Remote proctoring in complex percutaneous coronary intervention aided by mixed reality technology

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) has a lower success rate and a higher complication rate compared to PCI of non-occluded coronary arteries. Co-operation and supervision by a more experienced operator (proctoring) is associated with improved success of CTO-procedures. To assess the feasibility of remote proctoring using web-based communication and mixed reality technology in CTO-procedures. The PCI operator was equipped with a Microsoft HoloLens 2 head mounted display enabling visual and verbal interaction including holographic annotations with a remote proctor. Ten CTO-procedures were performed by a single PCI operator assisted by a remote proctor. Audio and video communication was successfully established in all procedures. All procedures were possible to perform with a Microsoft HoloLens 2 head mounted display. The PCI-operator experienced the remote proctoring as useful. Remote proctoring of CTO-procedures using mixed reality technology was feasible. The impact of the method regarding procedural and patient outcomes needs to be assessed in new studies.