RESUMO
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.
RESUMO
Carotid artery stenting (CAS) is a minimally invasive endovascular procedure used to treat carotid artery disease and is an alternative treatment option for carotid artery stenosis. Robotic assistance is becoming increasingly widespread in these procedures and can provide potential benefits over manual intervention, including decreasing peri- and post-operative risks associated with CAS. However, the benefits of robotic assistance in CAS procedures have not been quantitatively verified at the level of surgical tool motions. In this work, we compare manual and robot-assisted navigation in CAS procedures using performance metrics that reliably indicate surgical navigation proficiency. After extracting guidewire tip motion profiles from recorded procedure videos, we computed spectral arc length (SPARC), a frequency-domain metric of movement smoothness, average guidewire velocity, and amount of idle tool motion (idle time) for a set of CAS procedures performed on a commercial endovascular surgical simulator. We analyzed the metrics for two procedural steps that influence post-operative outcomes. Our results indicate that during advancement of the sheath to the distal common carotid artery, there are significant differences in SPARC (F(1, 22.3) = 6.12, p = .021) and idle time (F(1, 22.6) = 6.26, p = .02) between manual and robot-assisted navigation, as well as a general trend of lower SPARC, lower average velocity, and higher idle time values associated with robot-assisted navigation for both procedural steps. Our findings indicate that significant differences exist between manual and robot-assisted CAS procedures. These are quantitatively detectable at the granular-level of physical tool motion, improving the ability to evaluate robotic assistance as it grows in clinical use.