Background In acute ischaemic stroke, endovascular thrombectomy (ET) significantly reduces disability compared with thrombolytic therapy, but access to ET is currently limited. Leveraging telerobotic technology to disseminate neurosurgical expertise could increase access to ET. This proof-of-concept evaluation was performed to determine whether remote robotic ET (RRET), wherein an offsite neurosurgeon and an onsite interventional cardiologist collaboratively use telerobotics to perform ET, is technically feasible. Methods An ex vivo model of RRET was constructed by establishing a network connection between a robotic drive in a simulation laboratory and a robotic control unit 5 miles away. Using onsite assistance from an interventional cardiologist in the simulation laboratory, an offsite neurosurgeon used the robotic controls to attempt RRET on a fluid-filled silicone model of human vasculature containing simulated thrombus material in the left middle cerebral artery (MCA). Results From the offsite location 5 miles away, the neurosurgeon used the robotic system to successfully navigate a guidewire from the carotid artery to simulated thrombus in the MCA. Under the direction of the neurosurgeon, the onsite interventional cardiologist then successfully manually advanced an aspiration catheter over the guidewire to the thrombus, removed the guidewire and performed aspiration. Conclusions In this proof-of-concept evaluation, the technical feasibility of RRET was demonstrated in an ex vivo model and was collaboratively performed by an offsite neurosurgeon and an onsite interventional cardiologist. This report supports the design of future studies to determine if RRET could be used to increase access to ET for patients with acute ischaemic stroke. Data sharing not applicable as no datasets generated and/or analysed for this study.

中文翻译：

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远程机器人血管内血栓切除术治疗急性缺血性卒中

背景 在急性缺血性中风中，与溶栓治疗相比，血管内血栓切除术 (ET) 可显着降低残疾，但目前获得 ET 的机会有限。利用远程机器人技术传播神经外科专业知识可以增加获得 ET 的机会。进行此概念验证评估以确定远程机器人 ET (RRET) 是否在技术上可行，其中异地神经外科医生和现场介入心脏病专家协作使用远程机器人执行 ET。方法 通过在模拟实验室的机器人驱动器和 5 英里外的机器人控制单元之间建立网络连接，构建了 RRET 的离体模型。在模拟实验室使用介入心脏病专家的现场协助，一位异地神经外科医生使用机器人控制装置尝试在一个充满液体的人体脉管系统硅胶模型上进行 RRET，该模型包含左侧大脑中动脉 (MCA) 中的模拟血栓材料。结果 从 5 英里外的异地位置，神经外科医生使用机器人系统成功地将导丝从颈动脉引导到 MCA 中的模拟血栓。在神经外科医生的指导下，现场介入心脏病专家随后通过导丝成功地将抽吸导管推进至血栓，移除导丝并进行抽吸。结论 在这个概念验证评估中，RRET 的技术可行性在离体模型中得到证明，并由非现场神经外科医生和现场介入心脏病专家协作执行。本报告支持未来研究的设计，以确定 RRET 是否可用于增加急性缺血性卒中患者接受 ET 的机会。数据共享不适用，因为没有为本研究生成和/或分析的数据集。