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

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) 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) are associated with improved success of CTO procedures. This study aims 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.