Robotic Endovascular Intervention

Endovascular catheter navigation relies on continuous fluoroscopy, exposing patients and clinical staff to ionizing radiation throughout the procedure. We investigate whether a physics-based world model can sustain the navigation task between deliberately sparse X-ray acquisitions, and whether the model can signal when its internal state estimate is no longer reliable. We formulate sparse-fluoroscopy navigation as a partially observable Markov decision process where a Cosserat rod simulator supplies transition dynamics, sparse noisy projections provide observations, and a particle filter maintains a belief over the device state, reduced in this implementation to a tip state with a geometric contact proxy. We evaluate this formulation in a deliberately simplified setting: a synthetic planar vessel phantom with a quasi-static rod model and simulated projections, without clinical or animal data. In this setting, the belief-state model tracks the simulated tip with a root mean square error of 1.30 mm while acquiring observations at one fifteenth of the continuous rate (0.97 mm at every frame, 1.51 mm at one thirtieth), reported 90 percent credible intervals achieve 0.92 empirical coverage, and the belief-derived contact risk estimate discriminates unsafe contact events with an AUROC of 0.68. These results constitute a proof of concept on a simplified simulation rather than a demonstration of clinical readiness; their purpose is to establish that calibrated belief, rather than point-estimate accuracy alone, is the essential property a sparse-imaging world model must deliver.

Reliable three-dimensional (3D) navigation of magnetically actuated untethered microrobots remains a major barrier to clinical translation. X-ray fluoroscopy is the standard real-time imaging modality for endovascular procedures, but single-plane fluoroscopy provides only a two-dimensional (2D) projection, eliminating depth information and complicating autonomous navigation. Recovering this information through biplane imaging or repeated contrast-enhanced angiography increases procedural complexity, radiation exposure, or contrast burden. Here, we introduce VISTA (Virtual Integration for Spatial Tracking and Autonomy), a digital twin framework enabling contrast-free autonomous navigation under single-plane fluoroscopy. VISTA reconstructs vascular anatomy as a 3D digital twin, discretizes the vessel centerline into navigation milestones, and assigns the detected 2D robot position to the nearest projected milestone. Consecutive milestones define the local vessel orientation used to generate magnetic actuation commands, converting single-plane fluoroscopic observations into topology-constrained navigation states without requiring contrast injection during navigation. VISTA is demonstrated across anatomically distinct vascular phantoms under continuous flow and within the inferior vena cava of a live rat in vivo. Compared with conventional fluoroscopic human-in-the-loop control, VISTA reduced navigation time by up to 62%, corrective actuation commands by up to 98%, and radiation exposure by up to 57%. These results establish VISTA as a digital twin-guided framework for contrast-free autonomous navigation of untethered endovascular microrobots using widely available single-plane fluoroscopy.

Acoustic field-driven manipulation provides a non-contact and non-invasive strategy for controlling microscale and nanoscale objects, yet its extension to millimeter-scale robots was limited by insufficient propulsion efficiency in confined biological environments. Here, a coordinated multi-acoustic-field approach is introduced, which harnesses the synergistic action of acoustic radiation forces and acoustic streaming flows to enable controlled locomotion of millimeter-scale helical robots and enhance propulsion. Multiphysics simulations captured the dynamics of millimeter-scale helical robots under combined acoustic fields, and experimental validation demonstrated their locomotion capabilities, including planar navigation, inclined climbing, and vertical motion. Semi-autonomous navigation experiments further confirmed that ultrasonic synergy substantially improved maneuverability. In vitro tests in porcine venous vessels demonstrated that coordinated acoustic fields supported both unidirectional and reciprocating motion under biologically relevant confinement. These findings provide mechanistic insight into scaling acoustic micromanipulation to the millimetre regime and support biomedical applications requiring versatile and controllable robotic mobility.

Fenestrated/Branched endovascular aneurysm repair (FEVAR/BEVAR) require surgeons to navigate catheters and guidewires into various branches of the abdominal aorta, before deploying stent grafts to alleviate pressure on the aneurysm. Previous clinical studies suggests that surgeons continue to struggle with vessel access using standard commercial instruments, prolonging the procedural time and inducing further complications. In this work, we present two contributions to solving this problem: 1) A bespoke 2-segment steerable catheter, consisting of 4 degrees of freedom to enhance dexterity. 2) An expandable, modular tendon-driven actuation platform that can accommodate for the redundancies introduced in our system. To fabricate the catheter, we capitalized on thermal fiber drawing, a technique that creates high-aspect ratio devices at scale, and processed the catheter with laser micro-machining to soften its tip. We evaluated the system using simulations, where we investigated the catheter's bending stiffness, then its steerability with in-vitro experiments in vascular phantoms. This handheld, robotic steerable catheter system has the potential to shorten the length of future endovascular surgeries, and give clinicians the tools to resolve challenging clinical cases.

An endovascular intervention begins with a skilled clinician manually navigating a long, slender wire, called a guidewire, to the target location within the vasculature. Due to factors, such as vessel tortuosity and lack of steerability at the guidewire tip, manual navigation of a guidewire could be challenging, potentially resulting in vessel damage, perforation, dissection, and occlusion, as well as postsurgical complications, such as thrombosis. This work details the development of a handheld actuation mechanism for tendon-driven robotic guidewires by utilizing the aforementioned spooling mechanism. Incorporating the compact spooling mechanism into a handheld device enables clinicians to leverage both motorized guidewire steering and manual rotation and translation, if desired. The proposed device is designed such that, while holding the device, the clinician can execute feeding, rotation, and bending motions for up to 1.5 m of the robotically steerable guidewire using a joystick and momentary switch on the handle. Furthermore, the proposed device is demonstrated through navigation in an anatomically accurate phantom aorta model.

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.

Objective: To evaluate robotic controller interfaces for interventional neuroradiology procedures in-vitro incorporating a force-sensing platform to assess safety. Methods: A custom endovascular robot, device-mimicking controller, and sensorized neurovascular phantom were developed. Ten interventional neuroradiologists (4 novices, 6 experts) performed simulated navigations using four control modalities: device-mimicking controllers with and without haptic feedback, joystick-based input, and manual navigation. Navigation time, peak vessel-wall forces, incorrect catheterisations, and prolapse events were assessed, alongside user analyses. Results: Manual navigation was fastest (mean 47.7 s) compared to haptic-on (248.7 s), haptic-off (314.7 s), and joystick (392.6 s) modalities (p<0.001). Regardless of controller type, vessel-wall forces were below the 0.70 N puncture threshold; therefore all modalities were considered safe. Joystick produced significantly more prolapse events than manual control (1.56 vs 0.13; p=0.018). Operator experience was relevant to performance: experts made fewer incorrect catheterisations than novices (0.25 vs 0.62; p=0.035) and applied less vessel-wall force (p<0.0005); these effects were sustained across controllers but accentuated when haptics were on. Users perceived haptic on and haptic off as similarly intuitive, and more intuitive than joystick (p=0.033). Conclusion: Device-mimicking robotic controllers outperform joystick interfaces on most metrics; haptic feedback shows promising but non-significant performance benefits.

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.

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.

Autonomous microrobots navigating biological vasculature could enable targeted drug delivery and thrombolysis, yet training control policies for realistic environments remains an open challenge. Prior reinforcement learning (RL) studies of microrobotic navigation have been limited to idealized geometries that omit complex hydrodynamic flow fields, confined branching structures, and dense cellular obstacles found in vivo. Here, we develop a physically grounded simulation of a blood capillary network, incorporating realistic hydrodynamic flow fields, explicit red blood cell dynamics, and anatomically derived branching geometry, and train deep RL agents to navigate it via chemotaxis. We systematically map the physical limits of navigation across robot size and swimming speed, revealing a forbidden regime where Brownian motion and flow overcome propulsion. Successful agents independently discover multiple universal strategy types, including run-and-rotate and energy-efficient search-and-sit policies, regardless of robot parameters. Without retraining, these agents perform targeted blocking and unblocking of capillary flow, restoring throughput to healthy baseline levels. These results establish RL as a viable framework for developing autonomous microrobotic intervention strategies in complex biological environments.

Remote robotic-assisted endovascular intervention offers a promising approach to reduce clinician radiation exposure and physical strain, while extending specialized vascular care to geographically distant regions. Despite advancements, teleoperated endovascular intervention remains underexplored, especially for time-sensitive interventions like mechanical thrombectomy for acute stroke. The aim of the current review was to determine the evidence regarding teleoperated endovascular robotic systems, covering technical feasibility, communication infrastructure, and clinical outcomes. The review further identified research gaps and future directions. Following PRISMA guidelines, 16 studies were included that met the inclusion criteria out of 2501 initial search results. We found that teleoperated catheters and guidewires, driven by mechanical or electromagnetic systems, can be navigated across distances up to 7000 km. With robust communication infrastructure, network latency remained within clinically acceptable limits (30-163 ms). Although initial outcomes highlighted 100% procedural success in small-scale human trials, most evidence stemmed from animal or phantom models. Overall, the findings suggest that teleoperated endovascular intervention can reduce occupational hazards, expand patient access to urgent procedures, and optimize resource allocation. Future research should be conducted in low and middle income countries to demonstrate broader geographical access. Ultimately, multi-center clinical trials are required to validate the safety, efficacy, and generalization in diverse clinical settings.

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.