Design, analysis, and demonstration of the COAST guidewire robot with middle tube rotation for endovascular interventions.

Minimally invasive procedures for endovascular interventions involve manual navigation of a guidewire. Endovascular interventions encompassing highly tortuous vessels would benefit from guidewires which exhibit higher dexterity. This paper introduces a version of the COAST (COaxially Aligned STeerable) guidewire system capable of exhibiting higher dexterity. The system presented in this paper consists of three coaxially aligned tubes with a tendon to actuate the middle tube. Furthermore, it is possible to independently rotate the middle tube with respect to the outer tube. This variation enables the guidewire to achieve curvature in different planes while avoiding rotation of the entire structure. We also present the simulated stability of the guidewire with different outer tube geometries and experimentally validate the model. Experimental analysis and modeling of the kinematic behavior of the system is presented. A model to calculate the curvature vs. tendon stroke relationship for the optimal notch geometry is presented with an average RMSE of 0.16 mm. A control strategy addressing the snapping instabilities to ensure reliable operation is discussed. A custom phantom vessel and an aortic arch phantom model were used to demonstrate the ability of the system to safely navigate through tortuous pathways without exhibiting these elastic instabilities.