In a groundbreaking development, a team at St. Michael's Hospital in Toronto has successfully executed 10 brain angiograms using a robot that is remotely controlled by a neurosurgeon. This pioneering procedure aims to enhance stroke care accessibility for patients in northern Ontario, particularly those in remote areas.
A brain angiogram is a minimally invasive diagnostic method in which a catheter is inserted through the femoral artery located in the groin and navigated to the brain. During this process, a contrast dye is injected, allowing medical professionals to visualize any abnormalities in the blood vessels via X-ray imaging. Traditionally, the neurosurgeon operates alongside the patient in the operating room, manually manipulating the catheter. However, in what has been described as a world first, Dr. Vitor Mendes Pereira, head of St. Michael's neurovascular program, utilized a computer to control a robot that maneuvered the catheter through the patient's blood vessels.
The distance between Dr. Pereira and the robot was progressively increased during the procedures, initially across the room, then from another room in the hospital, and finally from St. Joseph's Health Centre, located approximately six kilometers away. Both St. Michael's Hospital and St. Joseph's are part of Unity Health Toronto. Dr. Pereira noted that the high-speed fibre optic internet connection facilitated a seamless experience, with no perceptible difference in visualization or surgical performance regardless of the operating location.
The next phase of this innovative project involves increasing the distance between Pereira and the robot to over 600 kilometers, reaching the Sault Area Hospital in Sault Ste. Marie, Ontario. Following additional diagnostic angiograms, the team plans to seek Health Canada approval for initiating a clinical trial to use robotic technology in performing endovascular thrombectomies on stroke patients. This procedure involves using a stent to capture and eliminate blood clots in the brain responsible for strokes.
Currently, there are no interventional specialists available to perform endovascular thrombectomies at the Sault Area Hospital, requiring stroke patients to be transported to the nearest stroke center in Sudbury. This journey can take between one hour via air ambulance and three and a half hours by road, exacerbating the urgency of timely treatment. Delays in receiving care after a stroke significantly increase the risk of neuron death, leading to greater disability or even death. Dr. Laura Stone, the medical director of the emergency department at Sault Area Hospital, emphasized the importance of immediate care, noting that stroke management standards are not fully available to their remote patient population.
However, with the installation of the robot in the Sault hospital, procedures could be conducted locally while Dr. Pereira controls the robot from his base in Toronto, effectively eliminating the need for patient transport during emergencies. Nicole Cancelliere, the research program manager at St. Michael's, will oversee training for the Sault Area Hospital staff on operating the robot and catheter insertion.
Dr. Michael Kutryk, who serves as both an interventional cardiologist and the head of cardiology at Sault Area Hospital, has been instrumental in creating a collaborative relationship between the two healthcare facilities. He highlighted the potential impact of this technology, asserting that access to robotic-assisted endovascular thrombectomies could be life-changing for patients, significantly improving their chances of recovery.
Dr. Kutryk anticipates that they could launch the robot-assisted thrombectomies at the Sault Area Hospital by late 2026 or early 2027. He expressed confidence in the safety of robot-assisted procedures, noting that the risks are minimal when the technology is used effectively. One critical concern is maintaining a stable internet connection throughout the operation, for which a backup plan is already in place to ensure continuity in case of any disruptions. In the event of a delay in the robot's response, medical teams can revert to traditional stroke care methods.
Given the low frequency of necessary procedures—approximately 12 to 15 endovascular thrombectomies each year—hiring a specialist for the Sault hospital is not feasible, making the robotic solution particularly advantageous. Dr. Stone remarked on the transformative potential of this technology in facilitating faster access to life-saving treatments for their patients. While the initial focus is on Sault Ste. Marie, the team at St. Michael's Hospital hopes that their work with robotic technology will benefit similar communities across the globe.
Developed by Remedy Robotics, a San Francisco-based company specializing in cardiovascular interventions, the robot used for the brain angiograms marks a significant advancement in medical technology, aimed at closing the gap in healthcare accessibility for remote regions.
