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

Area of Science:

• Neuroendovascular Surgery
• Robotics in Medicine
• Telerobotics

Background:

• Timely access to neurointerventional capabilities is a significant barrier in stroke care.
• Endovascular robotic systems offer potential solutions for expanded access and improved procedural precision.
• Telerobotic procedures can enhance clinical team safety.

Purpose of the Study:

• To evaluate the feasibility of intercontinental telerobotic navigation for endovascular stroke treatment.
• To assess the operator learning curve for a telerobotic endovascular system.
• To determine the efficacy of robotic-assisted aspiration thrombectomy in simulated large vessel occlusions.

Main Methods:

• A telerobotic system (magnetic field generator, mechanical advancer) was set up in Switzerland.
• A neurosurgeon in Arizona operated the system wirelessly to navigate a guidewire and aspiration catheter.
• Simulated middle cerebral artery (MCA) and basilar artery clots were targeted in a vascular phantom over 20 trials.

Main Results:

• Successful navigation and simulated clot aspiration were achieved from over 5700 miles away.
• Average navigational times to MCA (M1 segment) and basilar artery were 114 and 134 seconds, respectively.
• Operator mastery was demonstrated with a 77% reduction in navigational time over 20 procedural iterations.

Conclusions:

• This study presents the first intercontinental aspiration thrombectomy in a preclinical setting, comparable to clinical times.
• Telerobotic navigation shows early potential for endovascular stroke treatment, overcoming geographical barriers.
• The system's intuitive operation and lack of haptic feedback hindrance suggest future research and adoption potential.