From the Research
Robotic-assisted surgery is not typically used for placing coronary stents in patients with myocardial infarction (MI), and conventional percutaneous coronary intervention (PCI) remains the standard approach for stent placement. For a patient requiring multiple stents (7-8) for MI management, the primary concern is to restore blood flow to the affected heart muscle as quickly and safely as possible. The most recent and highest quality study on robotic-assisted surgical coronary artery revascularisation is from 2024 1, which shows that robotic-assisted CABG and hybrid coronary intervention provide good long-term outcomes in patients who are not candidates for conventional CABG. However, this study does not directly address the use of robotic-assisted surgery for placing multiple coronary stents in patients with MI.
The use of robotic assistance in endovascular interventions, such as carotid artery stenting, has been explored in several studies, including one from 2020 2 and another from 2020 3. These studies demonstrate the technical feasibility and preliminary safety of robotic-assisted platforms for treating carotid artery disease. However, the application of robotic-assisted surgery for coronary stent placement in patients with MI is not well established.
In contrast, conventional PCI is a well-established and widely used procedure for placing coronary stents in patients with MI. The procedure is typically performed in a cardiac catheterization laboratory, where a cardiologist threads a catheter through blood vessels to reach the coronary arteries and deploy stents to open blocked vessels. This approach has been shown to be safe and effective in numerous studies, including a systematic review and meta-analysis from 2023 4 that compared the efficacy and safety of clopidogrel versus aspirin in patients who completed dual antiplatelet therapy after PCI.
Key points to consider in the management of a patient requiring multiple stents for MI include:
- The use of dual antiplatelet therapy, including aspirin and a P2Y12 inhibitor, to reduce the risk of stent thrombosis and recurrent MI
- The importance of statin therapy to reduce the risk of recurrent cardiovascular events
- The potential benefits of beta-blockers and ACE inhibitors in reducing morbidity and mortality in patients with MI
- The need for careful consideration of the patient's individual clinical situation, including their medical history, comorbidities, and preferences, when making decisions about their care.
Overall, while robotic-assisted surgery may have a role in certain cardiac procedures, such as mitral valve repair or coronary artery bypass grafting, conventional PCI remains the standard approach for placing coronary stents in patients with MI, and robotic-assisted surgery is not typically used for this indication.