Robotic-assisted intracranial aneurysm treatment: 1 year follow-up imaging and clinical outcomes

Abstract

BackgroundThe use of robotics in medicine may enable increased technical accuracy, reduced procedural time and radiation exposure, and remote completion of procedures. We have previously described the first-in-human, robotic-assisted cerebral aneurysm treatment using the CorPath GRX Robotic System. In this report we discuss our early experiences and outcomes using this robotic device for endovascular treatment of intracranial aneurysms using stent-assisted coil embolization and flow diversion.MethodsThe patient and disease characteristics, procedural details, and follow-up imaging and clinical outcomes of consecutive patients undergoing robotically-assisted intracranial aneurysm embolization between November 2019 and February 2020 are presented.ResultsSix patients underwent robotically-assisted embolization of intracranial aneurysms. Four of the patients were treated with a neck-bridging stent (with or without coiling) and two patients were treated with a flow-diverting stent. Two patients were treated in the subacute period of subarachnoid hemorrhage and four patients were treated electively. All of the procedures could be completed robotically and there was no need for unplanned manual intervention. The technical success rate of the procedures was 100%. There was no morbidity or mortality associated with the procedures. One year follow-up imaging showed that four aneurysms were completely obliterated (Raymond-Roy Occlusion Classification (RROC) class I) and the remaining two were occluded with a residual neck (RROC class II).ConclusionsThe Corpath GRX Robotic System demonstrated a precise control over the microcatheter, wire and stent during aneurysm treatment. Robotic neuro-procedures seem to be safe and effective and demonstrate stable occlusion results in the midterm follow-up.

Bridging the gap: robotic applications in cerebral aneurysms neurointerventions - a systematic review

“…Through a manual reference search, we identified 1 work that met our inclusion criteria. Finally, we have included 7 works in this systematic review [ 8 – 14 ]. The full search strategy is depicted in Fig.…”

“…We have identified six original works focusing on the application of robotic devices for surgical interventions in aneurysm cases. Additionally, one work was identified as a follow-up to another study included in this review; we have included this work as part of the original investigation (Table 1 ) [ 8 ]. Four of these works originated from a US-Canadian collaboration, one was from the USA, one from France, and one from international collaboration.…”

“…CorPath GRX System (Corindus, Siemens Healthineers, USA) is a next-generation device, replacing the former version CorPath 200. The system is designed for vascular interventions (percutaneous coronary, peripheral and neuroendovascular) [ 8 , 9 , 12 ]. CorPath consists of a bedside unit and a remote steering unit for the physician (Fig.…”

Robotic Interventional Neuroradiology: Progress, Challenges, and Future Prospects

“…7 One-year follow-up of this study showed four aneurysms that were completely obliterated and the remaining two occluded with a residual neck. 8 A subsequent study was performed on a cohort of 10 patients requiring carotid artery angioplasty and stenting, with 3 patients converted to manual catheterization mid-procedure due to encounter with unexpected bovine arch findings. 9 Also in 2020, Nogueira et al reported a single-center technical report of the first four consecutive cases of carotid artery stenting for the treatment of severe symptomatic carotid stenosis with ipsilateral strokes on presentation utilizing the CorPath GRX Robotic System (Corindus Inc., Waltham, MA).…”

Artificial intelligence in the autonomous navigation of endovascular interventions: a systematic review

“…This system has performed diagnostic cerebral angiography procedures and ten carotid artery stenting procedures (Nogueira et al, 2020;Sajja et al, 2020;Weinberg et al, 2021). Furthermore, it has been recently used to perform robotassisted, neuroendovascular interventions including aneurysm embolization and epistaxis embolization (Pereira et al, 2020;Cancelliere et al, 2022;Saber et al, 2022). These systems use a controller-operator structure, where operators remotely control and navigate a robot through a patient's vasculature to the target site.…”