Background Given the impact and time criticality of Neurointervention, and the relatively small number of operators globally, technology aimed at enabling safe, remote, Neurointervention has great clinical value. A remotely operated Neurovascular robotic system was tested as part of a collaboration between Remedy Robotics Inc., the University of California medical centers. The same system was also tested by two international centers, one in Melbourne, Australia, and the other in Toronto, Canada. The primary goal of the study was to evaluate the feasibility and technical challenges involved in integrating the robotic system into a clinical environment, allowing for multiple remotely located operators to perform complete endovascular navigation from the femoral artery to MCA in a single day.

Methods Preoperative connectivity checks were performed prior to the procedure. Four remotely located clinicians from hospitals within and outside the University of California (UC) network connected to the robot. Using a silicone phantom, operators controlled up to four devices from the femoral artery to the middle cerebral artery (MCA). Injection of radiopaque contrast and audiovisual communication were also performed. On a separate day, two international operators connected to the robot located in San Francisco and performed the same procedure. Navigation success rate, time to procedural completion, rate of on-site assistance, latency, and other data were recorded.

Results All 6 remotely located operators successfully navigated from the femoral artery to either the left or right MCA within 15 minutes or less without on-site assistance. All operators successfully injected radiopaque contrast and engaged in audiovisual communication with on-site staff at will without assistance. Connectivity was monitored throughout each case, uncovering two minor episodes of protracted latency. There were no mechanical issues with either the robot or devices meaning that following placement of the first device in the femoral sheath, the robot and devices remained untouched for the duration of all 6 procedures.

Conclusion This study showcases the effective integration of a next-generation Neurovascular remote system into a clinical setting, highlighting its capability for unassisted navigation from the Femoral artery to MCA by various operators in rapid succession. It also showcases successful transcontinental navigation from nearly 8000 miles away. The study also highlights the challenges and limitations that have impeded the wider adoption of robotic-assisted Neurointervention and remote procedures in general.

Disclosures D. Bell: 4; C; Remedy Robotics, Inc. 5; C; Remedy Robotics, Inc.