Evaluation of robotic endovascular catheters for arch vessel cannulation
Evaluation of robotic endovascular catheters for arch vessel cannulation
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DOI：
10.1016/j.jvs.2011.03.218
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发表时间：
2011-09-01
影响因子：
4.3
通讯作者：
Cheshire, Nicholas J. W.
中科院分区：
文献类型：
--
作者：
Riga, Celia V.;Bicknell, Colin D.;Cheshire, Nicholas J. W.
目的：传统的导管不稳定和栓塞风险限制了弓解剖困难患者血管内治疗的采用。本研究探讨了遥控机器人导管系统是否可以增强弓血管插管。方法：17名具有不同血管内经验的临床医生在透视引导下，使用传统和机器人技术，在两个计算机断层扫描重建的脉冲血流模型（牛I型和III型主动脉弓）内对所有弓血管插管。比较定量指标（置管次数、导管尖端移动、血管壁撞击、导管挠度）和定性指标（帝国理工学院复杂血管内插管评分工具[IC3ST]）的表现评分。结果：机器人置管技术显著减少了颈动脉正中动脉插管次数和导管尖端移动的中位数。使用机器人导管，血管壁与主动脉弓壁的接触减少到零的中位数。在硬导丝交换过程中，机器人导管保持零偏转的稳定性，与导管插入颈动脉血管的距离无关。使用机器人系统后，总体IC3ST评分（四分位数范围）显著提高：I型弓评分为26/35 (20-30.8)vs 33/35 (31-34)， III型弓评分为20.5/35 (16.5-28.5)vs 26.5/35 (23.5-28.8), P =.001。小、中容积介入医师在机器人模拟技术的应用下表现出了明显的改善。大容量干预组没有统计学上的显著改善，但插管时间、运动和血管壁撞击明显减少。结论：机器人技术有可能减少时间，栓塞和导管脱位的风险，辐射暴露，以及颈动脉和弓血管插管所需的手工技能，同时提高整体表现得分。（中华花瓶外科杂志2011；54:79 -809。）临床相关性：脑栓塞事件和卒中风险是主动脉弓晚期血管内介入治疗中最具挑战性的问题。一种新型的遥控机器人导管系统有可能减少时间、栓塞风险、辐射暴露以及颈动脉和弓血管插管所需的手工技能，同时提高操作员的整体表现分数。
Objective: Conventional catheter instability and embolization risk limits the adoption of endovascular therapy in patients with challenging arch anatomy. This study investigated whether arch vessel cannulation can be enhanced by a remotely steerable robotic catheter system.Methods: Seventeen clinicians with varying endovascular experience cannulated all arch vessels within two computed tomography-reconstructed pulsatile flow phantoms (bovine type I and type III aortic arches), under fluoroscopic guidance, using conventional and robotic techniques. Quantitative (catheterization times, catheter tip movements, vessel wall hits, catheter deflection) and qualitative metrics (Imperial College Complex Endovascular Cannulation Scoring Tool [IC3ST]) performance scores were compared.Results: Robotic catheterization techniques resulted in a significant reduction in median carotid artery cannulation times and the median number of catheter tip movements for all vessels. Vessel wall contact with the aortic arch wall was reduced to a median of zero with robotic catheters. During stiff guidewire exchanges, robotic catheters maintained stability with zero deflection, independent of the distance the catheter was introduced into the carotid vessels. Overall IC3ST performance scores (interquartile range) were significantly improved using the robotic system: Type I arch score was 26/35 (20-30.8) vs 33/35 (31-34; P =.001), and type III arch score was 20.5/35 (16.5-28.5) vs 26.5/35 (23.5-28.8; P =.001). Low- and medium-volume interventionalists demonstrated an improvement in performance with robotic catmulation techniques. The high-volume intervention group did not show statistically significant improvement, but cannulation times, movements, and vessel wall hits were significantly reduced.Conclusion: Robotic technology has the potential to reduce the time, risk of embolization and catheter dislodgement, radiation exposure, and the manual skill required for carotid and arch vessel cannulation, while improving overall performance scores. (J Vase Surg 2011;54:799-809.)Clinical Relevance: Cerebral embolic events and the risk of stroke constitute the most challenging problem in advanced endovascular interventions in the aortic arch. A novel, remotely steerable robotic catheter system has the potential to reduce the time, embolization risk, radiation exposure, and the manual skill required for carotid and arch vessel cannulation, while improving overall operator performance scores.