Feasibility of a novel multi-device robotic system for multiple neurointerventional procedures: pre-clinical...

While the application of a robotic system in neurointerventional procedures has gained notable attention, the current robotic assistance is unsatisfactory. Therefore, we developed a novel robotic system, which was capable of simultaneous coaxial control of three catheters and one guidewire, coupled with rapid-exchange functionality. To evaluate the feasibility of the multi-device robotic system for diagnostic angiography, carotid artery stenting (CAS), vertebral artery (VA) stenting, flow diverter (FD) deployment and aneurysm coiling through preclinical study. The robotic system was tested for feasibility to complete all procedural steps of 5 neurovascular interventions navigating or deploying a variety of common neurovascular devices including the guidewires, catheters, micro-guidewires, microcatheters, coils, the FD, the cerebral protection device and different types of stents. The experimental lateral wall aneurysms were created in 3 live and anesthetized pigs by end-to-side anastomosis using an autologous venous pouch. A total of five surgically created aneurysms were allocated to coiling (n = 2), FD implantation (n = 2) and coiling + FD (n = 1). One VA and one CA were utilized for stenting. All planned procedures were performed successfully with no relevant technical complications or vascular damage. Notably, almost all procedural steps, from different navigation of catheters to device deployment, were completed robotically, with manual intervention limited to radiation-free device exchanges and loading. Robot-assisted operation does not increase the complexity of procedures. This pilot study demonstrates that the multi-device robotic system is feasible for cerebral angiography, navigation of the guiding catheter, aneurysm coiling, FD deployment, VA stenting and CAS.