Remote Robotic Neurointervention: Overcoming Procedural and Connectivity Challenges.

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.

Materials and methods: A robotic system was deployed at the Translational Research Imaging Center Lab at University of California, Los Angeles. Connectivity was assessed both before and during the procedures. Five remote neurointerventionalists operated 4 devices: 2 novel steerable catheters, 1 off-the-shelf microcatheter, and 1 guidewire from femoral access to the 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 end points included successful navigation to the MCA within 15 minutes, first-attempt vessel entry rate, and episodes of tooltip 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 minutes 1 second to 14 minutes, with a mean RTT of <150 ms; 2 brief episodes of unsafe latency (RTT of >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.