Endovascular robotic: feasibility and proof of principle for diagnostic cerebral angiography and carotid artery stenting

Sajja, Kalyan; Sweid, Ahmad; Saiegh, Fadi Al; Chalouhi, Nohra; Avery, Michael B; Schmidt, Richard F.; Tjoumakaris, Stavropoula; Gooch, M. Reid; Herial, Nabeel; Abbas, Rawad; Zarzour, Hekmat; Romo, Victor; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.1136/neurintsurg-2019-015763

Cited by 59 publications

(76 citation statements)

References 12 publications

(17 reference statements)

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“…Closely related to this topic is the introduction of robotics into the neurointerventional routine. To date, few groups have reported small case series of successful robot-assisted elective procedures [ 31 – 33 ], and first attempts are being made to create ethical and medicolegal frameworks [ 34 ] for neurointerventional robotics. The degree of autonomy of current robotic systems is however very low and their utility restricted by the incapability of performing essential tasks, such as puncturing the groin.…”

Section: The Future—where Are We Going?mentioning

confidence: 99%

Neurointervention in the 2020s: Where are We Going?

Goyal

Zwam

Moret³

et al. 2020

Clin Neuroradiol

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The 1970s and 1980s-Discovery The history of neurointervention is short as our field is still in its puberty. If one had to pinpoint a starting date, most would agree it was the early 1970s, although Luessenhop and Spence described a case of an endovascular embolization of a brain arteriovenous malformation as early as 1960 [1]. The 1970s was the time when the pioneers of the field boldly went where no one had gone before. Their brilliant minds made huge advancements in the understanding of complex vessel anatomy and neurovascular pathology, and we have to particularly recognize the tremendous input of Pierre Lasjaunias in the delicate and precise description of the vascular microanatomy of the base of the skull, and Fedor Serbinenko, who developed a technique to treat intracranial aneurysms and carotid cavernous sinus fistulas with a detachable latex balloon [2]. In the 1980s, Zeumer and Theron entered the field of endovascular stroke treatment and opened intracranial occlusions with locally administered fibrinolytics [3, 4]. Only a few conditions were treatable but the sudden knowledge gain was massive and

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Section: The Future—where Are We Going?mentioning

confidence: 99%

Neurointervention in the 2020s: Where are We Going?

Goyal

Zwam

Moret³

et al. 2020

Clin Neuroradiol

View full text Add to dashboard Cite

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“…The details of the interventional cases were not published; yet they compared robot-assisted angiography with matched angiographic controls and found no significant differences in procedural time, fluoroscopy times, and contrast volumes. In 2020, Sajja et al 53 published their experience using the CorPath GRX Robotic System to complete 7 transradial cerebral angiograms and 3 cases of carotid artery angioplasty and stent placement. 3 of the 7 angiography cases were converted to manual operation after discovery of a bovine arch that necessitated catheter exchange.…”

Section: Clinical Applications Of Robotic Neurointerventionmentioning

confidence: 99%

A Review of Robotic Interventional Neuroradiology

Beaman

Kaneko

Meyers

et al. 2021

AJNR Am J Neuroradiol

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Robotic interventional neuroradiology is an emerging field with the potential to enhance patient safety, reduce occupational hazards, and expand systems of care. Endovascular robots allow the operator to precisely control guidewires and catheters from a lead-shielded cockpit located several feet (or potentially hundreds of miles) from the patient. This has opened up the possibility of expanding telestroke networks to patients without access to life-saving procedures such as stroke thrombectomy and cerebral aneurysm occlusion by highly-experienced physicians. The prototype machines, first developed in the early 2000s, have evolved into machines capable of a broad range of techniques, while incorporating newly automated maneuvers and safety algorithms. In recent years, preliminary clinical research has been published demonstrating the safety and feasibility of the technology in cerebral angiography and intracranial intervention. The next step is to conduct larger, multisite, prospective studies to assess generalizability and, ultimately, improve patient outcomes in neurovascular disease.

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“…[22] CorPath GRX robotic-assisted platform, which is the nextgeneration successor of CorPath 200, includes more controlled and precise device manipulation especially after reaching the target site. [23] However, a physician is still needed for vascular access, for initial catheter guidance, for any device deployments and additional personnel are required for the procedure. The advantages that these robotic systems can bring should be considered and further efforts should be made to enhance especially the duration of their set-up, compatibility with current devices and reduce the cost to healthcare.…”

Section: State Of the Art In Tethered Endovascular Devicesmentioning

confidence: 99%

“…The advantages that these robotic systems can bring should be considered and further efforts should be made to enhance especially the duration of their set‐up, compatibility with current devices and reduce the cost to healthcare. In their evaluation of this platform toward elective diagnostic cerebral angiography and carotid artery stenting in ten patients, Sajja et al [ 23 ] drew attention to the fact that relying on the robotics system to manage or treat medical emergencies such as stroke would be detrimental until advanced systems are available for timely use. Finally, we acknowledge that such robotic systems hold a great potential provided that breakthrough advances take place in these devices.…”

Section: State Of the Art In Tethered Endovascular Devicesmentioning

confidence: 99%

Robotic Devices for Minimally Invasive Endovascular Interventions: A New Dawn for Interventional Radiology

Gündüz

Albadawi

Öklü

2020

Advanced Intelligent Systems

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Minimally invasive endovascular interventions have become the cornerstone of medical practice in the treatment of a variety of vascular diseases. Tools developed for these interventions have also opened new avenues for targeted delivery of therapeutics, such as chemotherapy or radiation therapy, using the vessels as highways into remote lesions. A more ambitious move toward an all‐endovascular approach to acute or chronic conditions, however, is fundamentally hindered by a variety of challenges, such as the complexity of the vascular anatomy, access to smaller vessels, the fragility of diseased vessels, emergency procedure requirements, prolonged exposure to ionizing X‐ray radiation, and patient‐specific factors including coagulopathy. These shortcomings necessitate new advances to the current practice. Smart soft‐body robots that fit the smallest vessels with high‐precision wireless control and autonomous capabilities have the potential to set the future standards of minimally invasive endovascular therapies. Herein, the current state of the small‐scale robotics from the viewpoint of endovascular applications is discussed, and their potential advantages to the existing tethered clinical devices are compared. Then, technical challenges and the clinical requirements toward realistic applications of small‐scale untethered robots inside the vasculature are discussed.

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Endovascular robotic: feasibility and proof of principle for diagnostic cerebral angiography and carotid artery stenting

Cited by 59 publications

References 12 publications

Neurointervention in the 2020s: Where are We Going?

Neurointervention in the 2020s: Where are We Going?

A Review of Robotic Interventional Neuroradiology

Robotic Devices for Minimally Invasive Endovascular Interventions: A New Dawn for Interventional Radiology

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