OBJECTIVE The purpose of this proof-of-concept study was to demonstrate the setup
and feasibility of transcarotid access for remote robotic neurointerventions in a
cadaveric model. METHODS The interventional procedures were performed in a fresh-frozen
cadaveric model using an endovascular robotic system and a robotic angiography imaging
system. A prototype remote, robotic-drive system with an ethernet-based network connectivity
and audio-video communication system was used to drive the robotic system remotely.
After surgical exposure of the common carotid artery in a cadaveric model, an 8-Fr
arterial was inserted and anchored. A telescopic guiding sheath and catheter/microcatheter
combination was modified to account for the "workable" length with the CorPath GRX
robotic system using transcarotid access. RESULTS To simulate a carotid stenting procedure,
a 0.014-inch wire was advanced robotically to the extracranial internal carotid artery.
After confirming the wire position and anatomy by angiography, a self-expandable rapid
exchange nitinol stent was loaded into the robotic cassette, advanced, and then deployed
robotically across the carotid bifurcation. To simulate an endovascular stroke recanalization
procedure, a 0.014-inch wire was advanced into the proximal middle cerebral artery
with robotic assistance. A modified 2.95-Fr delivery microcatheter (Velocity, Penumbra
Inc.) was loaded into the robotic cassette and positioned. After robotic retraction
of the wire, it was switched manually to a mechanical thrombectomy device (Solitaire
X, Medtronic). The stentriever was then advanced robotically into the end of the microcatheter.
After robotic unfolding and short microcatheter retraction, the microcatheter was
manually removed and the stent retriever was extracted using robotic assistance. During
intravascular navigation, the device position was guided by 2D angiography and confirmed
by 3D cone-beam CT angiography. CONCLUSIONS In this proof-of-concept cadaver study,
the authors demonstrated the setup and technical feasibility of transcarotid access
for remote robot-assisted neurointerventions such as carotid artery stenting and mechanical
thrombectomy. Using transcarotid access, catheter length modifications were necessary
to achieve "working length" compatibility with the current-generation CorPath GRX
robotic system. While further improvements in dedicated robotic solutions for neurointerventions
and next-generation thrombectomy devices are necessary, the transcarotid approach
provides a direct, relatively rapid access route to the brain for delivering remote
stroke treatment.
