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OBJECTIVE – An endovascular robotic system capable of remote catheter and sheath steerability has been used successfully in a variety of vascular beds in highly select centers in the United States. Its potential safety profile has been demonstrated with regard to aortic arch cannulation using the robotic system, however data is limited to pulsatile phantom models of the aortic arch. Therefore, we report our experience with the Magellan robotic system applied to carotid interventions and arch vessel cannulation in the porcine model with a focus on technical feasibility and histologic vessel trauma analysis.
METHODS – A consecutive series of short-term, non-survival experiments were performed in the porcine model. The Magellan robotic system was used to navigate and selectively cannulate the carotid and left subclavian arteries and deliver therapy using conventional endovascular devices. Aortic arch aortograms and standard selective cerebral angiograms were performed pre- and post-procedure. Immediate post mortem necropsy included gross tissue evaluation for intimal injury to the ostia of the great vessels and carotid bifurcation. Subsequent histopathologic analysis was performed to grade the severity of vessel wall injury using a published grading system already established in the porcine model.
RESULTS – Seventeen carotid and 6 left subclavian artery stenting procedures were performed in 10 animals by a single operator. All carotid stents were delivered in conjunction with commercially available embolic protection devices followed by routine post balloon dilation. There was 100% technical success with arch vessel cannulation and delivery of carotid and subclavian artery stents with no incidence of sheath instability. One animal died unexpectedly from a cardiac event before intervention was performed. On gross necropsy, there was no evidence of intimal injury to the ostia of the arch vessels or carotid bifurcation. Histopathologic analysis revealed no major injury to the internal elastic lamina, tunica media, or external elastic lamina in all cannulated ostia.
CONCLUSIONS – Carotid stenting and aortic arch cannulation is technically feasible using a robotically steerable catheter/sheath system and can be performed with minimal to no vessel trauma in the animal model. The Magellan Endovascular robotic system provides a stable sheath platform in the delivery of standard endovascular devices and its use may be potentially safer particularly in distant and tortuous vascular beds.