Search Results (9)

Background/Objectives: Persistent Left Superior Vena Cava (PLSVC) is a condition that may complicate the ablation of Atrioventricular nodal reentry tachycardia (AVNRT). We aimed to report technical experience in ablation under scuh clinical setting. Methods: 3D guided electrophysiological procedure was conducted and PLSVC was confirmed. Slow-pathway ablation for the AVNRT was performed and typical junctional rhythm during the ablation was observed. Results: Exactly the same AVNRT remained inducible after 10 radiofrequency applications, which was very likely because of suboptimal temperature increase due to lacking sustained stability/contact of the catheter given the PLSVC anatomy and the patient’s deep respiration based on our observation during the RF applications. A non-steerable long sheath was introduced to achieve more firm contact of the ablation catheter, the slow-pathway was successfully ablated with just 1 application (seen immediately occurred, continuous typical junctional rhythms during ablation, and significantly better temperature during the ablation). Conclusions: PLSVC-related anatomical changes may destabilize ablation catheter making it difficult to establish sufficient energy delivery at the slow-pathway region and put forward the need for multiple ablations. Timely identifying such scenarios (e.g., insufficient stability, insufficient temperature) could help better plan/change the ablation technique or strategy to achieve better procedure outcomes. This technical report reminds us that typical junctional beats may not be the only determinant for successful ablation of the slow-pathway. The key to the solution often relies on basic ablation biophysics. Full article

Magnetic soft continuum robots (MSCRs) hold significant potential in fulfilling the requirements of vascular interventional robots, enabling safe access to difficult-to-reach areas with enhanced active maneuverability, shape morphing capabilities, and stiffness variability. Their primary advantage lies in their tether-less actuation mechanism that can safely adapt to complex vessel structures. Existing commercial MSCRs primarily employ a magnetic-pull strategy, which suffers from insufficient driving force and a single actuation strategy, limiting their clinical applicability. Inspired by the inchworm crawling locomotion gait, we herein present a novel MSCR that integrates a magnetic sinusoidal actuation mechanism with adjustable frequency and kirigami structures. The developed MSCRs consist of two permanent magnets connected by a micro-spring, which is coated with a silicone membrane featuring a specific notch array. This design enables bio-inspired crawling with controllable velocity and active maneuverability. An analytical model of the magnetic torque and finite element analysis (FEA) simulations of the MSCRs has been constructed. Additionally, the prototype has been validated through two-dimensional in-vitro tracking experiments with actuation frequencies ranging from 1 to 10 Hz. Its stride efficiency has also been verified in a three-dimensional (3D) coronary artery phantom. Diametrically magnetized spherical chain tip enhances active steerability. Kirigami skin is coated over the novel guidewire and catheter, not only providing proximal anchorage for improved stride efficiency but also serving similar function as a cutting balloon. Under the actuation of an external magnetic field, the proposed MSCRs demonstrate the ability to traverse bifurcations and tortuous paths, indicating their potential for dexterous flexibility in pathological vessels. Full article

To treat cardiovascular diseases (i.e., a major cause of mortality after cancers), endovascular-technique-based guidewire has been employed for intra-arterial navigation. To date, most commercially available guidewires (e.g., Terumo, Abbott, Cordis, etc.) are non-steerable, which is poorly suited to the human arterial system with numerous bifurcations and angulations. To reach a target artery, surgeons frequently opt for several tools (guidewires with different size integrated into angulated catheters) that might provoke arterial complications such as perforation or dissection. Steerable guidewires would, therefore, be of high interest to reduce surgical morbidity and mortality for patients as well as to simplify procedure for surgeons, thereby saving time and health costs. Regarding these reasons, our research involves the development of a smart steerable guidewire using electroactive polymer (EAP) capable of bending when subjected to an input voltage. The actuation performance of the developed device is assessed through the curvature behavior (i.e., the displacement and the angle of the bending) of a cantilever beam structure, consisting of single- or multi-stack EAP printed on a substrate. Compared to the single-stack architecture, the multi-stack gives rise to a significant increase in curvature, even when subjected to a moderate control voltage. As suggested by the design framework, the intrinsic physical properties (dielectric, electrical, and mechanical) of the EAP layer, together with the nature and thickness of all materials (EAP and substrate), do have strong effect on the bending response of the device. The analyses propose a comprehensive guideline to optimize the actuator performance based on an adequate selection of the relevant materials and geometric parameters. An analytical model together with a finite element model (FEM) are investigated to validate the experimental tests. Finally, the design guideline leads to an innovative structure (composed of a 10-stack active layer screen-printed on a thin substrate) capable of generating a large range of bending angle (up to 190°) under an acceptable input level of 550 V, which perfectly matches the standard of medical tools used for cardiovascular surgery. Full article

New suction endoscopes, ureteral access sheaths (UAS) and catheters aim to improve the efficacy of flexible ureteroscopy and optimize its safety. Suction UAS with non-flexible tips have shown promising results, especially in maintaining low intrarenal pressure, but also in removing small debris and reducing the “snow globe” effect. In addition, suctioning UAS with a flexible tip offers the advantage of being able to be navigated through the pyelocaliceal system to where the laser lithotripsy is performed. It can also remove small stone fragments when the flexible ureteroscope is retracted, using the Venturi effect. Direct in-scope suction (DISS) involves aspirating dust and small stone debris through the working channel of a flexible ureteroscope, thus regulating intrarenal pressure and improving visibility. Steerable aspiration catheters are other devices designed to increase stone clearance of the pyelocaliceal system. They are inserted under fluoroscopic guidance into every calyx after retraction of the flexible ureteroscope, alternating irrigation and aspiration to remove dust and small gravels. Combining flexible-tip suction UAS and the DISS technique may offer some advantages worth evaluating. The advantage of using these instruments to achieve a low intrarenal pressure was demonstrated. The true practical impact on the long-term stone-free status is a matter requiring further studies. Full article

Minimally invasive endovascular procedures rely heavily on catheter devices. However, traditional catheters lack active steering requiring considerable skill on the surgeon’s part to accurately position the tip. While catheter tips could be made steerable using tendon-driven and Pneumatic Artificial Muscle (PAM) approaches, remote magnetic actuation is uniquely suited for this task due to its safety, controllability, and intrinsic miniaturization capabilities. Soft composite magnetic materials feature embedding distributed magnetic microparticles compared with attaching discrete permanent magnets proving beneficial in steerability and control. This work demonstrates the fabrication of a soft hollow magnetic tip that can be attached to a catheter to make the assembly steerable. The catheter tip is extensively characterized in terms of bending hysteresis, bending force, and dynamic response. The catheter showed average hysteresis between 5% and 10% and bending forces up to 0.8 N. It also showed a good dynamic response by changing its bending angle in <200 ms under a step response. Full article

In recent years, steerable needles have attracted significant interest in relation to minimally invasive surgery (MIS). Specifically, the flexible, programmable bevel-tip needle (PBN) concept was successfully demonstrated in vivo in an evaluation of the feasibility of convection-enhanced delivery (CED) for chemotherapeutics within the ovine model with a 2.5 mm PBN prototype. However, further size reductions are necessary for other diagnostic and therapeutic procedures and drug delivery operations involving deep-seated tissue structures. Since PBNs have a complex cross-section geometry, standard production methods, such as extrusion, fail, as the outer diameter is reduced further. This paper presents our first attempt to demonstrate a new manufacturing method for PBNs that employs thermal drawing technology. Experimental characterisation tests were performed for the 2.5 mm PBN and the new 1.3 mm thermally drawn (TD) PBN prototype described here. The results show that thermal drawing presents a significant advantage in miniaturising complex needle structures. However, the steering behaviour was affected due to the choice of material in this first attempt, a limitation which will be addressed in future work. Full article

Failed back surgery syndrome (FBSS) is a commonly encountered disease after lumbar surgery. There are many cases where it is difficult to choose a treatment because no specific cause can be found. Nevertheless, according to recent reports, adhesiolysis has shown reasonable evidence. However, considering its poor cost-effectiveness, adhesiolysis cannot be used as the first line of treatment. FBSS patients often suffer from chronic pain; accordingly, they become frustrated when this treatment produces a poor response. Therefore, before the procedure, the target group must be selected carefully. We sought to identify the pre-procedure factors predicting the effect of adhesiolysis in FBSS. A total of 150 patients were evaluated and analyzed retrospectively. Of these 150 patients, 69 were classified as responders three months after the procedure (46%). The outer diameter of the catheter during the procedure and grade of foraminal stenosis were correlated with the procedure effect. In conclusion, of the 2.1 mm diameter of the catheter, 1.7 mm of it was used during the procedure, and the milder the foraminal stenosis, the greater the pain reduction effect was three months after the procedure. Full article

This paper reports an active catheter-tip device functionalized by integrating a temperature-responsive smart polymer onto a microfabricated flexible heater strip, targeting at enabling the controlled steering of catheters through complex vascular networks. A bimorph-like strip structure is enabled by photo-polymerizing a layer of poly(N-isopropylacrylamide) hydrogel (PNIPAM), on top of a 20 × 3.5 mm² flexible polyimide film that embeds a micropatterned heater fabricated using a low-cost flex-circuit manufacturing process. The heater activation stimulates the PNIPAM layer to shrink and bend the tip structure. The bending angle is shown to be adjustable with the amount of power fed to the device, proving the device’s feasibility to provide the integrated catheter with a controlled steering ability for a wide range of navigation angles. The powered device exhibits uniform heat distribution across the entire PNIPAM layer, with a temperature variation of <2 °C. The operation of fabricated prototypes assembled on commercial catheter tubes demonstrates their bending angles of up to 200°, significantly larger than those reported with other smart-material-based steerable catheters. The temporal responses and bending forces of their actuations are also characterized to reveal consistent and reproducible behaviors. This proof-of-concept study verifies the promising features of the prototyped approach to the targeted application area. Full article

Vascular intervention involves inserting a catheter and guidewire into blood vessels to diagnose and treat a disease in an X-ray environment. In this conventional vascular intervention procedure, the doctor is exposed to considerable radiation. To reduce the exposure, we developed a master–slave robot system. A steerable catheter is employed to shorten the task-time and reduce the contact force applied to the vessel walls during catheter insertion. The steerable catheter helps to select a vascular branch; thus, the radiation exposure time for patients is reduced, and perforation in the patient’s vessel is prevented. Additionally, the robot system employs a haptic function to replicate the physician’s tactile sensing in vascular intervention. In this study, the effectiveness of the steering catheter and haptic function was demonstrated experimentally in comparison with a conventional catheter. Full article