Feasibility of Robotic-Assisted Neurovascular Interventions: Initial Experience in Flow Model and Porcine Model
Feasibility of Robotic-Assisted Neurovascular Interventions: Initial Experience in Flow Model and Porcine Model
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DOI：
10.1093/neuros/nyz064
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发表时间：
2020-02-01
期刊：
影响因子：
4.8
通讯作者：
Lumsden, Alan
中科院分区：
文献类型：
--
作者：
Britz, Gavin W.;Tomas, Johnny;Lumsden, Alan
背景 尽管用于心脏和外周血管介入的机器人辅助技术取得了进步，但用于神经血管介入的机器人辅助平台尚不可用。 目的 通过临床前研究评估 CorPath(R) GRX 机器人辅助平台（马萨诸塞州沃尔瑟姆的 Corindus Inc）用于神经血管介入的可行性。 方法 测试机器人系统在体外流动模型和活体麻醉中准确导航各种常见神经血管装置的能力。猪，在适合临床干预的条件和程序下进行。在两种模型中，在相当于颈总动脉的位置手动引入通路导管。在机器人辅助下，使用 0.014 导丝、2.4F/1.7F 微导管、裸金属支架和栓塞弹簧圈，将血管内导丝和导管引导穿过颈外动脉、颈内动脉和大脑后血管系统。 结果 血流模型和猪模型中的所有手术，包括导航、布线以及支架和弹簧圈的展开，均成功完成，没有出现技术并发症。当比较活体动物手术前后的血管造影时，没有发现外渗、夹层、血栓形成或其他血管损伤的证据。结论这是第一项证明使用机器人辅助平台进行颅内神经血管干预是可行的研究。该机器人系统成功地导航和部署特定于神经血管手术的小规格设备。鉴于机器人辅助手术对患者和外科医生的潜在好处，有必要对此适应症进行进一步研究。
BACKGROUND Despite advances in robotic-assisted technology for cardiac and peripheral vascular interventions, a robotic-assisted platform for neurovascular intervention is not yet available.OBJECTIVE To evaluate the feasibility of the CorPath((R)) GRX robotic-assisted platform (Corindus Inc, Waltham, Massachusetts) for neurovascular interventions through preclinical study.METHODS The robotic system was tested for its ability to accurately navigate a variety of common neurovascular devices in an in Vitro flow model and in a live, anesthetized pig, under conditions and following procedures appropriate for clinical intervention. An access catheter was introduced manually at the equivalent of the common carotid artery in both models. Endovascular wires and catheters were navigated through the external and internal carotid artery and posterior cerebral vasculature under robotic assistance, using 0.014 in guidewires, 2.4F/1.7F microcatheters, bare-metal stents, and embolic coils.RESULTS All procedures in both the flow and porcine models, including navigation, wiring, and deployment of the stent and coils, were performed successfully with no technical complications. There was no evidence of extravasation, dissection, thrombosis, or other vascular injury when angiography was compared before and after the live-animal procedure.CONCLUSION This is the first study to demonstrate that use of a robotic-assisted platform is feasible for intracranial neurovascular intervention. The robotic system was successful at navigating and deploying the small-gauge devices specific to neurovascular procedures. Given the potential benefits of robotic-assisted surgery for the patient and the surgeon, further investigation is warranted for this indication.