture. Transcatheter Melody valve replacement into the Contegra conduits is feasible. The Melody valve will expand the rings of the Contegra conduit to the largest valve diameter.

Author Disclosures: P. Chanthong, None; L. Quinonez, None; P. Boylen, Medtronic, Modest, Employment; J. Timinsky, None; J.Y. Coe, Medtronic, Modest, Consultant/Advisory Board; NuMed, Modest,Consultant/Advisory Board.

Radiation Exposure during Radial Access (Right vs. Left)

CIRCINTERVENTIONS.111.961185

Published online before print May 17, 2011

Referenced here, more to highlight the methodology of the adult study and for actual reports of measurement dose, etc. This adult study compares right and left radial access. Radiation exposures were similar between right and left radial approached. Slightly increased exposure to the wrist in right radial approach compared to left radial approach.

Operator Radiation Exposure During Percutaneous Coronary Procedures Through the Left or Right Radial Approach

The TALENT Dosimetric Substudy

1. Alessandro Sciahbasi, MD at al.


Background—Transradial percutaneous coronary procedures may be effectively performed through the right radial approach (RRA) or the left radial approach (LRA), but data on radiation dose absorbed by operators comparing the two approaches are lacking. The aim of the present study was to evaluate radiation dose absorbed by operators during coronary procedures through the RRA and LRA.

Methods and Results—Three operators were equipped with 5 different dosimeters (left wrist, shoulder, thorax outside the lead apron, thorax under the lead apron, and thyroid) during RRA or LRA for coronary procedures. Each month, the dosimeters were analyzed to determine the radiation dose absorbed. From February to December 2009, 390 patients were randomly assigned to the RRA (185 patients; age, 66±11 years) or the LRA (185 patients; age, 66±11 years). There were no significant differences in fluoroscopy time (for RRA, 369 seconds; interquartile range, 134 to 857 seconds; for LRA, 362 seconds; interquartile range, 142 to 885 seconds; P=0.58) between the 2 groups. There were no significant differences in monthly radiation dose at the thorax (0.85±0.46 mSv for RRA and 1.12±0.78 mSv for LRA, P=0.33), at the thyroid (0.36±0.2 mSv for RRA and 0.34±0.3 mSv for LRA, P=0.87), and at the shoulder (0.73±0.44 mSv for RRA and 0.94±0.42 mSv for LRA, P=0.27). The dose at the wrist was significantly higher for the RRA (2.44±1.12 mSv) compared with the LRA (1±0.8 mSv, P=0.002). In both radial approaches, the thoracic radiation dose under the lead apron was undetectable.

Conclusions—Compared with RRA, LRA for coronary procedures is associated with similar radiation dose for operators at the body, shoulder, or thyroid level, with a possible significant advantage at the wrist. The cumulative radiation dose for both approaches is well under to the annual dose-equivalent limit.

Clinical Trial Registration—URL: http://www.clinicaltrials.gov/. Unique identifier: NCT00282646.

Cath: Novelties. Fusing MRI with X-ray

Published ahead of print. Accessed on 5/2/2011
Circulation: Cardiovascular Imaging

X-ray Magnetic Resonance Fusion to Internal Markers and Utility in Congenital Heart Disease Catheterization

Yoav Dori1*, et al.
The Children's Hospital of Philadelphia, Philadelphia, PA & Siemens Healthcare, Malvern, PA
Corresponding author; email: doriy@email.chop.edu

Abstract
Background—X-ray magnetic resonance fusion (XMRF) allows for utilization of 3D data during cardiac catheterization. However, to date, technical requirements have limited the use of this modality in clinical practice. Here we report on a new internal marker XMRF method that we have developed and describe how we used XMRF during cardiac catheterization in congenital heart disease.

Methods and Results—XMRF was performed in a phantom and in 23 patients presenting for cardiac catheterization who also needed cardiac MRI for clinical reasons. The registration process was performed in less than 5 minutes per patient with minimal radiation (0.004 - 0.024 mSv) and without contrast. Registration error was calculated in a phantom and in 8 patients using the maximum distance between angiographic and 3D model boundaries. In the phantom the measured error in the AP projection had a mean of 1.15 mm (standard deviation 0.73). The measured error in patients had a median of 2.15 mm (IQR 1.65 - 2.56 mm). Internal markers included bones, airway, image artifact, calcifications, and the heart and vessel borders. The MRI data was used for road mapping in 17/23 (74%) cases and camera angle selection in 11/23 (48%) cases.

Conclusions—Internal markers based registration can be performed quickly, with minimal radiation, without the need for contrast, and with clinically acceptable accuracy using commercially available software. We have also demonstrated several potential uses for XMRF in routine clinical practice. This modality has the potential to reduce radiation exposure and improve catheterization outcomes.

Two video links:
http://circimaging.ahajournals.org/content/suppl/2011/04/29/CIRCIMAGING.111.963868.DC1/Video1.mov

Video showing MRI fusion with fluoro guiding cath procedure:
http://circimaging.ahajournals.org/content/suppl/2011/04/29/CIRCIMAGING.111.963868.DC1/Video2.mov

Balloon Pulmonary Angioplasty - Adverse reactions (C3PO group)

Balloon Angioplasty and Stenting of Branch Pulmonary Arteries
Adverse Events and Procedural Characteristics: Results of a Multi-Institutional Registry
Ralf J. Holzer, et al.
Circ Cardiovasc Interv Apr 26, 2011 (Pub ahead of print)

Background—Pulmonary artery (PA) balloon angioplasty and/or stenting (PA rehabilitation) is one of the most common procedures performed in the cardiac catheterization laboratory, but comprehensive and consistently reported data on procedure-related adverse events (AE) are scarce.

Methods and Results—Data were prospectively collected using a multicenter registry (Congenital Cardiac Catheterization Project on Outcomes). All cases that included balloon angioplasty and/or stent implantation in a proximal or lobar PA position were included. Multivariate analysis was used to evaluate for independent predictors of AE and need for early reintervention. Between February 2007 and December 2009, 8 institutions submitted details on 1315 procedures with a PA intervention. An AE was documented in 22% with a high severity (level 3 to 5) AE in 10% of cases. Types of AE included vascular/cardiac trauma (19%), technical AE (15%), arrhythmias (15%), hemodynamic AE (14%), bleeding via endotracheal tube/reperfusion injury (12%), and other AE (24%). AE were classified as not preventable in 50%, possibly preventable in 41%, and preventable in 9%. By multivariate analysis, independent risk factors for level 3 to 5 AE were presence of ≥2 indicators of hemodynamic vulnerability, age below 1 month, use of cutting balloons, and operator experience of <10 years. Reintervention during the study period occurred in 22% of patients undergoing PA rehabilitation.

Conclusions—PA rehabilitation is associated with a 10% incidence of high-level severity AE. Hemodynamic vulnerability, young age, use of cutting balloons, and lower operator experience were significant independent risk factors for procedure-related AE.

Link to article

Innovation: Robotic Coronary Angioplasty

J Am Coll Cardiol Intv, 2011; 4:460-465,

First-in-Human Evaluation of a Novel Robotic-Assisted Coronary Angioplasty System

Juan F. Granada, MD*,,*, Juan A. Delgado, MD, Maria Paola Uribe, MSCE, Andres Fernandez, MD, Guillermo Blanco, MD, Martin B. Leon, MD, Giora Weisz, MD
* Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, New York, New York Corbic Research Institute, Envigado, Colombia Corbic Medical Center, Envigado, Columbia New York Presbyterian Hospital, Columbia University Medical Center, New York, New York (Email: jgranada@crf.org)

Background: A remote-control, robotic-assisted angioplasty system is under development to address some of the procedural challenges and occupational hazards associated with traditional PCI.

Methods:

CorPath 200 robotic system (Corindus, Inc., Natick, Massachusetts) consists of a remote cockpit & a multicomponent bedside unit that enables the operator to advance, retract, and rotate guidewires and rapid exchange catheters. The primary endpoint was device clinical success (30% residual stenosis) without in-hospital major adverse cardiac events.

Technical success was defined as the ability of the system to complete all the planned angioplasty steps on the basis of procedural segments. Patients were followed up to 30 days after angioplasty procedure.

Results: A total of 8 patients were enrolled in the study. The primary endpoint was achieved in all patients (100%). The technical success of the robotic system was 97.9% in completing 47 of 48 planned steps. There were no device- or procedure-related complications and no in-hospital or 30-day major adverse cardiac events. The operators rated the robotic system performances as equal to or better than manual procedures in 97.5% of the cases. The operator radiation exposure was 97% lower than the levels found at the standard table position.

Conclusions: Early clinical experience with a robotic-assisted angioplasty system demonstrated feasibility, safety, and procedural effectiveness comparable to manual operation. In addition, the total operator exposure to radiation was significantly low. A larger study is warranted to verify the safety and effectiveness of robotic-assisted percutaneous coronary intervention.