Comparison of Robotic Assisted Carotid Stenting and Manual Carotid Stenting Through the Transradial Approach

Weinberg, Joshua; Sweid, Ahmad; Sajja, Kalyan; Gooch, M. Reid; Herial, Nabeel; Tjoumakaris, Stavropoula; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.1093/neuros/nyaa447_326

Cited by 7 publications

(11 citation statements)

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“…needed 2 procedures before total duration and fluoroscopy time began to reduce. 29 In our experience, 5 procedures were necessary before procedural times were reduced and kept stable (Figure 5).…”

Section: Discussionmentioning

confidence: 92%

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Robotically-assisted neuro-endovascular procedures: Single-Center Experience and a Review of the Literature

et al. 2022

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Introduction Robotics could expand treatment of rapidly progressive pathologies such as acute ischemic stroke, with the potential to provide populations in need prompt access to neuro-endovascular procedures. Methods Robotically-assisted (RA) neuro-endovascular procedures (RANPs) performed at our institution were retrospectively examined (RA-group, RG). A control group of manual neuro-endovascular procedures was selected (manual group, MG). Total operating room (OR) time, procedural time, contrast media use, fluoroscopy time, conversion from RA to manual control, procedural success, and complication rates were compared. A learning curve was identified. Results Forty-one (41) RANPs were analyzed. Ages ranged from 20–82 y.o. Indications included diagnostic cerebral angiography (37), extracranial carotid artery stenting (3), and transverse sinus stent (1). Total OR time was longer in RG (median 86 vs. 71 min, p < 0.01). Procedural time (median 56 vs. 45 min, p = 0.12), fluoroscopy time (median 12 vs. 12 min, p = 0.69) and contrast media usage (82 vs. 92 ml, p = 0.54) were not significantly different. Patient radiation exposure was similar, considering similar fluoroscopy times. Radiation exposure and lead apron use were virtually absent for the main surgeon in RG. Procedural success was 83% and conversion from RA to manual control was 17% in RG. No treatment-related complications occurred. A learning curve showed that, after the fifth procedure, procedural times reduced and stabilized. Conclusions This series may contribute to further demonstrating the safety and feasibility of RANPs. RANPs can potentially reduce radiation exposure and physical burden for health personnel, expand acute cerebrovascular treatment to underserved areas, and enhance telementoring. Prospective studies are necessary for results to be generalized.

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Section: Discussionmentioning

confidence: 92%

“…Current literature on RANP in the human in vivo CV system is summarized in Table 2. [21][22][23][24][25][26][27][28][29][30] Maybe the most important aspect of this technology is the potential to perform remote RANPs. In 2000, a telelaparoscopy was performed in Singapore while being controlled from the US.…”

Section: Discussionmentioning

confidence: 99%

Robotically-assisted neuro-endovascular procedures: Single-Center Experience and a Review of the Literature

et al. 2022

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“…Furthermore, new developments in robot-assisted neurovascular surgery are changing the treatment of aneurysms. Recent advances in engineering have led to the emergence of robotic neurointerventional procedures, including diagnostic cerebral angiography, carotid artery interventions, and the treatment of intracranial aneurysms 5–8. Robot-assisted neurointerventional procedures have the potential to increase accuracy and reduce occupational hazards for the surgical team.…”

Section: Introductionmentioning

confidence: 99%

Robotically assisted deployment of flow diverter stents for the treatment of cerebral and cervical aneurysms

Chivot

Bouzerar

Peltier

et al. 2023

J NeuroIntervent Surg

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BackgroundDespite the growing sophistication of robot-assisted surgery, it is necessary to demonstrate that robots can reliably perform complex procedures on site and then remotely. Although a flow diverter stent is one of the most effective and widely used devices, its placement is sometimes challenging.ObjectiveTo evaluate the feasibility and safety of the CorPath GRX robotic platform for the embolization of cerebral and cervical aneurysms using flow diverter stents.MethodsWe performed a single-center technical study of the first 10 flow diverter stent deployments with the CorPath GRX Robotic System (Corindus Inc, Waltham, Massachusetts, USA) for the treatment of cerebral aneurysms between April and October 2022.ResultsTen patients underwent robot-assisted embolization with flow diverter stents: there were nine intracranial aneurysms (paraclinoid n=6; posterior communicating artery aneurysm n=1; anterior communicating artery n=2) and one cervical aneurysm. Four procedures were performed with coils plus a flow diverter stent, one was performed with woven endobridge plus a flow diverter stent and four were performed with flow diverter stents alone. Of these procedures, two were performed with telescoping flow diverters.All flow diverter stents were deployed with robotic assistance, with only one partial conversion to a manual technique (caused by guidewire torquability limitations). No perioperative complications were observed.ConclusionRobot-assisted flow diverter stent deployment using the CorPath GRX platform is feasible and appears to be safe. Larger, in-depth studies of the technique’s safety and benefits are now warranted.

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“…Minimally invasive procedures account mainly for transfemoral or transradial catheter insertion with the need to manually manipulate guidewires through tortuous paths. These approaches are characterized by high technical complexity setting the need for trained expert operators or for complex robotic insertion systems [3][4][5]. Most of the image-guided robotic catheter systems proposed so far suffer from the use of ionizing radiations for imaging and from non-efficient actuation.…”

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confidence: 99%

An Artificial Intelligence-Aided Robotic Platform for Ultrasound-Guided Transcarotid Revascularization

Faoro

Maglio

Pane

et al. 2023

IEEE Robot. Autom. Lett.

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Transcarotid Artery Revascularization (TCAR) is typically performed by manual catheter insertion and implies radiation exposure for both the patient and the surgeon. Taking advantage from robotics and artificial intelligence (AI), this letter presents a robotic ultrasound (RUS) platform for improving the procedure. To this purpose, ultrasound (US) imaging is considered both in the pre-operative stage for procedure planning and in the intra-operative stage to track a catheter. 3D vascular volumes can be precisely reconstructed from sequences of 2D images exploiting robotic probe manipulation and AI-based image analysis. The method proved a median reconstruction error lower than 1 mm. Pre-operative information are mapped to the intra-operative scenario thanks to a US-based registration routine. The automatic probe alignment on the target vessel demonstrated to be as precise as 0.84°. The reconstructed 3D model can be exploited to automatically generate a catheter trajectory based on user inputs. Such trajectory enabled automatic insertion of a magnetic catheter steered by an external permanent magnet actuated by the RUS platform. Our results demonstrate a catheter tip target reaching error of 3.3 mm. We believe that these results can open the way for the introduction of robotics and AI in TCAR procedures enabling precise and automatic small-scale intravascular devices control.

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Comparison of Robotic Assisted Carotid Stenting and Manual Carotid Stenting Through the Transradial Approach

Cited by 7 publications

References 0 publications

Robotically-assisted neuro-endovascular procedures: Single-Center Experience and a Review of the Literature

Robotically-assisted neuro-endovascular procedures: Single-Center Experience and a Review of the Literature

Robotically assisted deployment of flow diverter stents for the treatment of cerebral and cervical aneurysms

An Artificial Intelligence-Aided Robotic Platform for Ultrasound-Guided Transcarotid Revascularization

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