Advantages and limitations of robotic endovacular catheters for carotid artery stenting

Carotid artery stenting (CAS) is an important development in the treatment of carotid artery stenosis and prevention of stroke. However, despite advances in technology, including embolic protection devices (EDPs), there are concerns that the embolic stroke risk is still too high in many reports, including a number of randomized controlled trials. Robotic technology has the potential to reduce the embolic risk by facilitating accurate and safe navigation to place sheaths in the common carotid artery, reducing the embolic load during this phase of the procedure prior to EDP placement. This paper identifies the embolic risk associated with different phases of the CAS procedure and predisposing factors that are primarily implicated in increased embolic load from a literature review. The potential for robotic technology to reduce risk in CAS is discussed using preclinical and experimental studies.