Remote Stroke Robots: Expanding Access to Critical Care

The Rise of Remote Robotic Stroke Treatment

The potential of remotely performed emergency stroke treatment, facilitated by robotics, is gaining significant momentum. These systems aim to connect patients in smaller medical facilities with expert surgeons located miles away, effectively eliminating hours from the treatment timeline. Recent demonstrations by Remedy Robotics and Sentante showcase the feasibility of this approach.

In September, a team in Toronto, led by Dr. Vitor Pereira of Unity Health, successfully completed a series of increasingly distant brain angiograms – the X-ray imaging component of EVT – culminating in procedures performed between hospitals across the city using the N1 system from Remedy Robotics. October saw Sentante’s technology used in a simulated EVT, connecting a surgeon in Jacksonville, Florida, with a cadaver in Dundee, Scotland, utilizing artificial blood flow.

“These advancements aren’t merely proof of concept; they represent a tangible shift towards the implementation of robotic and remote interventions,” states Dr. Pereira. “Soon, this will become a reality for numerous centers in rural and underserved areas.”

Navigating the Challenges of Distance and Connectivity

One of the primary hurdles in remote procedures is maintaining robust, high-speed connections over long distances. “While transatlantic procedures demonstrate the technology’s capabilities, a practical need for such extreme distances is questionable,” notes Edvardas Satkauskas, CEO of Sentante. “However, even this distance proves the feasibility of the concept.” Despite the inherent latency, the pace of EVT, while urgent, doesn’t demand instantaneous reactions, according to Satkauskas.

Redundancy in connectivity is also paramount. Remedy Robotics has incorporated measures to monitor connection quality and prevent potentially harmful movements in the event of a disruption, as explained by CEO David Bell. The IEEE Standards Association is actively working on standards to ensure the safety and reliability of these remote surgical systems.

Two Distinct Approaches to Robotic Precision

While both companies are understandably cautious about revealing proprietary details, their approaches to remote EVT differ significantly. Remedy Robotics emphasizes the integration of artificial intelligence. Their system utilizes machine learning to guide wires and overlays crucial information onto X-ray images, allowing remote physicians to control the robot via a laptop and intuitive software interface. The long-term vision is a centralized network where surgeons can remotely operate Remedy robots in multiple hospitals on demand.

Sentante, conversely, prioritizes a familiar tactile experience for surgeons. Their control console is designed to mimic the feel of traditional catheters and guide wires, incorporating force feedback to replicate the resistance encountered during manual EVT. “It’s incredibly intuitive to use,” says Dr. Ricardo Hanel, a neurosurgeon with Baptist Health in Jacksonville, who participated in the Sentante demonstration. The transatlantic procedure experienced a latency of approximately 120 milliseconds.

Sentante is actively collecting data from both images and force measurements to develop AI-assisted features, acknowledging that “we’ve essentially built a sophisticated piece of hardware to become a software company,” Satkauskas quips.

The Path to Widespread Clinical Adoption

Dr. Ahmet Gunkan, an interventional radiologist at the University of Arizona, highlights a key consideration: “The primary limitation of robotics remains the dependence on skilled interventionists at the patient’s bedside.” These bedside assistants will play a crucial role in patient preparation, equipment sterilization, and logistical support.

Remedy Robotics is focused on creating a system that can handle as much of the procedure autonomously as possible, streamlining the need for bedside intervention. Changes have been implemented since the initial Toronto demonstration to improve communication between remote and bedside clinicians, facilitated by the Remedy system, according to Bell.

While remote EVT is the ultimate goal, initial approvals may come for other, less critical endovascular procedures performed locally. The overarching aim is to improve patient outcomes through precision robotics, regardless of the surgeon’s location.

Remedy Robotics has a clinical trial planned for 2026 for on-premise neurointerventions and has partnered with the Australian Stroke Alliance to distribute its N1 system and conduct a future clinical trial for remote procedures. The company envisions the robot eventually treating up to 30 different conditions.

Satkauskas believes Sentante’s platform offers versatility for endovascular procedures throughout the body, fostering familiarity among bedside clinicians. The system is expected to launch in the EU next year for peripheral vascular interventions and has received a breakthrough device designation from the U.S. FDA for remote stroke treatment.

Other companies are also contributing to this evolving field. Corindus, acquired by Siemens in 2019, continues its telerobotic efforts, and Xcath has demonstrated a long-distance simulated EVT, with plans for local robotic EVT with live patients. Stryker is also developing robotic solutions for stroke intervention.

As Dr. Hanel aptly puts it, “It’s an incredibly exciting time to be a neurointerventionalist.”

What ethical considerations should guide the implementation of remote surgical technologies? And how can we ensure equitable access to these advancements for all patients, regardless of their location or socioeconomic status?

Frequently Asked Questions About Remote Stroke Treatment

• What is endovascular thrombectomy (EVT)?

  EVT is a minimally invasive procedure used to remove blood clots from the brain, restoring blood flow and minimizing damage during an ischemic stroke.

• Why is time so critical in stroke treatment?

  During a stroke, approximately 2 million neurons die each minute. The faster treatment is administered, the more brain tissue can be saved, and the better the patient’s chances of recovery.

• How do Remedy Robotics and Sentante differ in their approach to remote EVT?

  Remedy Robotics focuses on AI-driven automation and remote control via software, while Sentante prioritizes a tactile experience for surgeons with a console that mimics traditional instruments.

• What are the potential benefits of remote robotic stroke treatment?

  Remote EVT can significantly reduce the time to treatment for patients in remote areas, potentially saving lives and minimizing long-term disability.

• What challenges remain before remote EVT becomes widely available?

  Challenges include ensuring reliable connectivity, obtaining regulatory approvals, and training healthcare professionals to operate and support these systems.

• What role does artificial intelligence play in remote stroke treatment?

  AI is being used to automate certain aspects of the procedure, enhance image guidance, and improve the precision of robotic movements.