- A projected shortage of cardiologists is pushing the Mayo Clinic to consider telemedicine for conducting some minimally invasive coronary interventions, such as inserting stents.
The Minnesota-based health system recently announced a multi-phase, multi-year partnership with Waltham, Mass.-based Corindus Vascular Robotics, funded by a $3.3 million charitable grant, to develop a telemedicine platform by which a remote doctor can perform percutaneous coronary interventions (PCIs).
The “telestenting” project will be led by Mackram E. Eleid, MD, an Interventional Cardiologist at the Mayo Clinic Department of Cardiovascular Medicine and an Associate Professor of Medicine at the Mayo Clinic College of Medicine, who will be working with the Corindus CorPath GRX System. The process enables a remote doctor to guide a telemedicine robot conducting the procedure.
The preclinical project is being driven in part by a U.S. Health Resources and Services Administration study that estimates a severe physician shortage by 2025, including a deficit of some 7,000 cardiologists and a global shortage of specialists able to conduct PCIs.
“Corindus is committed to developing a high tech cardiovascular model that improves efficiency, integrates the latest technology, and ultimately improves patient care,” company CEO Mark Toland said in a press release.
He said the platform, which was approved by the U.S. Food and Drug Administration in 2016 for robotic-assisted PCI in the cardiac catheterization lab, could help with remote treatment of endovascular disease and stroke.
“Telestenting is at the core of this strategy," he added.
The telemedicine platform gained worldwide recognition roughly a year ago following a study published in the journal Eurointervention by a team of researchers led by Ryan D Madder, of Spectrum Health’s Frederik Meijer Heart & Vascular Institute in Grand Rapids, Mich.
In that study, conducted in 2014 and 2015, 20 patients were treated, six presenting with MI, 13 with unstable angina and one with stable symptoms. In all, 19 of 22 treatments were successfully conducted via telestenting.
“If telestenting were developed into a procedure capable of being performed over long geographic distances, it could be applied to improve access to PCI in medically under-served regions and might represent a novel alternative to inter-hospital transfer for primary PCI in patients with ST-segment elevation myocardial infarction (STEMI),” Madder and his colleagues reported.
Madder told Cardiovascular News that more studies will need to be done to prove that telestenting can work.
“It is important to recognize that this study represents a small initial step in the development of telestenting,” he said. “There are many barriers to overcome to develop telestenting further, including the need for a second operator at the remote site. Who that second operator should be has not yet been determined. It is clear, however, that many remote geographic sites around the globe do not currently have access to an interventional cardiologist. This is particularly problematic when patients present to these remote sites with acute myocardial infarction.”
He also sees the value of the telemedicine platform in treating patients in underserved areas. According to a 2012 study, roughly 80 percent of Americans live within an hour of a healthcare provider capable of conducting PCIs; in more remote areas, that number drops to about 40 percent.
“There is a need for us to develop novel approaches to overcome some of these barriers, and [telestenting] may be one approach,” he told The Cardiovascular Research Foundation’s TCTMD magazine.
“What we’ve shown is that it’s feasible for a physician - using telecommunications and a robotic system - to actually perform PCI on a patient successfully from outside the confines of a procedure room,” he added.