1Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston.
2Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary; and.
Neurosurg Focus. 2022 Jan;52(1):E18. doi: 10.3171/2021.10.FOCUS21511.
The purpose of this proof-of-concept study was to demonstrate the setup and feasibility of transcarotid access for remote robotic neurointerventions in a cadaveric model.
The interventional procedures were performed in a fresh-frozen cadaveric model using an endovascular robotic system and a robotic angiography imaging system. A prototype remote, robotic-drive system with an ethernet-based network connectivity and audio-video communication system was used to drive the robotic system remotely. After surgical exposure of the common carotid artery in a cadaveric model, an 8-Fr arterial was inserted and anchored. A telescopic guiding sheath and catheter/microcatheter combination was modified to account for the "workable" length with the CorPath GRX robotic system using transcarotid access.
To simulate a carotid stenting procedure, a 0.014-inch wire was advanced robotically to the extracranial internal carotid artery. After confirming the wire position and anatomy by angiography, a self-expandable rapid exchange nitinol stent was loaded into the robotic cassette, advanced, and then deployed robotically across the carotid bifurcation. To simulate an endovascular stroke recanalization procedure, a 0.014-inch wire was advanced into the proximal middle cerebral artery with robotic assistance. A modified 2.95-Fr delivery microcatheter (Velocity, Penumbra Inc.) was loaded into the robotic cassette and positioned. After robotic retraction of the wire, it was switched manually to a mechanical thrombectomy device (Solitaire X, Medtronic). The stentriever was then advanced robotically into the end of the microcatheter. After robotic unfolding and short microcatheter retraction, the microcatheter was manually removed and the stent retriever was extracted using robotic assistance. During intravascular navigation, the device position was guided by 2D angiography and confirmed by 3D cone-beam CT angiography.
In this proof-of-concept cadaver study, the authors demonstrated the setup and technical feasibility of transcarotid access for remote robot-assisted neurointerventions such as carotid artery stenting and mechanical thrombectomy. Using transcarotid access, catheter length modifications were necessary to achieve "working length" compatibility with the current-generation CorPath GRX robotic system. While further improvements in dedicated robotic solutions for neurointerventions and next-generation thrombectomy devices are necessary, the transcarotid approach provides a direct, relatively rapid access route to the brain for delivering remote stroke treatment.
本概念验证研究的目的是在尸体模型中展示经颈动脉入路进行远程机器人神经介入的设置和可行性。
在尸体模型中使用血管内机器人系统和机器人血管造影成像系统进行介入操作。使用带有基于以太网的网络连接和音视频通信系统的远程机器人驱动系统原型来远程驱动机器人系统。在尸体模型的颈总动脉暴露后，插入并固定 8Fr 动脉。使用经颈动脉入路，对伸缩式引导鞘和导管/微导管组合进行修改，以适应 CorPath GRX 机器人系统的“可用”长度。
为了模拟颈动脉支架置入术，机器人将 0.014 英寸导丝推进至颅外颈内动脉。通过血管造影确认导丝位置和解剖结构后，将自膨式快速交换镍钛诺支架装载到机器人卡匣中，推进并机器人跨越颈动脉分叉处释放。为了模拟血管内卒中再通术，机器人辅助将 0.014 英寸导丝推进到近端大脑中动脉。将改良的 2.95Fr 输送微导管（Penumbra Inc. 的 Velocity）装载到机器人卡匣中并定位。在机器人撤回导丝后，手动将其切换到机械血栓切除术装置（Solitaire X，Medtronic）。然后，将支架取栓器机器人推进微导管的末端。在机器人展开和短微导管回缩后，手动移除微导管并使用机器人辅助取出支架取栓器。在血管内导航过程中，通过二维血管造影引导器械位置，并通过三维锥形束 CT 血管造影确认。
在这项尸体概念验证研究中，作者展示了经颈动脉入路进行远程机器人辅助神经介入（如颈动脉支架置入术和机械血栓切除术）的设置和技术可行性。使用经颈动脉入路，需要对导管长度进行修改，以适应当前一代 CorPath GRX 机器人系统的“工作长度”兼容性。虽然神经介入专用机器人解决方案和下一代取栓装置的进一步改进是必要的，但经颈动脉入路为大脑提供了一种直接、相对快速的通道，用于提供远程卒中治疗。
