Neuroendovascular-specific engineering modifications to the CorPath GRX Robotic System

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OBJECTIVE

The aim of this study was to evaluate new, neuroendovascular-specific engineering and software modifications to the CorPath GRX Robotic System for their ability to support safer and more effective cranial neurovascular interventions in a preclinical model.

METHODS

Active device fixation (ADF) control software, permitting automated manipulation of the guidewire relative to the microcatheter, and a modified drive cassette suitable for neuroendovascular instruments were the respective software and hardware modifications to the current CorPath GRX robot, which was cleared by the FDA for percutaneous coronary and peripheral vascular intervention. The authors then trialed the modified system in a live porcine model with simulated neuroendovascular pathology. Femoral access through the aortic arch to the common carotid artery was accomplished manually (without robotic assistance), and the remaining endovascular procedures were performed with robotic assistance. The system was tested for the enhanced ability to navigate and manipulate neurovascular-specific guidewires and microcatheters. The authors specifically evaluated the movement of the wire forward and backward during the advancement of the microcatheter.

RESULTS

Navigation of the rete mirabile and an induced aneurysm within the common carotid artery were successful. The active device fixation feature enabled independent advancement and retraction of the guidewire and working device relative to the microcatheter. When ADF was inactive, the mean forward motion of the guidewire was 5 mm and backward motion was 0 mm. When ADF was active, the mean forward motion of the guidewire was 0 mm and backward motion was 1.5 mm. The modifications made to the robotic cassette enabled the system to successfully manipulate the microcatheter and guidewire safely and in a manner more suited to neuroendovascular procedures than before. There were no occurrences of dissection, extravasation, or thrombosis.

CONCLUSIONS

The robotic system was originally designed to navigate and manipulate devices for cardiac and peripheral vascular intervention. The current modifications described here improved its utility for the more delicate and tortuous neurovascular environment. This will set the stage for the development of a neurovascular-specific robot.

ABBREVIATIONS ADF = active device fixation; AI = artificial intelligence; CCA = common carotid artery; ICA = internal carotid artery; PCI = percutaneous coronary intervention; PVI = peripheral vascular intervention.
Article Information

Contributor Notes

Correspondence Gavin W. Britz: Houston Methodist Hospital, Houston, TX. gbritz@houstonmethodist.org.INCLUDE WHEN CITING Published online November 29, 2019; DOI: 10.3171/2019.9.JNS192113.Disclosures Mr. Falb and Mr. Tomas: employed by Corindus. Dr. Desai: direct stock ownership in Corindus Vascular Robotics. Dr. Lumsden: consultant for and direct stock ownership in Corindus.
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