An Experimental Validation of Behavior-Based Motions for Robotic Coronary Guidewire Crossing Techniques

Abstract

Percutaneous Coronary Intervention (PCI) is a non-surgical approach used to open narrowed coronary arteries and restore arterial blood flow to heart tissue. During a PCI procedure, the clinician uses X-ray fluoroscopy to visualize and guide the catheter, guidewire, and other devices (e.g. angioplasty balloons and stents). Robot-assisted PCI could potentially reduce the radiation exposure of operators and provide a more ergonomic workflow. However, modeling and controlling of the guidewire remains challenging because of the interplay of guidewire motions, the tip properties (e.g., loads, coating), and the local cross-sectional area of the vessel lumen (e.g, stenosis) and results in a highly non-linear system. Thus, robot-assisted PCI devices are still passively controlled by human operators at the cockpit. In this paper, we introduce methods to generate distal guidewire motions that take advantage of the fast response of a robotic system and which may be difficult to generate by a human hand. The fundamental motions that a robot can use to control the movement and direction of the guidewire are rotation and pushing/retracting, from the proximal end of the guidewire outside the insertion point on the patient’s body. We begin by investigating combinations of these fundamental motions under structured environmental settings and conduct a systematic empirical comparison of task completion time for a given setting. We then demonstrate improved dynamic behavior motions for a soft guidewire, which shows a promising speed-up by $33\%$ and $44\%$ for two difficult stenosis cases.