Progressive Experience Fusion for Multi-Task World Model Control in Endovascular Navigation

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.

Mechanical thrombectomy (MT) is typically the optimal treatment for acute ischemic stroke involving large vessel occlusions, but access is limited due to geographic and logistical barriers. Reinforcement learning (RL) shows promise in autonomous endovascular navigation, but generalization across 'long' navigation tasks remains challenging. We propose a Hierarchical Modular Multi-Agent Reinforcement Learning (HM-MARL) framework for autonomous two-device navigation in vitro, enabling efficient and generalizable navigation. HM-MARL was developed to autonomously navigate a guide catheter and guidewire from the femoral artery to the internal carotid artery (ICA). A modular multi-agent approach was used to decompose the complex navigation task into specialized subtasks, each trained using Soft Actor-Critic RL. The framework was validated in both in silico and in vitro testbeds to assess generalization and real-world feasibility. In silico, a single-vasculature model achieved 92-100% success rates on individual anatomies, while a multi-vasculature model achieved 56-80% across multiple patient anatomies. In vitro, both HM-MARL models successfully navigated 100% of trials from the femoral artery to the right common carotid artery and 80% to the right ICA but failed on the left-side vessel superhuman challenge due to the anatomy and catheter type used in navigation. This study presents the first demonstration of in vitro autonomous navigation in MT vasculature. While HM-MARL enables generalization across anatomies, the simulation-to-real transition introduces challenges. Future work will refine RL strategies using world models and validate performance on unseen in vitro data, advancing autonomous MT towards clinical translation.

Mechanical thrombectomy (MT) is a time-critical intervention for acute ischemic stroke; however, access remains limited due to a shortage of neuroradiologists and specialized centers. Reinforcement learning (RL) offers potential to automate endovascular navigation and improve accessibility, yet current models lack standardized frameworks to assess navigation difficulty for model training and evaluation. This study aims to identify vascular metrics associated with navigation difficulty and to develop an automated pipeline for quantitative vascular feature extraction, enabling future complexity grading. Vascular trees were segmented from computed tomography angiograms from 61 patients, and vascular metrics including aortic arch type, presence of bovine arch, vessel length, tortuosity, take-off angle, number of reverse curves, were measured using a custom pipeline. A Soft Actor-Critic RL algorithm was used for 120 s autonomous navigation. Outcomes were analyzed using both mixed effects linear and logistic regression. On the left side, the presence of a bovine arch and aortic arch type II/III increased navigation time by 30.19 s and 37.92 s, respectively, while greater tortuosity (\b{eta} = 118.20) further prolonged the procedure and reduced success probability. On the right side, type II/III arches extended procedure time by 45.94 s, while each additional reverse curve was associated with 3.96 s longer navigation time and lower probability of success. These findings demonstrate for the first time that MT agent navigation difficulty is strongly influenced by vascular geometry. The proposed automated pipeline enables objective and quantitative characterization of vascular features, providing a foundation for future development of standardized complexity grading and RL model evaluation, without aiming to demonstrate clinically generalizable autonomous navigation.