Neuroendovascular-specific engineering modifications to the CorPath GRX Robotic System

2020 ◽  
Vol 133 (6) ◽  
pp. 1830-1836 ◽  
Author(s):  
Gavin W. Britz ◽  
Sandip S. Panesar ◽  
Peter Falb ◽  
Johnny Tomas ◽  
Virendra Desai ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Robotic System ◽  
Robotic Assistance ◽  
Peripheral Vascular ◽  
Forward Motion ◽  
Active Device ◽  
Vascular Intervention ◽  
Peripheral Vascular Intervention ◽  
The Common ◽  
The Mean

OBJECTIVEThe 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.METHODSActive 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.RESULTSNavigation 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.CONCLUSIONSThe 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.

Therapeutic efficacy of vacuum-assisted-closure therapy in the treatment of lymphatic complications following peripheral vascular interventions and surgeries

Vascular ◽  
2014 ◽  
Vol 23 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Ufuk Aydin ◽  
Alper Gorur ◽  
Orhan Findik ◽  
Abdullah Yildirim ◽  
Cevdet Ugur Kocogullari
Keyword(s):  
Primary Therapy ◽  
Peripheral Vascular ◽  
Vacuum Assisted Closure ◽  
Vascular Intervention ◽  
Vac Therapy ◽  
Group I ◽  
First Choice ◽  
Peripheral Vascular Intervention ◽  
The Mean ◽  
Lymphatic Complications

Objectives Lymphatic complications, lymphocele and lymphorrhea being the leading, are generally encountered after vascular interventions and surgeries. The present study aimed to evaluate the outcomes of vacuum-assisted-closure (VAC) therapy, which we frequently prefer as the first-choice treatment for such complications. Materials and methods Among patients undergoing peripheral vascular intervention or surgery between January 2008 and February 2012, the medical files of 21 patients who received VAC therapy or other treatment due to symptomatic lymphatic complications were retrospectively analyzed and the results were discussed. Results Group I consisted of 10 patients (three with lymphocele and seven with lymphorrhea) who underwent VAC therapy as the first-choice treatment, Group II consisted of 11 patients of which 7 patients received various therapies before VAC therapy and 4 patients received other treatments alone. The patients who received VAC therapy as the primary therapy demonstrated more rapid wound healing, early drainage control, and shorter hospital stay. The mean hospital medical cost was €1038 (range, €739–1826) for the patients who primarily underwent VAC therapy; it was calculated to be €2137 (range, €1610–3130) for the other patients ( p = 0.001). Conclusion In addition to its safety and good clinical outcomes, VAC therapy also has economic advantages and should be the primary method for the treatment of lymphatic complications.

Initial Experience in a Pig Model of Robotic-Assisted Intracranial Arteriovenous Malformation (AVM) Embolization

2019 ◽  
Vol 19 (2) ◽  
pp. 205-209
Author(s):  
Virendra R Desai ◽  
Jonathan J Lee ◽  
Johnny Tomas ◽  
Alan Lumsden ◽  
Gavin W Britz
Keyword(s):  
Arteriovenous Malformation ◽  
Clinical Intervention ◽  
Robotic System ◽  
Robotic Assistance ◽  
Initial Experience ◽  
Peripheral Vascular ◽  
Contrast Extravasation ◽  
Intracranial Arteriovenous Malformation ◽  
Robotic Assisted ◽  
The Common

Abstract BACKGROUND Robotic assistance for coronary and peripheral vascular pathologies is steadily gaining popularity. However, it has yet to be applied to neurovascular intervention. OBJECTIVE To establish the feasibility of the CorPath® GRX robotic-assisted platform (Corindus Inc, Waltham, Massachusetts) for intracranial arteriovenous malformation (AVM) embolization. METHODS This robotic system was used to embolize intracranial AVMs (n = 4) in 2 anesthetized pigs, under controlled conditions appropriate for clinical intervention. Initially, a catheter was manually introduced into the common carotid artery (CCA). Then, the robotic system was used to advance the catheter into the ascending pharyngeal artery (APA) towards the rete mirabilis, which was used as a model for an AVM, using 0.014 in guidewires and 2.4F/1.7F microcatheters. After doing a pre-embolization APA run, which demonstrated good visualization of the rete, dimethyl sulfoxide (DMSO) was instilled into the microcatheter. A negative roadmap was then done, and Onyx was used to embolize the rete. RESULTS All 4 AVMs were completely obliterated with no complications, including no contrast extravasation, dissection, thrombosis, or other vascular injury. CONCLUSION This study is the first to demonstrate the feasibility of a robotic-assisted platform for intracranial AVM embolization.

Abstract 196: Gender-based Differences in Presentation and Treatment of Patients Undergoing Peripheral Vascular Intervention

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Niveditta Ramkumar ◽  
Bjoern D Suckow ◽  
Jack L Cronenwett ◽  
Philip P Goodney
Keyword(s):  
Disease Severity ◽  
Treatment Modality ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Older Age ◽  
Tissue Loss ◽  
Peripheral Vascular ◽  
Vascular Intervention ◽  
Peripheral Vascular Intervention ◽  
Gender Based

Introduction: While men and women are at equal risk for peripheral arterial disease (PAD), studies suggest that women present at an older age and with more advanced disease. The purpose of this analysis is to evaluate gender-based differences in disease presentation and its effect on treatment modality among patients who underwent peripheral vascular intervention (PVI) for PAD. Methods: Using national registry data from the Vascular Quality Initiative, univariate analysis, of patient-, limb- and artery-specific characteristics were performed by gender for procedures from 2010-2013. Statistical significance was determined by the Student’s T-test or Chi-squared test. Results: In this real-world cohort, there were 26,873 eligible procedures for 23,940 patients that had 30,668 limbs and 44,927 arteries treated. Compared to men, women presented at an older age (69 vs 71 years, p<0.001) and with more rest pain and tissue loss than claudication (RR=1.13, 95% CI: 1.10-1.16). Women had more severe lesions than men, as measured by TASC classification (TASC C or D RR= 1.81, 95% CI: 1.74-1.87) ( Table 1 ). There were no meaningful gender-based differences in artery treated or treatment modality ( Figure 1 ). Treatment modality was determined by disease severity (indication and TASC classification) and artery treated rather than gender. Conclusion: Although gender-based differences in PAD presentation exist, these differences do not extend to treatment modality, which is determined by disease severity and artery treated. Further investigation is required to appreciate the effect of disease severity and treatment modality on patient outcomes after PVI.

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