TY - JOUR
T1 - Transcarotid access for remote robotic endovascular neurointerventions
T2 - a cadaveric proof-of-concept study
AU - Berczeli, Marton
AU - Chinnadurai, Ponraj
AU - Legeza, Peter T.
AU - Britz, Gavin W.
AU - Lumsden, Alan B.
N1 - Funding Information:
We express our appreciation for preparing the study to Evan Honeycutt, Rebecca Barnes, Tim Edwards, Johnny Tomas, and the Corindus remote support team. We thank the contribution of Mark Trevino (thrombectomy system) and Michael Bryant (TCAR stent system) for providing technical support. Dr. Berczeli is supported by Semmelweis University’s scholarship: “Kiegészítő Kutatási Kiválósági Ösztöndíj” EFOP-3.6.3-VEKOP-16-2017-00009.
Publisher Copyright:
© 2022. AANS except where prohibited by US copyright law.
PY - 2022/1
Y1 - 2022/1
N2 - OBJECTIVE The purpose of this proof-of-concept study was to demonstrate the setup and feasibility of transcarotid access for remote robotic neurointerventions in a cadaveric model. METHODS The interventional procedures were performed in a fresh-frozen cadaveric model using an endovascular robotic system and a robotic angiography imaging system. A prototype remote, robotic-drive system with an ethernet-based network connectivity and audio-video communication system was used to drive the robotic system remotely. After surgical exposure of the common carotid artery in a cadaveric model, an 8-Fr arterial was inserted and anchored. A telescopic guiding sheath and catheter/microcatheter combination was modified to account for the “workable” length with the CorPath GRX robotic system using transcarotid access. RESULTS To simulate a carotid stenting procedure, a 0.014-inch wire was advanced robotically to the extracranial internal carotid artery. After confirming the wire position and anatomy by angiography, a self-expandable rapid exchange nitinol stent was loaded into the robotic cassette, advanced, and then deployed robotically across the carotid bifurcation. To simulate an endovascular stroke recanalization procedure, a 0.014-inch wire was advanced into the proximal middle cerebral artery with robotic assistance. A modified 2.95-Fr delivery microcatheter (Velocity, Penumbra Inc.) was loaded into the robotic cassette and positioned. After robotic retraction of the wire, it was switched manually to a mechanical thrombectomy device (Solitaire X, Medtronic). The stentriever was then advanced robotically into the end of the micro-catheter. After robotic unfolding and short microcatheter retraction, the microcatheter was manually removed and the stent retriever was extracted using robotic assistance. During intravascular navigation, the device position was guided by 2D angiography and confirmed by 3D cone-beam CT angiography. CONCLUSIONS In this proof-of-concept cadaver study, the authors demonstrated the setup and technical feasibility of transcarotid access for remote robot-assisted neurointerventions such as carotid artery stenting and mechanical thrombectomy. Using transcarotid access, catheter length modifications were necessary to achieve “working length” compatibility with the current-generation CorPath GRX robotic system. While further improvements in dedicated robotic solutions for neurointerventions and next-generation thrombectomy devices are necessary, the transcarotid approach provides a direct, relatively rapid access route to the brain for delivering remote stroke treatment.
AB - OBJECTIVE The purpose of this proof-of-concept study was to demonstrate the setup and feasibility of transcarotid access for remote robotic neurointerventions in a cadaveric model. METHODS The interventional procedures were performed in a fresh-frozen cadaveric model using an endovascular robotic system and a robotic angiography imaging system. A prototype remote, robotic-drive system with an ethernet-based network connectivity and audio-video communication system was used to drive the robotic system remotely. After surgical exposure of the common carotid artery in a cadaveric model, an 8-Fr arterial was inserted and anchored. A telescopic guiding sheath and catheter/microcatheter combination was modified to account for the “workable” length with the CorPath GRX robotic system using transcarotid access. RESULTS To simulate a carotid stenting procedure, a 0.014-inch wire was advanced robotically to the extracranial internal carotid artery. After confirming the wire position and anatomy by angiography, a self-expandable rapid exchange nitinol stent was loaded into the robotic cassette, advanced, and then deployed robotically across the carotid bifurcation. To simulate an endovascular stroke recanalization procedure, a 0.014-inch wire was advanced into the proximal middle cerebral artery with robotic assistance. A modified 2.95-Fr delivery microcatheter (Velocity, Penumbra Inc.) was loaded into the robotic cassette and positioned. After robotic retraction of the wire, it was switched manually to a mechanical thrombectomy device (Solitaire X, Medtronic). The stentriever was then advanced robotically into the end of the micro-catheter. After robotic unfolding and short microcatheter retraction, the microcatheter was manually removed and the stent retriever was extracted using robotic assistance. During intravascular navigation, the device position was guided by 2D angiography and confirmed by 3D cone-beam CT angiography. CONCLUSIONS In this proof-of-concept cadaver study, the authors demonstrated the setup and technical feasibility of transcarotid access for remote robot-assisted neurointerventions such as carotid artery stenting and mechanical thrombectomy. Using transcarotid access, catheter length modifications were necessary to achieve “working length” compatibility with the current-generation CorPath GRX robotic system. While further improvements in dedicated robotic solutions for neurointerventions and next-generation thrombectomy devices are necessary, the transcarotid approach provides a direct, relatively rapid access route to the brain for delivering remote stroke treatment.
KW - Direct carotid access
KW - Endovascular robot
KW - Remote interventions
KW - Remote mechanical thrombectomy
KW - Remote neuro-intervention
KW - Remote stroke intervention
KW - Trans-carotid approach
KW - Robotic Surgical Procedures
KW - Humans
KW - Thrombectomy/methods
KW - Treatment Outcome
KW - Endovascular Procedures/methods
KW - Robotics
KW - Stents
KW - Cadaver
KW - Stroke/surgery
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UR - http://www.scopus.com/inward/citedby.url?scp=85123037202&partnerID=8YFLogxK
U2 - 10.3171/2021.10.FOCUS21511
DO - 10.3171/2021.10.FOCUS21511
M3 - Article
C2 - 34973671
AN - SCOPUS:85123037202
SN - 1092-0684
VL - 52
SP - E18
JO - Neurosurgical focus
JF - Neurosurgical focus
IS - 1
M1 - E18
ER -