The first transradial robotic implantation of a stent in the carotid artery has been done in the US at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania.
The procedure was done with the Corindus robot intended for internal vascular surgery but, in this procedure, the robot reached the carotid artery through the radial artery in the wrist. The treatment approach consisted of a 6 French prelude Merritt sheath inserted in the right radial artery. A Sim2, SIM BHLH transcription factor 2, shaped in an arch, with the robot then catheterized the left common carotid with the robot. Both were exchanged to a Benchmark catheter with the 6.0 spider protection device advancing the robot through the Stenosis. The 5.0 X 30 Aviator plus balloon was advanced with the robot and balloon angioplasty was performed manually.
According to Pascal Jabbour, MD, the neurosurgeon who led the procedure, this is what distinguishes this process from previously performed operations through the thigh, is that the radial approach is safer. There is a decrease in radiation exposure, heavy lead shields are unnecessary, and more precise targeting and movement of microwire and microcatheter is possible.
Although the robot is not approved by the Food and Drug Administration (FDA) for intracranial procedures, intracranial procedures are possible with a 14 or 18-gauge wire, a microwire, and a microcatheter. Future applications may include remote stroke interventions in geographically remote areas. During this procedure, the first robotic transradial angiogram was also done.
James Geyer, MD, and Paul Cox
Nidhiben Anadani, MD
Bettina Balint, MD