Remote robotic endovascular thrombectomy for acute ischaemic stroke

Abstract

BackgroundIn acute ischaemic stroke, endovascular thrombectomy (ET) significantly reduces disability compared with thrombolytic therapy, but access to ET is currently limited. Leveraging telerobotic technology to disseminate neurosurgical expertise could increase access to ET. This proof-of-concept evaluation was performed to determine whether remote robotic ET (RRET), wherein an offsite neurosurgeon and an onsite interventional cardiologist collaboratively use telerobotics to perform ET, is technically feasible.MethodsAn ex vivo model of RRET was constructed by establishing a network connection between a robotic drive in a simulation laboratory and a robotic control unit 5 miles away. Using onsite assistance from an interventional cardiologist in the simulation laboratory, an offsite neurosurgeon used the robotic controls to attempt RRET on a fluid-filled silicone model of human vasculature containing simulated thrombus material in the left middle cerebral artery (MCA).ResultsFrom the offsite location 5 miles away, the neurosurgeon used the robotic system to successfully navigate a guidewire from the carotid artery to simulated thrombus in the MCA. Under the direction of the neurosurgeon, the onsite interventional cardiologist then successfully manually advanced an aspiration catheter over the guidewire to the thrombus, removed the guidewire and performed aspiration.ConclusionsIn this proof-of-concept evaluation, the technical feasibility of RRET was demonstrated in an ex vivo model and was collaboratively performed by an offsite neurosurgeon and an onsite interventional cardiologist. This report supports the design of future studies to determine if RRET could be used to increase access to ET for patients with acute ischaemic stroke.

Neighbourhood deprivation, distance to nearest comprehensive stroke centre and access to endovascular thrombectomy for ischemic stroke: a population-based study

“…Remote robotic EVT is an evolving technology that may offer a means of treating patients from rural areas with EVT before transport, thereby mitigating the effect of distance to a CSC on the likelihood of receiving EVT. 34 Future work should attempt to replicate our findings without limiting the study cohort to people treated with alteplase. Furthermore, researchers should investigate whether people from areas with low socioeconomic status experience worse outcomes and have longer times to treatment than those from areas with high socioeconomic status.…”

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

“…In the near future, robotic assistance could potentially be used for acute stroke interventions in remote geographic locations and in areas where a neurointerventionalist is not available. Thanks to a successful adaptation of the CorPath GRX system, Patel et al have performed the first remote robot-assisted percutaneous coronary intervention in patients,18 whereas Singer et al provided proof of concept for the technical feasibility of remote robotic thrombectomy in an ex vivo model 19…”

Robotically performed diagnostic coronary angiography

“…Endovascular thrombectomy has been convincingly demonstrated to be superior to thrombolytic therapy for acute large vessel stroke, 23 but availability of catheter‐based stroke care is exceptionally limited in rural areas 19,22 . The development of remote robotic endovascular thrombectomy, which theoretically could disseminate the technical expertise to perform catheter‐based stroke interventions in rural geographies, is underway 24,25 …”

“…19,22 The development of remote robotic endovascular thrombectomy, which theoretically could disseminate the technical expertise to perform catheter-based stroke interventions in rural geographies, is underway. 24,25…”