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26th July 2023
While interventional neuroradiology endovascular procedures are normally controlled using joystick movements, a new study suggests that a device mimicking robotic controller, which directly copies the operator’s movements, allows for a better performance and outcomes.
Published in the International Journal of Computer Assisted Radiology and Surgery, researchers developed an interventional radiology simulator with a profile of vessels, catheters and guidewire beam modelling.
The participants were six experienced interventional neuroradiologists, two novice neuroradiologists and one interventional radiologist. These individuals then performed a navigation task on the simulator with three different human-computer interfaces.
A number of metrics were used to evaluate and characterise each interface, including the time taken for navigation, number of incorrect catheterisations, number of catheter and guidewire prolapses and forces applied to vessel walls. Finally, participants responded to a questionnaire to evaluate the perception of the robotic controllers.
The researchers found that the time taken for navigation, the number of incorrect catheterisations and the number of catheter and guidewire prolapses were better for the device mimicking robotic controller compared to a joystick controlled approach. In feedback, the interventional radiologists reported a preference for the device mimicking controller for interventional neuroradiology procedures.
Lead author on the study, and PhD candidate in cancer imaging, Benjamin Jackson said: ‘There is a lack of interventional neuroradiologists across the UK and globally. In the UK alone, around 6,000 patients per year are unable to access the most beneficial stroke care. This paper is the first steps towards developing tele-operated robotic solutions to help give patients access to the care they need.‘
Study author Thomas Booth, reader in neuroimaging, School of Biomedical Engineering and Imaging Sciences at King’s College London, added: ‘Whilst this is an intuitive result, robots in interventional radiology are typically controlled using button presses and joystick movements, so the findings may change the direction of robotic development in this emerging field.‘
17th November 2021
Endovascular treatment (EVT) alone, a non-surgical intervention for the sudden loss of brain function in patients who experience blood clots, does not benefit from addition of intravenous alteplase in terms of the disability outcome at 90 days. This was the conclusion of an open-label, randomised trial by a team from the Department of Neurology, AMC, the Netherlands.
Whether or not the addition of the thrombolytic agent, alteplase to EVT for patients with a stroke would be of greater benefit is unclear and was the subject of the Multicenter Randomised Clinical Trial of Endovascular Treatment for Acute Ischaemic Stroke (MR CLEAN). The trial was undertaken in 20 hospitals in the Netherlands, France and Belgium and recruited adult patients (> 18 years of age) who had an acute ischaemic stroke due to an intracranial occlusion of the anterior circulation. Included patients were those eligible for EVT and intravenous alteplase within 4.5 hours of symptom onset, defined as stroke-related neurological symptoms or the time at which the patient was last seen well. Eligible patients had a score of 2 or more on the National Institutes of Health Stroke Scale (NIHSS), which ranged from 0 (no symptoms) to a maximum of 42 (most severe deficit). Patients were randomised 1:1 to receive either EVT alone or intravenous alteplase (0.9 mg/kg, 10% as a bolus and 90% as a 1-hour infusion, prior to the initiation of EVT which was permitted before the end of the alteplase infusion. The primary endpoint of the trial was functional outcome on the modified Rankin scale which ranges from 0 (no disability) to 6 (death), which was assessed after 90 days.
In total, 539 patients were included in with final analysis, with a median age of 71 years (56.6% male) with 273 randomised to receive endovascular treatment alone. After 90 days, the median score on the modified Rankin scale was 3 in the EVT-alone group and 2 in the alteplase-EVT group with an adjusted odds ratio, OR of 0.84 (95% CI 0.62 – 1.15, p = 0.28). Mortality was 20.5% with EVT and 15.8% for the combination group, (adjusted OR = 1.39, 95% CI 0.84 – 2.30). In addition, a symptomatic intracranial haemorrhage occurred in 5.9% and 5.3% of those assigned to EVT and alteplase respectively, for which the difference was also non-significant.
Given this non-significant finding, the authors concluded that EVT alone was not superior to alteplase followed by EVT.
LeCouffe NE et al. A Randomized Trial of Intravenous Alteplase before Endovascular Treatment for Stroke. N Eng J Med 2021