Technical and Clinical Progress on Robot-Assisted Endovascular Interventions: A Review

Design and hierarchical analysis of magnetic actuated robot: A governing equation based approach

As the alternative solution to the conventional guidewire, the magnetic robot can help interventionists perform percutaneous coronary intervention (PCI) because magnetic fields are transparent and safe for biological tissues. Despite extensive research on magnetic robots, the exploration of their deflection control for practical applications still requires further research. In this paper, a hierarchical analysis framework (HAF) is proposed to control the magnetic robot's deflection. Six deflection subpatterns are analyzed through HAF, incorporating statistical and regression analyses to establish governing equations of magnetic robots. The performance of the control equations is validated through precise control of the magnetic continuum robot (MCR) and magnet-tipped robot (MTR) in both uniform and gradient magnetic fields. Experimental results show that under the uniform magnetic field, the average root mean square error (RMSE) of governing equation of MCR is 0.08±0.05°, 0.41±0.34°, 1.47±0.49° and 1.07±0.66° for four-types horizontal deflection, 0.19±0.07mm and 0.16±0.10mm for two-types vertical deflection, respectively. Based on the governing equations, the MTR is able to precisely navigate to coronary arteries with various degrees of stenosis (30%, 52%, and 60%), and successfully pass through a series of rings, with an average error of 1.05 mm. The research successfully demonstrates the potential of HAF in creating robust and reliable governing equations for magnetic actuation in medical robotics, with significant implications for enhancing the precision and safety of PCI procedures.

Safety and feasibility study of a novel robotic system in an in vivo porcine vascular model

PURPOSE

The goal of this preclinical study is to assess the functionality, technical feasibility, and safety of a new vascular robotic LIBERTYR 3 System, in the microcatheterization of vascular targets using a range of guidewires and microcatheters.

MATERIAL AND METHODS

An anesthetized pig served as an arterial model for the robotic device (LIBERTYR3; Microbot Medical Ltd, Yoqneam, IL). The primary efficacy endpoint was the evaluation of its capability to selectively catheterize predetermined distal arterial branches in the liver, kidneys, and mesenteric arteries (technical success), under fluoroscopy guidance. The primary safety endpoint was the occurrence of angiographic acute catheterization-related complications (dissection, thrombosis, embolism, perforation). The catheterizations were conducted by two interventional radiologists that present different work experience in endovascular procedures (18 and 2 years respectively), using a variety of microcatheters and wires. Various procedural parameters such as functionality, practicality, ease of use, and time required for selective catheterization, were evaluated, and recorded.

RESULTS

All pre-determined arteries were successfully selectively catheterized (100% technical success), by both operators. No angiographic acute complications occurred. The microcatheters and wires were manipulated using the remote portable console in an effortless manner that maintained a high level of accuracy. Mean time for selective catheterization was 131 ± 82 s. The robot's conversion function to manual operation was successfully demonstrated.

CONCLUSION

Robotic navigation and catheterization of selected target arteries were accomplished without observable vascular damage, suggesting that the LIBERTYR 3 robotic system is a reliable and safe tool for robotic-assisted endovascular navigation. Further experimental studies are required to evaluate safety and efficacy prior to introduction into clinical practice.

Neuroendovascular Surgery Applications in Craniocervical Trauma

Cerebrovascular injuries resulting from blunt or penetrating trauma to the head and neck often lead to local hemorrhage and stroke. These injuries present with a wide range of manifestations, including carotid or vertebral artery dissection, pseudoaneurysm, occlusion, transection, arteriovenous fistula, carotid-cavernous fistula, epistaxis, venous sinus thrombosis, and subdural hematoma. A selective review of the literature from 1989 to 2023 was conducted to explore various neuroendovascular surgical techniques for craniocervical trauma. A PubMed search was performed using these terms: endovascular, trauma, dissection, blunt cerebrovascular injury, pseudoaneurysm, occlusion, transection, vasospasm, carotid-cavernous fistula, arteriovenous fistula, epistaxis, cerebral venous sinus thrombosis, subdural hematoma, and middle meningeal artery embolization. An increasing array of neuroendovascular procedures are currently available to treat these traumatic injuries. Coils, liquid embolics (onyx or n-butyl cyanoacrylate), and polyvinyl alcohol particles can be used to embolize lesions, while stents, mechanical thrombectomy employing stent-retrievers or aspiration catheters, and balloon occlusion tests and super selective angiography offer additional treatment options based on the specific case. Neuroendovascular techniques prove valuable when surgical options are limited, although comparative data with surgical techniques in trauma cases is limited. Further research is needed to assess the efficacy and outcomes associated with these interventions.