First case report of a percutaneous coronary intervention with intracoronary lithotripsy in a heavily calcified and tortuous right coronary artery using the R-One+ robotic system.

Background: Advancement in interventional techniques has significantly improved the ability of percutaneous coronary intervention (PCI) to treat complex coronary artery disease. Despite these advancements, coronary artery calcification poses a substantial challenge during PCI, contributing to increased risks of procedural complications, prolonged procedure duration, and an increase in radiation exposure dose for both patients and physicians. Recently, robotic PCI has emerged, allowing physicians to remotely control and deliver wires and catheters, leading to a notable reduction of the operator radiation exposure and a decrease in the risk of operator physical injuries such as back pain.

Case summary: We report the first robotic PCI with the R-One⁺™ robotic system using intracoronary lithotripsy for lesion preparation of two heavily calcified lesions in a tortuous right coronary artery of a 60-year-old male patient followed by double drug-eluting stent implantation.

Discussion: Robotic PCI with the R-One⁺™ system can not only manage wires, balloons, or stent systems but can also precisely position more bulky catheters such as intracoronary lithotripsy catheters to the target site even in the presence of a tortuous access.