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

Abstract

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.

Magnetic Soft Materials and Robots

“…For clinical applications that involve contact of the device with circulating blood, such as the magnetically guided intravascular devices, hemocompatibility should also be evaluated to ensure that the device materials cause no adverse responses such as thrombosis, coagulation, hemolysis, and complement activation during their intended uses. For example, thrombosis on the robot can impede robotic functionality (e.g., increasing the mechanical rigidity) and may lead to distal tissue ischemia, while complement activation may not only render the robot nonfunctional but also cause systemic impacts due to the subsequent inflammatory response . Material-mediated complement activation is a complex process that depends on multiple factors such as the physical and chemical properties of the material and the surface area and surface architecture of the device. , Further studies will be required to evaluate such material-mediated biological and physiological responses to evaluate both short-term and long-term systemic responses and thereby to ensure the safety of magnetic soft materials and robots for their applications to blood-contacting medical devices.…”

Heat‐Mitigated Design and Lorentz Force‐Based Steering of an MRI‐Driven Microcatheter toward Minimally Invasive Surgery

“…Steerable (active) catheters and continuum robots offer an alternative to traditional passive guidewire‐based catheter deployment techniques with improvements in maneuverability and remote manipulation. [ 3 , 4 , 5 , 6 , 7 ] The main challenge in active catheter design is transmitting force and torque through the soft slender body to actuate the catheter tip. Most commercial systems such as Sensei X and Magellan (Hansen Medical, Mountain View, CA, USA) use tendon‐based force transmission.…”

Locomotion of Sensor‐Integrated Soft Robotic Devices Inside Sub‐Millimeter Arteries with Impaired Flow Conditions

“…Steering guidewires and endovascular devices using robotic actuation promise to improve the speed, safety, and efficacy of interventions. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Integration of electronic devices on endovascular instruments such as force, temperature, pressure, and flow sensors [25][26][27] facilitated the development of intelligent machines that are capable of navigating the cardiovascular system autonomously. [28] Sensor-integrated catheters have been miniaturized to millimeter [29][30][31][32] and even micrometer scale [33] using microengineering methods.…”