Toronto Hospital Innovates Remote Robotic Stroke Treatment

St. Michael’s Hospital in Toronto has reached a significant milestone in stroke care by successfully conducting ten brain angiograms using a remotely controlled robot operated by a neurosurgeon. This innovative approach could transform how critical stroke treatment is delivered to patients in northern Ontario, particularly those in remote areas.

A brain angiogram is a minimally invasive diagnostic procedure that involves inserting a catheter into the femoral artery and guiding it to the brain. By injecting contrast dye, healthcare providers can identify any issues within the blood vessels through X-ray imaging. Traditionally, the physician performs this procedure in close proximity to the patient. In a pioneering effort, Dr. Vitor Mendes Pereira, head of St. Michael’s neurovascular program, utilized a computer to control a robot that maneuvered the catheter during the angiograms.

As part of this groundbreaking initiative, the distance between Dr. Pereira and the robot progressively increased during the procedures. Initially, he operated the robot from across the room, then from another room in the hospital, and finally from St. Joseph’s Health Centre, located approximately six kilometers away. Both hospitals are part of Unity Health Toronto. Utilizing an “incredibly fast” fibre optic internet connection, Dr. Pereira reported that he experienced no difference in visualization or surgical experience regardless of the distance from the operating room.

The next phase of this project aims to extend the operational distance to more than 600 kilometers, connecting Toronto with the Sault Area Hospital in Sault Ste. Marie, Ontario. Following additional diagnostic angiograms, the team plans to seek approval from Health Canada to initiate clinical trials using the robotic technology for endovascular thrombectomies (EVTs). This procedure involves using a stent to capture and remove blood clots that cause strokes. Currently, patients requiring EVTs must be transported to the nearest stroke center in Sudbury, Ontario, which can take from one hour via air ambulance to three and a half hours by road.

Dr. Laura Stone, medical director of the Sault Area Hospital’s emergency department, highlighted the urgency of timely treatment for stroke patients, stating, “Every delay in getting treatment after a stroke translates into more neurons dying, which means more disability — or death — for the patient.” She emphasized that having the robotic technology available at the Sault hospital would allow for immediate treatment, significantly improving patient outcomes.

The St. Michael’s team, led by research program manager and technologist Nicole Cancelliere, is committed to training the technologists and staff at Sault Area Hospital on how to operate the robot and insert the catheter. Dr. Michael Kutryk, interventional cardiologist and head of cardiology at Sault Area Hospital, has been instrumental in establishing this partnership. He underscored the potential impact of this technology: “It’s going to be the difference between somebody being paralyzed and dysarthric — not able to speak — compared to somebody walking out of the hospital two or three days later.”

Dr. Kutryk anticipates that the robot-assisted EVTs could be operational at Sault Area Hospital by late 2026 or early 2027. He noted that the robotic system is exceptionally safe in human hands, minimizing the likelihood of complications during procedures.

While one of the primary risks is potential disruption to the internet connection between the surgeon and the robot, Dr. Pereira stated that the connection undergoes rigorous testing. There are plans for backup connections to ensure continuity. If any delays occur, the procedure can be halted, and the hospital staff will revert to traditional stroke care methods.

This innovative approach addresses the challenge of hiring a dedicated neurovascular specialist to be on call for EVTs at the Sault hospital, where there are only 12 to 15 patients needing the procedure each year. Dr. Stone expressed optimism about the robotic technology, stating, “We’re increasing the speed to these patients getting this life-saving procedure done.”

The partnership with Sault Ste. Marie is just the beginning, as the St. Michael’s team hopes their research will benefit patients in other remote regions as well. Dr. Kutryk described the project as “kind of a perfect thing to do for a robot,” suggesting that such advancements may soon become commonplace in hospitals globally.

The robot utilized for these brain angiograms was developed by Remedy Robotics, a San Francisco-based company specializing in cardiovascular interventions. This remarkable advancement in stroke care could soon change the landscape of medical treatment for remote communities.