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Dreyfus R, Boehler Q, Lyttle S, Gruber P, Lussi J, Chautems C, Gervasoni S, Berberat J, Seibold D, Ochsenbein-Kölble N, Reinehr M, Weisskopf M, Remonda L, Nelson BJ. Dexterous helical magnetic robot for improved endovascular access. Sci Robot 2024; 9:eadh0298. [PMID: 38354258 DOI: 10.1126/scirobotics.adh0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024]
Abstract
Treating vascular diseases in the brain requires access to the affected region inside the body. This is usually accomplished through a minimally invasive technique that involves the use of long, thin devices, such as wires and tubes, that are manually maneuvered by a clinician within the bloodstream. By pushing, pulling, and twisting, these devices are navigated through the tortuous pathways of the blood vessels. The outcome of the procedure heavily relies on the clinician's skill and the device's ability to navigate to the affected target region in the bloodstream, which is often inhibited by tortuous blood vessels. Sharp turns require high flexibility, but this flexibility inhibits translation of proximal insertion to distal tip advancement. We present a highly dexterous, magnetically steered continuum robot that overcomes pushability limitations through rotation. A helical protrusion on the device's surface engages with the vessel wall and translates rotation to forward motion at every point of contact. An articulating magnetic tip allows for active steerability, enabling navigation from the aortic arch to millimeter-sized arteries of the brain. The effectiveness of the magnetic continuum robot has been demonstrated through successful navigation in models of the human vasculature and in blood vessels of a live pig.
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Affiliation(s)
- R Dreyfus
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - Q Boehler
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - S Lyttle
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - P Gruber
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - J Lussi
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - C Chautems
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - S Gervasoni
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - J Berberat
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - D Seibold
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - N Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- Institute of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
| | - M Reinehr
- University of Zurich, Zurich, Switzerland
| | - M Weisskopf
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - L Remonda
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - B J Nelson
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
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Burel J, Gerardin E, Papagiannaki C, Shotar E, Sourour N, Laporte C, Hermet PL, Premat K, Dacher JN, Clarençon F. Direct Aspiration versus Combined Technique for Distal Medium-Vessel Occlusions: Comparison on a Human Placenta Model. AJNR Am J Neuroradiol 2023; 44:441-446. [PMID: 36958799 PMCID: PMC10084908 DOI: 10.3174/ajnr.a7831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/23/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy appears to be a promising option for distal medium-vessel occlusions, for which intravenous thrombolysis is effective but may be insufficient when used alone. This study aimed to determine the optimal technique for these distal mechanical thrombectomies using the human placenta model. MATERIALS AND METHODS Twenty-four procedures were performed, allowing comparison of direct aspiration (n = 12) versus the combined technique (n = 12). Two positions of the aspiration catheter were tested for each of these techniques: in direct contact with the clot and at a distance from it (5-10 mm). Two types of clots were tested: red blood cell-rich clots and fibrin-rich clots. First-pass recanalization and induced arterial collapse and traction were assessed. RESULTS The first-pass recanalization was less frequent for direct aspiration than for the combined technique, without reaching statistical significance (41.7% versus 75.0%, P = .098). Full collapse (P < .001) and extended arterial traction (P = .001) were significantly less frequent for direct aspiration. For direct aspiration with the aspiration catheter not in direct contact with the clot, there was not a single first-pass recanalization and there was systematic arterial collapse, resulting in a no-flow in the aspiration syringe. CONCLUSIONS The combined technique appears to be more harmful, and although direct aspiration has a lower rate of first-pass recanalization, it seems appropriate to try direct aspiration as a first-line procedure. However, if the aspiration catheter cannot reach the clot, it is not useful or even risky to try aspiration alone. These results need to be confirmed by clinical studies.
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Affiliation(s)
- J Burel
- From the Departments of Radiology (J.B., E.G., C.P., P.-L.H., J.-N.D.)
- Groupe de Recherche Clinique BioFast (J.B., F.C.), Sorbonne University, Paris, France
| | - E Gerardin
- From the Departments of Radiology (J.B., E.G., C.P., P.-L.H., J.-N.D.)
| | - C Papagiannaki
- From the Departments of Radiology (J.B., E.G., C.P., P.-L.H., J.-N.D.)
| | - E Shotar
- Department of Neuroradiology (E.S., N.S., K.P., F.C.), Assistance Publique-Hôpitaux de Paris, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - N Sourour
- Department of Neuroradiology (E.S., N.S., K.P., F.C.), Assistance Publique-Hôpitaux de Paris, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - C Laporte
- Obstetrics and Gynecology (C.L.), Rouen University Hospital, Rouen, France
| | - P-L Hermet
- From the Departments of Radiology (J.B., E.G., C.P., P.-L.H., J.-N.D.)
| | - K Premat
- Department of Neuroradiology (E.S., N.S., K.P., F.C.), Assistance Publique-Hôpitaux de Paris, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - J-N Dacher
- From the Departments of Radiology (J.B., E.G., C.P., P.-L.H., J.-N.D.)
| | - F Clarençon
- Groupe de Recherche Clinique BioFast (J.B., F.C.), Sorbonne University, Paris, France
- Department of Neuroradiology (E.S., N.S., K.P., F.C.), Assistance Publique-Hôpitaux de Paris, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
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