Real-Time Remote Telerobotic Magnetic Navigation for Endovascular Simulated Stroke Thrombectomy Across 5700 Miles

摘要

BACKGROUND AND OBJECTIVES: While many trials of the last decade have shifted the paradigm of stroke care toward endovascular therapy, a lack of timely access to centers with neurointerventional capabilities for many patients has remained a significant barrier to care. Endovascular robotic systems are poised to address this need for expanded access through telerobotic procedures, while also benefiting clinical team safety and raising the possibility of improved procedural precision. METHODS: A telerobotic setup consisting of a magnetic field generator and a mechanical advancer was placed with a silicone vascular phantom in an interventional suite in Switzerland and connected by wireless internet to an operator console in Arizona. From the operator console, the neurosurgeon navigated a guidewire and aspiration catheter to simulated middle cerebral artery (MCA) (n = 10) and basilar artery (n = 10) clots in consecutive timed procedural trials in evaluation of system feasibility and operator learning curve. RESULTS: From over 5700 miles away, the neurosurgeon navigated an aspiration catheter to 10 MCA and 10 basilar artery simulated large vessel occlusions. Clot aspiration was attempted in 4 trials and successful in each. Endovascular navigational time over 10 procedural trials to the M1 segment of the MCA and 10 trials to the basilar artery were completed on average in 114 seconds (SD 44.4 seconds) and 134 seconds (SD 65.8 seconds), respectively. Sufficient operator mastery was demonstrated in 20 procedural iterations with an average 77% reduction in navigational time from aortic arch initial to final trials. CONCLUSION: To our knowledge, we present the first intercontinental aspiration thrombectomy in the preclinical setting in comparable time to the clinical practice and demonstrate the early potential of telerobotic navigation. A lack of haptic feedback did not pose a hindrance, and the potential for intuitive operation offers to drive future research and adoption of this telesurgery system.