Remote Robotic Neurointervention: Overcoming Procedural and Connectivity Challenges.

Abstract

Background and purpose: Access to endovascular interventions for neurointerventional procedures remains concentrated in metropolitan centers, limiting availability in smaller cities, rural regions, and developing nations. The feasibility of remote robotic intervention faces several challenges, including enabling full robotic navigation, managing contrast injection, and maintaining stable network connectivity. This study addresses these key obstacles.

Methods: A robotic system was deployed at the Translational Research Imaging Center (TRIC) lab at UCLA. Connectivity was assessed both before and during the procedures. Five remote Neurointerventionalists operated four devices-two novel steerable catheters, one off-the-shelf microcatheter, and one guidewire-from femoral access to the middle cerebral artery (MCA) in a silicone vascular model. Radiopaque contrast injections were performed, and audiovisual communication was maintained throughout. Connectivity metrics, including round-trip time (RTT) and bandwidth, were monitored. Primary endpoints included successful navigation to the MCA within 15 minutes, first-attempt vessel entry rate, and episodes of tool-tip contact with the vessel wall.

Results: Following catheter placement in the femoral sheath, all procedures were fully robotically controlled without bedside intervention. Procedural times ranged from 11:01 to 14:00 minutes, with a mean RTT below 150ms. Two brief episodes of unsafe latency (RTT >150 ms) were recorded. First-attempt vessel entry was successful in 84.2% of cases, and minimal vessel wall contact occurred (1-2 episodes per procedure).

Conclusions: This study demonstrates the feasibility of remote robotic neurointervention, effectively addressing key challenges in robot-assisted endovascular procedures and network connectivity management.

Abbreviations: PTZ = Pan Tilt Zoom Camera; RTT = round-trip time; TRIC = Translational Research Imaging Center lab at UCLA; RR = Remedy Robotics; LCCA = Left Common Carotid Artery; RCFA = right common femoral artery; ACA = Anterior Cerebral Artery; ICA = Internal Carotid Artery.