Magnetic catheterization using a medical robotic platform
Authors:   The BioRobotics Institute, Scuola Superiore Sant’Anna, Ansari M.HD. ,   Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna,   Department of Mechanical Engineering, KU Leuven,   Department of Biomechanical Engineering, Delft University of Technology,   Department of Electronics, Information and Bioengineering, Politecnico di Milano,   Department of Computer Science, University of Verona, Wu D. , Trauzettel F. , Li Z. , Barata B. F. , Ha X-T. , Dall’Alba D. , Borghesan G. , Ourak M. , Iacovacci V. , Tognarelli S. , Dankelman J. , De Momi E. , Breedveld P. , Fiorini P. , Vander Sloten J. , Menciassi A. , Vander Poorten E. 
Published: September 2024

A Chronic Total Occlusion (CTO) is a type of arte- rial blockage, which has persisted for more than three months, affecting the coronary arteries of the heart. Traditionally, CTO is treated by making a large incision in the chest area. This is a highly invasive procedure. Instead, catheter based approaches offer smaller inci- sions and exploit the vessels as access routes to re- mote anatomic regions [1]. Navigating catheters through narrow, fragile, and deformable vessels requires consid- erable skill [2]. Robotic distributed control approaches could potentially improve catheter navigation to bypass anomalies and prevent tissue damage [3]. However, when handling relatively stiff instruments, avoiding tis- sue damage remains difficult. For particularly tortuous vessels, remote actuation through magnetic fields could help in performing complex coordinated motion in three dimensional (3D) space. Magnetic fields are safe and highly controllable [4], and magnetic catheters can be made soft and compliant [5]. A good understanding of the catheters whereabouts remains important. Visual- ization during endovascular catheterization procedures mainly relies on fluoroscopy, a harmful X-ray based modality that only offers two dimensional (2D) views [6]. Instead, Augmented Reality (AR) assisted 3D visu- alization can limit exposure to harmful radiation. In this work, a prototype of a medical robotic platform aimed at magnetic catheterization for CTO treatment is developed (Figure 1). The system integrates sev- eral components: a multi-lumen guide catheter, termed 3Flex, a magnetic catheter (MC), a catheter driver, and a navigation control module conceived to help teleoper- ation of the 3Flex. The 3Flex catheter [7] is designed to carry within it an MC controlled by an External Permanent Magnet (EPM) carrying KUKA robotic arm. The system is designed to operate through a two-stage approach 1) initially, navigating the 3Flex from the groin incision to predefined positions in the ascending aorta, followed by 2) extending the MC from within the 3Flex, continuing under magnetic navigation to reach the blockage site located in the Left Coronary Artery (LCA). The details of the control module and the first stage involving a successful positioning of the 3Flex in the ascending aorta, and the characterization of the MC have been outlined in previous works [8][9][10]. The robotic control of a magnetic catheter for catheterization of the coronary arteries has not yet been shown for this platform, which is the second stage of the procedure. This abstract concentrates on detailing the second stage of the procedure and also evaluates the optimal position of the 3Flex catheter for effective treatment.