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Coronary artery disease

What is coronary artery disease?

Coronary artery disease is caused by a narrowing of the coronary arteries due to a build-up of calcified deposits, or plaque, on the vessel walls. This process is called atherosclerosis.

Two main arteries supply blood to the heart – the left coronary artery (which in turn splits into two smaller arteries, the left anterior descending and the left circumflex artery), and the right coronary artery. These arteries are the main blood vessels that ensure the heart muscle gets enough oxygen. There is little communication between the two. As a result, the occlusion (blocking) of these vessels rapidly causes necrosis (tissue death) of the heart muscle. This is called myocardial infarction.

Myocardial infarction is the leading cause of death worldwide.

Time is a significant variable in treating coronary artery disease.

Risk factors

A number of factors increase the risk of developing coronary artery disease:

  • Smoking
  • Hypertension
  • Diabetes (elevated blood sugar)
  • Cholesterol: an elevated level of fats, particularly LDL cholesterol, in the blood is a major risk factor. Low HDL cholesterol is also a risk factor.
  • Being overweight
  • Lack of physical activity

Symptoms

As coronary artery disease develops slowly, symptoms appear at a late stage, when the narrowing has already reached a certain level.

One of the first symptoms is a feeling of ‘tightness’ in the chest on exertion (walking quickly, running, etc.), called angina. This takes the form of intense pain deep in the chest, and is a sign that the heart muscle is not getting enough oxygen.

It may also be felt after meals, when digesting food, or when resting at night. Often, it feels like this pain is radiating into the left arm. It can also radiate into the neck, the lower jaw, the right arm, or into the back and stomach.

The standard treatment for this condition is PCI

This intervention is carried out following a coronary angiogram, which determines the area to be treated and the degree of stenosis requiring revascularization.

Our treatment solution

The R-OneTM robotic platform was designed to improve operation conditions during PCI’s, particularly phyisician comfort and safety.

It is a minimally invasive procedure, during which a catheter is inserted into the body at the wrist (radial artery) or the groin (femoral artery). This catheter travels up the peripheral blood vessels to the start of the blocked coronary artery.

A contrast medium may be injected into the catheter to make the progression of the instruments visible on x-ray imaging monitors.

Following this, a guidewire is inserted into the catheter and placed in the blocked artery. It is moved to the lesion by the cardiologist, who is seated at the radioprotected control unit.

Subsequently, a stent-carrying balloon, previously mounted on the guidewire, then moves to the lesion to be treated and is inflated, so that the lumen of the artery (the space inside the vessel) is restored and the blood circulation through this zone is improved.

The balloon is then deflated so the device can be removed, leaving the stent in place.

All these actions are carried out by the cardiologist from the robotic platform’s radioprotected control unit.

What are the benefits?

  • Optimized stent placement
  • Safe navigation
  • Increased physician comfort
  • Reduced stress (protection from x-rays)

Learn more

 

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Peripheral artery disease

Peripheral artery disease (PAD), particularly in the legs, is caused by the narrowing of the arteries supplying blood to the body (other than those that supply the heart).

If it is not treated rapidly and measures are not taken to improve the patient’s lifestyle (stopping smoking, regular physical exercise, balanced diet, etc.), it can cause differing levels of disability and lead to amputation.

Risk factors

  • Smoking
  • Diabetes (elevated blood sugar)
  • Hypertension
  • Cholesterol
  • Being overweight
  • Lack of physical activity

Symptoms

PAD can be divided into four stages:

  • Subclinical, can only be diagnosed with an ankle-brachial index reading
  • Intermittent claudication, characterized by cramp-like pain in the legs when walking. The pain is such that the person has to stop
  • The third stage manifests as pain in the legs when resting, particularly at night. This pain may require the patient to sleep sitting up – this is a sign of stenosis that must be treated rapidly
  • The final stage takes the form of sharp, intense pain accompanied by paleness of the legs and/or issues with moving them (loss of sensation) associated with insufficient or absence of oxygenation. This is referred to as trophic disorders, ulcer and gangrene. These issues represent an urgent vascular emergency, and may lead to amputation

The standard treatment for this condition is PCI

As with coronary artery disease, peripheral artery disease can be treated with angioplasty.

This consists of dilating the narrowed arteries using an instrument called a balloon to revascularize the blocked area. A stent (a small spring-shaped metal implant) may be inserted to maintain the blood flow after dilatation.

This is a minimally invasive procedure carried out under local anesthetic.

Our treatment solution

R-oneTM, the first robotic platform developed by Robocath, was designed to meet the needs of interventional cardiology.

The next generation of robotics will also handle peripheral revascularizations, such as peripheral artery disease, with a more or less identical treatment protocol to revascularization of the heart muscle.

Robotic assistance will ensure surgeon comfort and safety during procedures, offering extreme precision when using instruments.

Stroke

A stroke can be caused by the obstruction or rupture of a blood vessel supplying the brain. In most cases, a vessel is obstructed. This is called an ischemic stroke. A ruptured vessel is called a hemorrhagic stroke.

A stroke represents an extreme emergency, as it can have severe consequences. Time is a key factor. The quicker a stroke is treated, the lower the risk of serious adverse effects.

Risk factors

  • Hypertension
  • Lack of physical activity
  • Abdominal obesity
  • High cholesterol level
  • Smoking
  • Poor diet
  • Psychosocial issues
  • Diabetes

Symptoms

A stroke can manifest as partial or total paralysis of one or more limbs, reduced feeling or numbness affecting the face, speech difficulty (incoherent speech), balance and memory issues, and vision problems.

Treatments

In the case of cerebral infarction, the treatment consists of unblocking the obstructed vessel as quickly as possible. Two methods are currently used to do this:

  • Thrombolysis (fibrinolysis): this involves an intravenous injection of a drug that can dissolve the blood clot blocking the vessel
  • Mechanical thrombectomy: Several recent studies1 have demonstrated the benefits of mechanical thrombectomy. This operation consists of passing a catheter along the artery to the obstructing clot and sucking or ‘catching’ the clot using a stent. This technique enables longer intervention times (up to 6 hours after the stroke) than thrombolysis (limited to 4.5 hours for intra venous perfusion and 6 hours for arterial access with the introduction of a catheter)

1 Mechanical thrombectomy in acute ischemic strokeL. Derex, T.-H. Cho, 2017

What we offer

Alongside its robotic assistance platform for treating coronary artery disease, Robocath has started R&D work with a view to designing a robotic assistance platform for mechanical thrombectomy.

In addition to the benefits of this new treatment, robotic assistance will enable surgeons to carry out procedures under better conditions (complete protection from x-rays, precise navigation, etc.).