Purpose: Robotic-assisted carotid artery stenting (CAS) cases have been demonstrated
with promising results. However, no quantitative measurements have been made to compare
manual with robotic-assisted CAS. This study aims to quantify surgical performance
using tool tip kinematic data and metrics of precision during CAS with manual and
robotic control in an ex vivo model. Materials and Methods: Transfemoral CAS cases
were performed in a high-fidelity endovascular simulator. Participants completed cases
with manual and robotic techniques in 2 different carotid anatomies in random order.
C-arm angulations, table position, and endovascular devices were standardized. Endovascular
tool tip kinematic data were extracted. We calculated the spectral arc length (SPARC),
average velocity, and idle time during navigation in the common carotid artery and
lesion crossing. Procedural time, fluoroscopy time, movements of the deployed filter
wire, precision of stent, and balloon positioning were recorded. Data were analyzed
and compared between the 2 modalities. Results: Ten participants performed 40 CAS
cases with a procedural success of 100% and 0% residual stenosis. The median procedural
time was significantly higher during the robotic-assisted cases (seconds, median [interquartile
range, IQR]: 128 [49.5] and 161.5 [62.5], p=0.02). Fluoroscopy time differed significantly
between manual and robotic-assisted procedures (seconds, median [IQR]: 81.5 [32] and
98.5 [39.5], p=0.1). Movement of the deployed filter wire did not show significant
difference between manual and robotic interventions (mm, median [IQR]: 13 [10.5] and
12.5 [11], p=0.5). The postdilation balloon exceeded the margin of the stent with
a median of 2 [1] mm in both groups. Navigation with robotic assistance showed significantly
lower SPARC values (-5.78 +/- 3.14 and -8.63 +/- 3.98, p=0.04) and higher idle time
values (8.92 +/- 8.71 and 3.47 +/- 3.9, p=0.02) than those performed manually. Conclusions:
Robotic-assisted and manual CAS cases are comparable in the precision of stent and
balloon positioning. Navigation in the carotid artery is associated with smoother
motion and higher idle time values. These findings highlight the accuracy and the
motion stabilizing capability of the endovascular robotic system. Clinical Impact
Robotic assistance in the treatment of peripheral vascular disease is an emerging
field and may be a tool for radiation protection and the geographic distribution of
endovascular interventions in the future. This preclinical study compares the characteristics
of manual and robotic-assisted carotid stenting (CAS). Our results highlight, that
robotic-assisted CAS is associated with precise navigation and device positioning,
and smoother navigation compared to manual CAS.
