Is robotic dead for NV? - Ep.1/2

In recent years, the application of robotics in diagnostic and therapeutic neurointerventions has created signifcant excitement. Robotic technologies hold important promises, with the most significant being the potential for enabling remote interventions. No matter how improved physician skills or endovascular tools become, the time-dependent nature of stroke will always be a barrier to achieving good clinical outcomes due to transportation delays.1 Additionally, robotics may enable reproducible, safe, and precise treatments by overcoming intrinsic physical limitations and enhancing human performance in an ergonomic environment protected from radiation, without the need of lead aprons.2 

The publication of a multicentric non-inferiority trial, which reported 94% technical success with only four major complications in 117 endovascular treatments of intracranial aneurysms with CorPath GRX (Corindus) robotic assistance, had fueled this excitement.3 However, after important feasibility studies, the retrieval of CorPath GRX from neurointervention created disappointment and raised questions: Is robotics dead for neurointervention? 

Nevertheless, the confirmation of intent to return to the neurovascular market with a different concept by the Corindus (Siemens) team and new robotic startups showcases that robotics in neurointervention is going to flourish rather than die. Nanoflex Robotics is a startup dedicated to telerobotic interventions. In addition to robotic systems and remote interventions, they offer magnetism-enabled technology, which can guide the tip of guidewires or catheters in the desired direction using magnetic-enabled direction control. 

XCath robotic system offers electrosteerable wires, which obviate the manual need for microguidewire shaping. Recently, there has been a proof-of-concept demo of remote thrombectomy performed between Abu Dhabi and Seoul on a silicon model.4 The Sentante robotic system offers a slightly different concept. It is a fully managed robotic system; from the diagnostic catheter to 0.035, the robot can exchange the diagnostic catheter to a guiding catheter, then allow continuing the procedure with a 0.014 system. Basically, the robotic system copies the motion of the operator. There are no robotically steerable guidewires, so it's a pure reproduction of operator movements. 

Apart from robotic systems, another component worth discussing is the importance of digital assistance. Currently, there are multiple software simulations that help in optimal device selection during endovascular treatment. Under the lead of Dr. Christian Ferreira, our team performed a systematic review and meta-analysis of the literature to assess the impact of digital assistance on device selection. Our major findings were: 

Rather than just device selection and treatment planning, digital assistance can continuously be used during the procedure to monitor the real-time live tracking of devices and wires in use. Dr. Kenichi Kono presented his experience and innovation with real-time AI assistance. He shared his experience with Neuro-Vascular Assist (iMed Technologies, Tokyo, Japan) in carotid stenting.6 

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