Learning Expert Strategy for Autonomous Robotic Endovascular Intervention via Decoupled Procedural Execution
Authors: Yanxi Chen, Tianliang Yao, Shaolong Tang, Jiyuan Zhao, Hengyu Hu, Zhaoxing Li, Antonio J. Sánchez Egea, Peng Qi
Abstract
Endovascular interventions are high-stakes procedures requiring precise device operation within complex and tortuous vascular anatomies. Autonomous endovascular navigation has the potential to standardize procedural quality and reduce the performance variability inherent in manual operation. Although Reinforcement Learning (RL) approaches have demonstrated promise in enabling autonomy in endovascular intervention, they often struggle with explicit constraint satisfaction and safety guarantees. To address these challenges, a learning-based expert strategy is introduced, enhancing procedural consistency in autonomous endovascular intervention by explicitly decoupling high-level strategic decision-making from low-level procedural execution. The proposed framework replicates the expert clinical decision-making process: a strategic RL policy generates global navigation intents, which are subsequently refined through an expert-informed execution module. This module ensures that robot movements strictly adhere to expert operational norms, real-time kinematic limits, and vessel safety constraints. Experimental evaluation across high-fidelity 3D simulations and a real-world robotic platform demonstrates that the proposed framework not only outperforms baseline policies but also effectively replicates expert-level proficiency. The framework achieves a high navigation success rate (> 96%) and a 29.3% reduction in operational steps, which translates to enhanced operative efficiency and minimized device-vessel interaction. Furthermore, a 13% reduction in trajectory variance indicates superior procedural standardization, aligning autonomous behavior with established clinical norms. These results underscore its potential to enhance the predictability, safety, and consistency of robotic endovascular interventions.
Autonomous mechanical thrombectomy (MT) presents substantial challenges due to highly variable vascular geometries and the requirements for accurate, real-time control. While reinforcement learning (RL) has emerged as a promising paradigm for the automation of endovascular navigation, existing approaches often show limited robustness when faced with diverse patient anatomies or extended navigation horizons. In this work, we investigate a world-model-based framework for autonomous endovascular navigation built on TD-MPC2, a model-based RL method that integrates planning and learned dynamics. We evaluate a TD-MPC2 agent trained on multiple navigation tasks across hold out patient-specific vasculatures and benchmark its performance against the state-of-the-art Soft Actor-Critic (SAC) algorithm agent. Both approaches are further validated in vitro using patient-specific vascular phantoms under fluoroscopic guidance. In simulation, TD-MPC2 demonstrates a significantly higher mean success rate than SAC (58% vs. 36%, p < 0.001), and mean tip contact forces of 0.15 N, well below the proposed 1.5 N vessel rupture threshold. Mean success rates for TD-MPC2 (68%) were comparable to SAC (60%) in vitro, but TD-MPC2 achieved superior path ratios (p = 0.017) at the cost of longer procedure times (p < 0.001). Together, these results provide the first demonstration of autonomous MT navigation validated across both hold out in silico data and fluoroscopy-guided in vitro experiments, highlighting the promise of world models for safe and generalizable AI-assisted endovascular interventions.
Robotic-assisted endovascular interventions demand accurate, stable, and context-aware guidewire navigation in complex and patient-specific vascular anatomies. Despite recent advances in robotic precision and learning-based control, existing autonomous navigation methods remain limited by their reliance on static reward functions and the lack of explicit procedural reasoning regarding anatomical context and task progression. To address these challenges, this paper proposes a vision-language procedural reasoning (VL-PR) framework for autonomous guidewire navigation. The framework integrates a multimodal large language model (MLLM) as a procedural reasoning module that interprets real-time visual observations to infer high-level navigation contexts. Instead of generating low-level control commands, the inferred procedural insights enable context-aware reward adaptation by dynamically adjusting the importance of reward components across different navigation phases. This approach allows a single policy to resolve competing objectives and handle complex transitions while preserving a consistent global task goal. Experiments on a physical robotic platform across diverse vascular scenarios demonstrate enhanced task reliability and streamlined navigational efficiency, highlighting the advantages over static-reward methods and offering a scalable solution for complex and multi-task robotic endovascular procedures.
Robot-assisted endovascular intervention can potentially reduce radiation exposure, improve surgeon ergonomics, enable telesurgery, support active assistance and autonomy, and enhance procedural precision. However, existing systems often suffer from limited procedural coverage because constrained patient-side setups, restricted flexibility, and complex instrument exchange hinder clinical workflow integration. This work presents a compact robotic system for endovascular interventions that enables continuous translational and rotational manipulation of standard endovascular instruments. The system consists of two alternating carts with pneumatically actuated membrane grippers integrated into rotating gripper gears. Its top-loading design allows rapid exchange of instruments such as guidewires and catheters without changing the robotic setup. A leader-follower control strategy enables continuous motion despite the finite stroke of each cart. The system was evaluated in motion-tracking experiments with guidewires and catheters and in an in vitro vascular phantom. The motion-tracking experiments showed generally smooth translational and rotational motion profiles. Across all tested guidewire and catheter experiments, the mean relative tracking errors were 3.6% for translational motion and 4.1% for rotational motion. In the vascular phantom, robot-assisted navigation reached the target in most trials, demonstrating the feasibility of the proposed manipulation concept under in vitro conditions. The presented robotic system demonstrates technical feasibility for continuous manipulation of standard endovascular instruments in bench-top and in vitro experiments. The compact top-loading design may ease instrument exchange and clinical workflow integration. Future work will focus on improving gripping performance, actuation speed, force feedback, and evaluation in more clinically realistic settings.
Jonas Fischer, Lennart Karstensen, Franziska Mathis-Ullrich