Tele-operated robotic thrombectomy in acute stroke

Project reference: DTP_SIE_18 This project has already been allocated and is no longer available for applications
First supervisor: Thomas Booth 
Second supervisor: Kawal Rhode 

Project summary: Stroke is the second leading cause of death across the world, annually killing approximately 6 million people and the third leading cause of disability. In England, Wales and Northern Ireland, 85,000 people are hospitalised with stroke each year. Time from onset to treatment is known to be especially critical, with the effectiveness of treatment declining rapidly in the first few hours after stroke. More recently, thrombectomy has shown substantially improved clinical outcomes in patients with large vessel occlusion present in approximately 40% of patients with acute ischaemic stroke. Thrombectomy may be effective up to 6h or more after stroke onset (depending on patient selection) but also demonstrates reducing effect size with increasing time from stroke onset. The proportion of patients eligible for thrombectomy in the UK has been estimated at about 10%. Providing thrombectomy presents a significant challenge for health services. The procedure is typically carried out by a neuro-interventionist. 
 

Project description: Robotically-assisted angiography in the cerebral vasculature has only recently been described by three groups. For neurointerventional applications, the lack of a platform specifically designed to accommodate very small devices and microcatheters— and the technically demanding “micromovements” required to successfully navigate these tools through the cerebral vasculature — has left neurointerventional robotics virtually unexplored. This is a limitation of the Magellan system which is now no longer commercially available. 

 

Two basic mechanisms have been developed to perform robotic surgery in general. Some robotic systems are telemanipulators, which means that they essentially copy the operator’s movements directly. Other systems transform the movements of the operator such that a joystick can manipulate a guidewire or microcatheter. These systems are motivated by improving the neurointerention procedure itself. 

 

Given that the motivation of this project is to develop tele-operated robotic thrombectomy to allow local treatment to be performed remotely from a specialist neuroscience centre, the emphasis is on the former system i.e. developing robotic systems that are telemanipulators. The key advantage compared to the three systems described above is that operators would perform tasks in a way that is identical with their current practice with little new learning required (i.e. pushing and rotating catheters and wires as opposed to using a joystick). The large amount of delicate manipulation of the tiny catheter (2.1 Fr) and wire (0.014 inch) that occurs during the procedure demand that a major focus of the project would be on haptic feedback which is a major concern in the current joystick-controlled systems. 

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