Evaluation of Robotic-Assisted Carotid Artery Stenting in a Virtual Model Using Motion-Based Performance Metrics.

Autor:	Legeza PT; Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA.; Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary., Lettenberger AB; Department of Mechanical Engineering, Mechatronics and Haptic Interfaces Laboratory, Rice University, Houston, TX, USA., Murali B; Department of Mechanical Engineering, Mechatronics and Haptic Interfaces Laboratory, Rice University, Houston, TX, USA., Johnson LR; Department of Mechanical Engineering, Mechatronics and Haptic Interfaces Laboratory, Rice University, Houston, TX, USA., Berczeli M; Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA.; Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary., Byrne MD; Department of Psychological Sciences, Rice University, Houston, TX, USA., Britz G; Department of Neurosurgery, Houston Methodist Hospital, Houston, TX, USA., O'Malley MK; Department of Mechanical Engineering, Mechatronics and Haptic Interfaces Laboratory, Rice University, Houston, TX, USA., Lumsden AB; Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA.
Jazyk:	angličtina
Zdroj:	Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2024 Jun; Vol. 31 (3), pp. 457-465. Date of Electronic Publication: 2022 Sep 22.
DOI:	10.1177/15266028221125592
Abstrakt:	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. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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