Modeling Robotic-Assisted Mechanical Thrombectomy Procedures with the CorPath GRX Robot: The Core-Flow Study

Alejandro Tomasello; David Hernández; Jiahui Li; Riccardo Tiberi; Eila Rivera; Joan Daniel Vargas; Cristina Losada; Magda Jablonska; Marielle Esteves; Maria Lourdes Diaz; Judith Cendrero; Manuel Requena; Francesco Diana; Marta De Dios; Trisha Singh; Laura Ludovica Gramegna; Marc Ribo

doi:10.3174/ajnr.A8205

Modeling Robotic-Assisted Mechanical Thrombectomy Procedures with the CorPath GRX Robot: The Core-Flow Study

AJNR Am J Neuroradiol. 2024 Apr 25. doi: 10.3174/ajnr.A8205. Online ahead of print.

Authors

Alejandro Tomasello^{1

2}, David Hernández³, Jiahui Li⁴, Riccardo Tiberi⁴, Eila Rivera⁵, Joan Daniel Vargas³, Cristina Losada³, Magda Jablonska^{4

6}, Marielle Esteves⁷, Maria Lourdes Diaz⁸, Judith Cendrero⁴, Manuel Requena^{3

4

9}, Francesco Diana^{3

5}, Marta De Dios³, Trisha Singh³, Laura Ludovica Gramegna⁵, Marc Ribo^{2

4

9}

Affiliations

¹ From the Interventional Neuroradiology Section (A.T., D.H., J.D.V., C.L., M. Requena, F.D., M.D.D., T.S.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain. alejandrotomasello@gmail.com.
² Departamento de Medicina (A.T.), Universitat Autònoma de Barcelona, Barcelona, Spain.
³ From the Interventional Neuroradiology Section (A.T., D.H., J.D.V., C.L., M. Requena, F.D., M.D.D., T.S.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
⁴ Stroke Research (J.L., RT., M.J., J.C., M. Requena, M. Ribo), Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
⁵ Vall d'Hebron Institut de Recerca (E.R., F.D., L.L.G.), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
⁶ 2nd Department of Radiology (M.J.), Medical University of Gdańsk, Gdańsk, Poland.
⁷ Experimental Surgery Unit (M.E.), Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
⁸ Departament De Radiologia Vascular Interventista (M.L.D.), Hospital General Universitario Arnau de Villanova, Lleida, Spain.
⁹ Stroke Unit (M. Requena, M. Ribo), Neurology Department Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.

PMID: 38663990
DOI: 10.3174/ajnr.A8205

Abstract

Background and purpose: Endovascular robotic devices may enable experienced neurointerventionalists to remotely perform endovascular thrombectomy. This study aimed to assess the feasibility, safety, and efficacy of robot-assisted endovascular thrombectomy compared with manual procedures by operators with varying levels of experience, using a 3D printed neurovascular model.

Materials and methods: M1 MCA occlusions were simulated in a 3D printed neurovascular model, linked to a CorPath GRX robot in a biplane angiography suite. Four interventionalists performed manual endovascular thrombectomy (n = 45) and robot-assisted endovascular thrombectomy (n = 37) procedures. The outcomes included first-pass recanalization (TICI 2c-3), the number and size of generated distal emboli, and procedural length.

Results: A total of 82 experimental endovascular thrombectomies were conducted. A nonsignificant trend favoring the robot-assisted endovascular thrombectomy was observed in terms of final recanalization (89.2% versus manual endovascular thrombectomy, 71.1%; P = .083). There were no differences in total mean emboli count (16.54 [SD, 15.15] versus 15.16 [SD, 16.43]; P = .303). However, a higher mean count of emboli of > 1 mm was observed in the robot-assisted endovascular thrombectomy group (1.08 [SD, 1.00] versus 0.49 [SD, 0.84]; P = .001) compared with manual endovascular thrombectomy. The mean procedural length was longer in robot-assisted endovascular thrombectomy (6.43 [SD, 1.71] minutes versus 3.98 [SD, 1.84] minutes; P < .001). Among established neurointerventionalists, previous experience with robotic procedures did not influence recanalization (95.8% were considered experienced; 76.9% were considered novices; P = .225).

Conclusions: In a 3D printed neurovascular model, robot-assisted endovascular thrombectomy has the potential to achieve recanalization rates comparable with those of manual endovascular thrombectomy within competitive procedural times. Optimization of the procedural setup is still required before implementation in clinical practice.