Comparison of Robotic and Manual Percutaneous Coronary Intervention in Complex Coronary Artery Disease: A Propensity‐Matched Analysis
Jing Yang, Zijing Liu, Yuqi Fang, Yizhu Yan, Jing Xie, Tao Huang, Ge Zhang, Tienan Sun, Guangyao ZhaiBackground
Robotic‐assisted percutaneous coronary intervention (R‐PCI) has been developed to reduce operator radiation exposure and enhance procedural precision. As a next‐generation China‐developed R‐PCI platform, the ETcath200 system incorporates visual resistance feedback to partly overcome the inherent lack of tactile sensation during R‐PCI. However, comparative data between R‐PCI and manual PCI (M‐PCI) in highly complex coronary lesions remain limited.
Objectives
To compare the safety and efficacy of ETcath200‐guided R‐PCI versus conventional M‐PCI in a cohort characterized by complex coronary lesions.
Methods
This single‐center, prospective study enrolled patients with at least one AHA/ACC type B2 or C coronary lesion between March and June 2025. A total of 20 patients were treated with R‐PCI, whereas 400 patients received M‐PCI. After 1:1 propensity‐score matching, 19 matched patient pairs were analyzed. Clinical success served as the primary endpoint and was considered achieved when residual stenosis was < 30%, final TIMI flow was grade 3, and no in‐hospital major adverse cardiac events (MACE) occurred. Thirty‐day outcomes were also assessed.
Results
Clinical success was achieved in 100% of both groups, with no in‐hospital or 30‐day MACE. Procedural duration (60.26 ± 23.68 min vs. 71.32 ± 27.45 min, p = 0.192) and contrast volume (141.58 ± 47.76 mL vs. 131.05 ± 41.89 mL, p = 0.475) were similar between groups. Operator radiation exposure was markedly lower with R‐PCI (0.06 ± 0.04 μSv vs. 1096.15 ± 313.14 μSv, p < 0.001). One guidewire‐induced dissection occurred in the R‐PCI group and was successfully managed by conversion to manual PCI.
Conclusions
In this propensity‐matched cohort, ETcath200‐guided R‐PCI achieved acute outcomes comparable to M‐PCI in complex coronary lesions while substantially reducing operator radiation exposure. Larger multicenter studies with longer follow‐up are warranted.