Real-Time Remote Telerobotic Magnetic Navigation for Endovascular Middle Cerebral Artery and Basilar Artery Stroke Thrombectomy in a Simulated Mechanical Model Across 5,700 Miles

Introduction: While many trials of the last decade have shifted the paradigm of stroke care towards endovascular therapy, limited access to neurointerventional capable centers for many patients has remained a barrier to care. Endovascular robotic systems are posed to expand access through remote procedures while also raising the possibility of improved procedural precision.

Methods: A telerobotic set-up consisting of an electromagnetic navigation system and mechanical advancer was placed with a silicone vascular phantom in an interventional suite in Zurich, Switzerland, and connected by broadband to an operator console in Phoenix, Arizona. From the operator console, the neurosurgery team navigated a 0.038” magnetic guidewire and industry standard aspiration catheter to a simulated clot in 20 sequential procedural trials for which time of navigation from the aortic arch to neurovascular target was recorded to evaluate operator learning curve.

Results: From over 5,700miles away, the neurosurgery team successfully navigated to a simulated large vessel occlusion and completed clot aspiration in all passes in which it was attempted. Navigational time over 10 procedural trials from aortic arch to the M1 and 10 trials from aortic arch to distal basilar artery were completed in a mean of 2.06 minutes. Sufficient operator mastery was demonstrated in 20 procedural iterations with an average 77% reduction in navigational time from aortic arch initial to final trials.

Conclusion : This study demonstrated the feasibility of telerobotic neuro-endovascular navigation and clot aspiration in comparable time to the clinical setting. A lack of haptic feedback was not a hindrance, and the potential for intuitive operation offers to drive the adoption of this mobile system. To our knowledge, we present the first intercontinental aspiration thrombectomy in the pre-clinical setting and demonstrate the early potential of robotics to expand access to stroke care and reduce occupational risks on interventional team members.