Reducing contact forces in the arch and supra-aortic vessels using the Magellan robot

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Abstract

Objective:

Conventional catheter manipulation in the arch and supra-aortic trunks carries a risk of cerebral embolization. This study proposes a platform for detailed quantitative analysis of contact forces (CF) exerted on the vasculature, in order to investigate the potential advantages of robotic navigation.

Methods:

An anthropomorphic phantom representing a type I bovine arch was mounted and coupled onto a force/torque sensor. Three-axis force readings provided an average root-mean-square modulus, indicating the total forces exerted on the phantom. Each of the left subclavian, left common carotid, and right common carotid arteries was cannulated within a simulated endovascular suite with conventional (n = 42) vs robotic techniques (n = 30) by two operator groups: experts and novices. The procedure path was divided into three phases, and performance metrics corresponding to mean and maximum forces, force impact over time, standard deviation of forces, and number of significant catheter contacts with the arterial wall were extracted.

Results:

Overall, median CF were reduced from 1.20 N (interquartile range [IQR], 0.98–1.56 N) to 0.31 N (IQR, 0.26–0.40 N; P < .001) for the right common carotid artery; 1.59 N (IQR, 1.11–1.85 N) to 0.33 N (IQR, 0.29–0.43 N; P < .001) for the left common carotid artery; and 0.84 N (IQR, 0.47–1.08 N) to 0.10 N (IQR, 0.07–0.17 N; P < .001) for the left subclavian artery. Robotic navigation resulted in significant reductions for the mean and maximum forces for each procedural phase. Significant improvements were also seen in other metrics, particularly at the target vessel ostium and for the more anatomically challenging procedural phases. Force reductions using robotic technology were evident for both novice and expert groups.

Conclusions:

Robotic navigation can potentially reduce CF and catheter-tissue contact points in an in vitro model, by enhancing catheter stability and control during endovascular manipulation.

Clinical Relevance:

Cerebral embolization and the risk of stroke remain as major concerns in advanced endovascular interventions in the aortic arch. Steerable robotic catheter navigation has the potential to reduce the embolic burden by reducing contact forces and catheter-tissue contact during different phases of arch navigation and carotid cannulation, with implications on improved training and reduced learning curves for complex endovascular procedures in the clinical setting.

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