Toronto Hospital Innovates with Remote Robotic Stroke Care

A team at St. Michael’s Hospital in Toronto has achieved a significant milestone in stroke treatment by successfully conducting ten brain angiograms using a remotely controlled robotic system. This innovative approach, led by Dr. Vitor Mendes Pereira, head of the neurovascular program, promises to enhance stroke care for patients in northern Ontario, particularly those in remote areas.

A brain angiogram is a minimally invasive procedure that allows medical professionals to examine blood vessels in the brain. Traditionally, doctors perform this procedure by physically manipulating a catheter inserted through the femoral artery. In a groundbreaking development, Dr. Pereira utilized a computer to control a robot that navigated the catheter remotely, demonstrating a significant advancement in medical technology.

Throughout the procedures, the distance between Dr. Pereira and the robot gradually increased, starting from within the same room and extending to another room in the hospital. Ultimately, he operated the robot from St. Joseph’s Health Centre, located approximately six kilometres away. The connection between the computer and the robot relies on a high-speed fibre optic internet link, allowing for seamless operation.

Dr. Pereira remarked, “I didn’t see any difference on being here in this (operating) room, in the same building or being in another hospital in terms of visualization and also on the surgical experience.”

The next phase of this initiative involves increasing the distance to over 600 kilometres, targeting the Sault Area Hospital in Sault Ste. Marie, Ontario. Once the team completes additional diagnostic angiograms, they plan to seek approval from Health Canada to initiate a clinical trial for conducting endovascular thrombectomies (EVTs) remotely. This procedure is critical for removing blood clots in stroke patients, a service currently unavailable at the Sault Area Hospital.

Patients suffering strokes at the Sault Area Hospital must currently be transported to the nearest stroke centre, which can take between one hour via air ambulance and up to three and a half hours by road. Delays in treatment can result in significant neurological damage, leading to increased rates of disability or death. Dr. Laura Stone, medical director of the emergency department at the Sault Area Hospital, stated, “Every delay in getting treatment after a stroke translates into more neurons dying… Time is brain.”

If the robotic system is implemented at the Sault Area Hospital, Dr. Pereira would be able to perform EVTs remotely, significantly reducing the time patients wait for treatment. The team at St. Michael’s, led by research program manager Nicole Cancelliere, will provide training for technologists and staff at the Sault Area Hospital on how to operate the robot and manage the catheter insertion process.

Dr. Michael Kutryk, an interventional cardiologist and head of cardiology at the Sault Area Hospital, is instrumental in fostering collaboration between the two facilities. He emphasized the life-altering potential of this technology, saying, “It’s going to be the difference between somebody being paralyzed and not able to speak compared to somebody walking out of the hospital two or three days later.”

The robotic-assisted EVTs are anticipated to be operational at the Sault Area Hospital as early as late 2026 or early 2027. Dr. Kutryk highlighted the safety of the robotic system, noting, “This is kind of a perfect thing to do for a robot because it’s so safe in human hands.”

While the main concern is the reliability of the internet connection between the robot and the surgeon, Dr. Pereira assured that rigorous tests will be conducted to ensure a stable link, with backup systems in place. Should any issues arise during a procedure, the team can revert to standard stroke care methods.

Although the Sault Area Hospital was selected for this pioneering project, the St. Michael’s team hopes that their research will benefit patients in other remote regions as well. Dr. Kutryk expressed optimism about the future, saying, “This is maybe a little bit ‘Star Wars,’ but this is going to be a reality, I think, very, very soon in hospitals around the world.”

The robotic system used for these angiograms was developed by Remedy Robotics, a San Francisco-based company specializing in cardiovascular interventions. This advancement not only represents a leap forward in stroke care but also showcases the potential of technology to bridge healthcare gaps in remote areas.