First transradial robotic carotid stenting in the US

The patient had a left-sided severe carotid stenosis discovered after the workup for an ipsilateral stroke 

Treatment approach:

• A 6 French prelude Merritt sheath was inserted in the right radial artery 
• A Sim 2 was inserted, shaped in the arch with the robot then catheterized the left common carotid with the robot 
• Exchanged to a Benchmark catheter 
• With the robot a 6.0 spider protection device was advanced with the robot through the Stenosis 
• A 5.0 X 30 Aviator plus balloon was advanced robotically and balloon angioplasty was performed manually 
• Robotically, the exchange was performed and a precise pro stent 8.0 x 40 was brought up and deployed 

At this point:

• the robot is not FDA approved for intracranial, it can control a guide catheter but with a 14 or 18 wire (no 035 or 038 yet) 
• It controls a micro wire and a microcatheter too.
• Pascal Jabbour also used it for the first time to perform a transradial angiogram, shaping the Sim 2 in the arch and catheterizing proximal vessels with no wire 
• The future application would be eventually remote stroke interventions in geographically remote areas 

Advantages & challenges:

According to Pascal Jabbour, with the current version, the advantages are:

• Decreased radiation exposure to the operator 
• Ergonomic advantage (no need to wear heavy lead and stress the spine)
• More precise torquing and movement of microwire and microcatheter 

... and challenges :

• absence of haptic feedback, this will be needed for intracranial procedures