Telerobotic neurovascular interventions with magnetic manipulation

Advances in robotic technology have been adopted in various subspecialties
of both open and minimally invasive surgery, offering benefits such as
enhanced surgical precision and accuracy with reduced fatigue of the
surgeon. Despite the advantages, robotic applications to endovascular
neurosurgery have remained largely unexplored because of technical
challenges such as the miniaturization of robotic devices that can reach
the complex and tortuous vasculature of the brain. Although some
commercial systems enable robotic manipulation of conventional guidewires
for coronary and peripheral vascular interventions, they remain unsuited
for neurovascular applications because of the considerably smaller and
more tortuous anatomy of cerebral arteries. Here, we present a
teleoperated robotic neurointerventional platform based on magnetic
manipulation. Our system consists of a magnetically controlled guidewire,
a robot arm with an actuating magnet to steer the guidewire, a set of
motorized linear drives to advance or retract the guidewire and a
microcatheter, and a remote-control console to operate the system under
real-time fluoroscopy. We demonstrate our system’s capability to navigate
narrow and winding pathways both in vitro with realistic neurovascular
phantoms representing the human anatomy and in vivo in the porcine
brachial artery with accentuated tortuosity for preclinical evaluation. We
further demonstrate telerobotically assisted therapeutic procedures
including coil embolization and clot retrieval thrombectomy for treating
cerebral aneurysms and ischemic stroke, respectively. Our system could
enable safer and quicker access to hard-to-reach lesions while minimizing
the radiation exposure to physicians and open the possibility of remote
procedural services to address challenges in current stroke systems of
care.