The Endovascular Revolution: Democratizing Access to Lifesaving Technology

Over the past decades, the medical community has made fantastic leaps in innovation and medicine that have improved survival rates and quality of life for patients dealing with cancer, kidney disease, heart disease, and other life-threatening conditions. Yet, stroke still affects 15 million people worldwide every year, killing five million and leaving another five million permanently disabled, with life-changing impacts to their mobility, speech, thought processes and emotions, and more. 

In addition to costing countless lives, stroke has a significant economic impact, as survivors are often unable to work and require extensive treatment, care, and rehabilitation. The global cost of stroke and stroke-related disabilities currently represents 0.66% of Global GDP and is projected to cost $1 trillion by 2030. Better prevention and treatment of stroke is needed to reduce morbidity and financial toll, making it both a humanitarian and an economic imperative. 

Democratizing access to critical care

About 87% of strokes are ischemic, in which blood flow to the brain is blocked. Due to the high degree of clinical complexity in neuro-interventional procedures for ischemic stroke, current treatments for ischemic strokes — including intravenous thrombolysis and endovascular thrombectomy — face numerous navigation, targeting, and control issues that can result in suboptimal clinical outcomes. 

In 2001, the treatment paradigm for a range of conditions changed forever when Dr. Fred Moll founded Intuitive Surgical and pioneered the global introduction of surgical robots into ORs. This innovation paved the way for robotics to assist with minimally invasive hysterectomies, prostactectomies, cardiac valve repairs, and more, adding a new layer of technology to patient care. 

More than two decades later, surgical robotics’ next revolution — bringing endovascular robotics to ORs across the world to treat high-need conditions such as stroke — may be equally impactful. 

Surgical robotics offers precise navigation of the human vasculature, which is notoriously complex, vast, and difficult to navigate. Watching a neuro-interventionalist control an endovascular robot is like watching a complex, elegant dance. Surgical robotics can revolutionize clinical outcomes for stroke and other serious endovascular conditions, enabling safer procedures with faster recovery times and less disruption. Yet, access to minimally invasive treatment of complex vascular conditions is still limited worldwide. Bringing endovascular robots to ORs and healthcare facilities worldwide is key to improving stroke prevention and treatment and reducing the morbidity and financial burden of stroke and other life-threatening vascular conditions.

A race to unchartered territory  

Throughout human history, hardship and competition have led to many of the lifesaving technological leaps we take for granted today. In medical robotics, that competition is forming around a high stakes race to bring emergent medical care to patients remotely. In other words, we can use telecommunications to treat patients in remote locations. Today, there are at least fifteen companies in various stages of pursuing the noble mission of addressing stroke care through telerobotics.  

Every preclinical milestone moves the field closer to making remote treatment for strokes a reality. We recently saw the world’s first demonstration of a remote, cross-continental stroke procedure known as mechanical thrombectomy. The ability to conduct mechanical thrombectomies remotely will be critical to democratizing access to this life-saving procedure, which today is only performed in a handful of stroke centers across the United States. 

Neuro-endovascular procedures are complex — therefore, the right telerobotic stroke solution will surely lie in the intersection of medicine, networking, videotelephony, cybersecurity, imaging, and artificial intelligence. Taking technologies from the lab to mass market clinics will undoubtedly require the creation of novel clinical workflows and legal arrangements. I like to say that robotics makes hard things easier and easy things harder. In telerobotics, we must recognize the inherent limitations of surgical robotics and innovate new technology to compensate. For example, robotic motors will never match the synchrony and precision of highly trained human hands. To account for that, we must develop novel, highly precise steering mechanisms.  

Current iterations of endovascular robotics platforms have struggled to add practical clinical value from the beginning to the end of procedures. They involve too many variables that can fail, have too many robot-specific requirements from the clinics they operate in, and have too many limitations on patient anatomies. In short, they have not tangibly improved clinical outcomes to offset the increased cost, time, and complexity associated with surgical robotics. 

To realize the next generation in surgical endovascular robotics and build solutions that bring treatment to patients in need, we must rely on the first principles approaches that arise from clinical practicalities. Stroke, in particular, represents an area of medicine with myriad challenges combined with significant need from a large patient population. With the right technology and approach, the democratization of life-saving endovascular procedures is within our reach.

Photo: PhonlamaiPhoto, Getty Images

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