July 28, 2017
The Magellan™ Robotic Catheter System at the TriHealth Neuroscience Institute has a new destination -- the brain -- thanks to Andrew Ringer, MD, a neurosurgeon with Mayfield Brain & Spine and TriHealth Chief of Neurosciences.
The Magellan, acquired through a generous donation to the Good
Samaritan Foundation, has been used since 2014 to treat vascular disease
of the aorta, carotid arteries, renal arteries, and lower extremities.
But after being introduced to the technology, Dr. Ringer suggested that
the robot could also help surgeons perform endovascular (in-the-artery)
procedures through winding, hair-pin vessels of the brain.
After Dr. Ringer and his colleagues began using the Magellan in
February 2015 to perform 1) diagnostic angiography to acquire an x-ray
of blood flow in an artery; and 2) intracranial intervention to break up
clots inside the arteries of emergency stroke patients, he began
partnering with the manufacturer, Hansen Medical, to develop new
technology specifically engineered for intracranial use. Since that
time, Dr. Ringer and his team have diagnosed or treated more than 50
patients with the help of robotic technology at Good Samaritan Hospital.
The results have the potential to change the future of stroke care.
Dr. Ringer and his team were able to demonstrate that robotically
assisted cerebral angiography and intervention are safe and technically
feasible, with no significant difference in mean procedure times, the
time spent under fluoroscopy (continuous, real-time x-ray), or the
volume of contrast agent needed to visualize the arteries. In none of
the cases did the surgeons abandon use of the robot in order to continue
the procedure manually.
Equally important, because the robot can be controlled remotely, it
has the potential to facilitate acute stroke intervention for patients
who do not have immediate access to a comprehensive stroke center.
"Imagine a day when someone with an acute stroke doesn't have to wait
to be transferred to me for a thrombectomy procedure, but can just go
down the hall from the emergency department to the angiography suite,
where I control the procedure from where I am located at that time," Dr.
Ringer says. "This could allow us to provide treatment an hour earlier
in many cases."
The first in the world to document a prospective case series of
robot-assisted cerebral angiography and intracranial intervention, Dr.
Ringer and his team published results of the first 23 patients April
2017 in the journal Neurosurgical Focus. Christopher Carroll, MD,
co-author and neurosurgical resident at the University of Cincinnati,
presented the case series at the annual meeting of the American
Association of Neurological Surgeons in Los Angeles last month.
The timing could not be better.
"Just last week, results from a new stroke trial were released
that indicate that even more patients may benefit from stroke
interventions than we thought," Dr. Ringer says. "This trial, the DAWN
trial, shows that some patients whose stroke is still small on
specialized imaging might benefit for as long as 24 hours after their
stroke. This will increase the need to make endovascular treatment
available to patients, and we want to lead the way in making this care
Technological advances have made the role of endovascular treatment
for acute stroke increasingly important. For years stroke specialists
had dreamed of being able to move quickly and aggressively to remove
bulky, large-vessel blood clots, which may account for as many as half
of the 630,000 ischemic strokes suffered by Americans each year. Because
large clots cannot be easily dissolved with medication, patients who
suffered such blockages were at grave risk of dying or suffering
Endovascular specialists were still waiting as recently as 2013, when
a multi-center trial (Interventional Management of Stroke III) found
that patients had no better outcomes with IV medication than with direct
treatment of the clot. But even as those results were being published,
clot-retriever technology was maturing. And in January 2015 researchers
demonstrated for the first time that patients with clots blocking large
vessels had better outcomes when the clots were extracted with an
endovascular device than when treated with medication alone.
"Our ability to leverage the Magellan for intracranial care is
occurring at an opportune time," Says Dr. Ringer. "It coincides with
technological improvements in the safety of device design, navigation,
image transfer, and remote communications. As those pieces come
together, the promise of Magellan is that it may enhance clot-retrieval
technologies by making them available to more patients in our community,
the region, and around the world."
In addition to Drs. Ringer and Carroll, co-authors of the
Neurosurgical Focus paper are Shawn Vuong, MD, Ryan Tackla, MD, and
William Jeong, MD. All were residents at UC at the time of the study.
Disclosures: Dr. Ringer and his team have no financial relationship with Hansen Medical.