Context Aware Catheter Navigation for Improved Stent Deployment (Creativity@Home Pilot)

Cardiovascular disease is the major cause of deaths in the Western world, of which vascular disease is a main contributing factor. One particular form of vascular disease is Abdominal Aortic Aneurysm (AAA), which is one of the leading causes of death. The prevalence of AAA is 1.3% in men 45-54 years of age, rising to 12.5% in men over the age of 75. For women, although AAA is rare in younger age groups, it is found in 5.2% of those over 75. Aortic aneurysms, if left untreated, risk rupture, with only 25% of cases reaching to hospital alive, with operative mortality exceeding 40%. Endovascular repair offers several advantages over open surgery: faster recovery time, reduced need for general anaesthesia, no laparotomy, less blood loss, and decreased risk of erectile dysfunction. Endovascular repair procedures are likely to be a cost-effective alternative in cases for which open surgery is unsuitable. The aim of the project is to integrate real-time sensing, shape instantiation combined with modelling of in situ catheter-tissue interaction for context-aware catheter manipulation and stent deployment under dynamic active constraints. The project is timely in that the ageing population implies increasing prevalence of aortic aneurysm and for this patient group, traditional open surgery is unsuitable due to the major trauma involved. Technically, it is also timely to explore the latest developments in multi-modal intra-operative imaging, sensing and robotics for minimally invasive therapy. The proposed research on context-aware, robotically assisted catheter navigation addresses some of the major challenges faced by endovascular repair and the expected research results will guide future designs of control interfaces for flexible robotics, and exploration of models with quasi-physical behaviour and constraints are more conducive to rapid adaptation to intra-operative variation.

Recent advances in robotic catheter guidance systems have offered significantly improved catheter manipulation for endovascular intervention with more degrees-of-freedom. Clinical benefit from robotic control and guidance systems is significant in that they assist and simplify navigation and localisation tasks in complex surgical settings, reducing operator fatigue and risk of error. The potential stakeholders that will benefit from this research include: Academia (both UK and international) in medical imaging, sensing, robotics and general biomedical engineering; Public and private sectors in healthcare provision; Medical devices industry; none-government organisations focussed on prevention and management of cardiovascular diseases; and more importantly patients and the general public. With demographic shift associated with ageing population, the proposed research can have a potentially significant impact on addressing the challenges faced by the current healthcare system and future improvement of minimally invasive therapies targeted for these patients. The main benefits of robotic-assisted endovascular intervention include minimised trauma, reduced complications, decreased hospital stay, improved anatomical and functional visualisation, and safer procedure by introducing active constraints. Patients also benefit from shorter procedures, lower exposure to contrast, and thus decreased nephrotoxic risk. Lowering the risk of endovascular repair procedures would enable more patients to qualify for elective intervention than otherwise would have been possible, which can lower overall treatment costs given that emergency repair incurs a much greater expense than elective surgical repair. This would also contribute to lower mortality from the condition. The benefit from this research includes potentially significant technological, social, commercial and economic impact. It not only enhances research capacity but also brings tangible knowledge transfer opportunities. The project addresses important research and development challenges, and the end results are likely to transform clinical research and practices in endovascular intervention, minimally invasive surgery, and interventional imaging. The project also provides opportunities in cross-scale morphological and functional integration of surgical information and the technical innovations described are introduced we are likely to generate opportunities in clinical applications that lead to personalisation of healthcare treatment.