First-in-the-world Remote, Transatlantic Robotic-Guided Thrombectomy in a Perfused Human Cadaveric Model Using the Sentante Endovascular Robotic Platform

Background: Endovascular thrombectomy is the treatment of choice for large-vessel occlusions yet global access remains severely limited by the scarcity and geographic concentration of neuro-interventionists. Robotic systems capable of remote operation may overcome this inequity but the feasibility of long-distance and transatlantic neuro-endovascular use has not been demonstrated in human vasculature. Methods: The first remote transatlantic robotic-guided thrombectomies using whole-body perfused human cadavers were conducted. Procedures were performed using the Sentante Robotic System for Endovascular Intervention (UAB Inovatyvi Medicina), operated sequentially from the local control room, Image Guided Therapy Research Facility, University of Dundee; Surgical Skills Centre, Ninewells Hospital, Dundee; and Baptist Neurological Institute, Florida, US. The system is largely device agnostic, allowing control of commercially available aspiration catheters and stent-retrievers after manual femoral access. Human thrombi were placed in anterior and posterior cerebral arteries. The primary endpoint was technical feasibility; secondary endpoints were latency and operator radiation exposure. Results: 11 remote procedures were completed across three cadavers and three sites. Safe navigation and clot engagement were achieved in all cases using aspiration and/or stent-retriever systems from multiple manufacturers. The median network round trip time was 119 ms (range 0–330 ms); no disconnections or mechanical failures occurred. Haptic feedback was reported as indistinguishable from live procedures. Radiation exposure to the remote operator was 0 mSv. Conclusion: Remote and transatlantic robotic-guided thrombectomy is technically feasible in a lifelike perfused human cadaveric model. This study is the first demonstration of complete endovascular navigation and clot retrieval under remote robotic control and establishes the foundation for future first-in-human clinical translation.