Endovascular interventions are high-stakes procedures requiring precise device operation within complex and tortuous vascular anatomies. Autonomous endovascular navigation has the potential to standardize procedural quality and reduce the performance variability inherent in manual operation. Although Reinforcement Learning (RL) approaches have demonstrated promise in enabling autonomy in endovascular intervention, they often struggle with explicit constraint satisfaction and safety guarantees. To address these challenges, a learning-based expert strategy is introduced, enhancing procedural consistency in autonomous endovascular intervention by explicitly decoupling high-level strategic decision-making from low-level procedural execution. The proposed framework replicates the expert clinical decision-making process: a strategic RL policy generates global navigation intents, which are subsequently refined through an expert-informed execution module. This module ensures that robot movements strictly adhere to expert operational norms, real-time kinematic limits, and vessel safety constraints. Experimental evaluation across high-fidelity 3D simulations and a real-world robotic platform
Remote robotic-assisted endovascular intervention offers a promising approach to reduce clinician radiation exposure and physical strain, while extending specialized vascular care to geographically distant regions. Despite advancements, teleoperated endovascular intervention remains underexplored, especially for time-sensitive interventions like mechanical thrombectomy for acute stroke. The aim of the current review was to determine the evidence regarding teleoperated endovascular robotic systems, covering technical feasibility, communication infrastructure, and clinical outcomes. The review further identified research gaps and future directions. Following PRISMA guidelines, 16 studies were included that met the inclusion criteria out of 2501 initial search results. We found that teleoperated catheters and guidewires, driven by mechanical or electromagnetic systems, can be navigated across distances up to 7000 km. With robust communication infrastructure, network latency remained within clinically acceptable limits (30-163 ms). Although initial outcomes highlighted 100% procedural success in small-scale human trials, most evidence stemmed from animal or phantom models. Overall, the
Autonomous mechanical thrombectomy (MT) presents substantial challenges due to highly variable vascular geometries and the requirements for accurate, real-time control. While reinforcement learning (RL) has emerged as a promising paradigm for the automation of endovascular navigation, existing approaches often show limited robustness when faced with diverse patient anatomies or extended navigation horizons. In this work, we investigate a world-model-based framework for autonomous endovascular navigation built on TD-MPC2, a model-based RL method that integrates planning and learned dynamics. We evaluate a TD-MPC2 agent trained on multiple navigation tasks across hold out patient-specific vasculatures and benchmark its performance against the state-of-the-art Soft Actor-Critic (SAC) algorithm agent. Both approaches are further validated in vitro using patient-specific vascular phantoms under fluoroscopic guidance. In simulation, TD-MPC2 demonstrates a significantly higher mean success rate than SAC (58% vs. 36%, p < 0.001), and mean tip contact forces of 0.15 N, well below the proposed 1.5 N vessel rupture threshold. Mean success rates for TD-MPC2 (68%) were comparable to SAC (60%
In endovascular surgery, the precise identification of catheters and guidewires in X-ray images is essential for reducing intervention risks. However, accurately segmenting catheter and guidewire structures is challenging due to the limited availability of labeled data. Foundation models offer a promising solution by enabling the collection of similar domain data to train models whose weights can be fine-tuned for downstream tasks. Nonetheless, large-scale data collection for training is constrained by the necessity of maintaining patient privacy. This paper proposes a new method to train a foundation model in a decentralized federated learning setting for endovascular intervention. To ensure the feasibility of the training, we tackle the unseen data issue using differentiable Earth Mover's Distance within a knowledge distillation framework. Once trained, our foundation model's weights provide valuable initialization for downstream tasks, thereby enhancing task-specific performance. Intensive experiments show that our approach achieves new state-of-the-art results, contributing to advancements in endovascular intervention and robotic-assisted endovascular surgery, while addressing
Robot-assisted endovascular intervention offers a safe and effective solution for remote catheter manipulation, reducing radiation exposure while enabling precise navigation. Reinforcement learning (RL) has recently emerged as a promising approach for autonomous catheter steering; however, conventional methods suffer from sparse reward design and reliance on static vascular models, limiting their sample efficiency and generalization to intraoperative variations. To overcome these challenges, this paper introduces a sample-efficient RL framework with online expert correction for autonomous catheter steering in endovascular bifurcation navigation. The proposed framework integrates three key components: (1) A segmentation-based pose estimation module for accurate real-time state feedback, (2) A fuzzy controller for bifurcation-aware orientation adjustment, and (3) A structured reward generator incorporating expert priors to guide policy learning. By leveraging online expert correction, the framework reduces exploration inefficiency and enhances policy robustness in complex vascular structures. Experimental validation on a robotic platform using a transparent vascular phantom demonstra
Robotic-assisted endovascular interventions demand accurate, stable, and context-aware guidewire navigation in complex and patient-specific vascular anatomies. Despite recent advances in robotic precision and learning-based control, existing autonomous navigation methods remain limited by their reliance on static reward functions and the lack of explicit procedural reasoning regarding anatomical context and task progression. To address these challenges, this paper proposes a vision-language procedural reasoning (VL-PR) framework for autonomous guidewire navigation. The framework integrates a multimodal large language model (MLLM) as a procedural reasoning module that interprets real-time visual observations to infer high-level navigation contexts. Instead of generating low-level control commands, the inferred procedural insights enable context-aware reward adaptation by dynamically adjusting the importance of reward components across different navigation phases. This approach allows a single policy to resolve competing objectives and handle complex transitions while preserving a consistent global task goal. Experiments on a physical robotic platform across diverse vascular scenario
Purpose: Developing and testing a framework that integrates real-time catheter shape reconstruction, interactive simulations, and mixed reality visualization to enable accurate monitoring of catheter-vessel interactions during endovascular navigation. Methods: A finite element model (FEM) of the venous pathway from the right femoral vein to the inferior vena cava was generated from computed tomography data and implemented into an interactive simulation. Catheter motion was imposed as boundary condition, and catheter-vessel contact was modeled with a Lagrange multiplier formulation to compute vessel deformation. The framework was tested in-vitro using a sensorized catheter with Fiber Bragg Grating and electromagnetic sensors as it was advanced through a silicone replica of the vascular anatomy. Real-time sensor read-outs fed the simulation, and the updated catheter and vessel geometries were streamed to Hololens 2. The performance and accuracy of FEM-computed vessel wall displacement were validated against experimental ground-truth obtained via stereo frames triangulation. Results: The simulated time exceeded the real temporal extent by 12% during initial navigation and by 45% when
Endovascular interventions are a life-saving treatment for many diseases, yet suffer from drawbacks such as radiation exposure and potential scarcity of proficient physicians. Robotic assistance during these interventions could be a promising support towards these problems. Research focusing on autonomous endovascular interventions utilizing artificial intelligence-based methodologies is gaining popularity. However, variability in assessment environments hinders the ability to compare and contrast the efficacy of different approaches, primarily due to each study employing a unique evaluation framework. In this study, we present deep reinforcement learning-based autonomous endovascular device navigation on three distinct digital benchmark interventions: BasicWireNav, ArchVariety, and DualDeviceNav. The benchmark interventions were implemented with our modular simulation framework stEVE (simulated EndoVascular Environment). Autonomous controllers were trained solely in simulation and evaluated in simulation and on physical test benches with camera and fluoroscopy feedback. Autonomous control for BasicWireNav and ArchVariety reached high success rates and was successfully transferred
Long-term mortality rates after endovascular aneurysm repair (EVAR) remain elevated due to post-EVAR rupture caused by loss of seal in stent graft sealing zones. Structured CT review using centerline measurements improves detection, but current workflows require manual centerline editing and expert operators. We propose a transformer framework for automated, protocol-driven sealing zone assessment that combines 3D centerline tracking with embedding-based geometric prediction. Two state-of-the-art image-to-graph models are evaluated for aorto-iliac centerline extraction from follow-up CT and for measurement of stent position, vessel diameters, and seal lengths according to EVAR4C protocol. Across the full test set and a challenging no-contrast subset, the proposed fully automatic method outperforms the commercial semi-automatic workflow.
Cardiovascular diseases remain the leading cause of global mortality, with minimally invasive treatment options offered through endovascular interventions. However, the precision and adaptability of current robotic systems for endovascular navigation are limited by heuristic control, low autonomy, and the absence of haptic feedback. This thesis presents an integrated AI-driven framework for autonomous guidewire navigation in complex vascular environments, addressing key challenges in data availability, simulation fidelity, and navigational accuracy. A high-fidelity, real-time simulation platform, CathSim, is introduced for reinforcement learning based catheter navigation, featuring anatomically accurate vascular models and contact dynamics. Building on CathSim, the Expert Navigation Network is developed, a policy that fuses visual, kinematic, and force feedback for autonomous tool control. To mitigate data scarcity, the open-source, bi-planar fluoroscopic dataset Guide3D is proposed, comprising more than 8,700 annotated images for 3D guidewire reconstruction. Finally, SplineFormer, a transformer-based model, is introduced to directly predict guidewire geometry as continuous B-splin
Endovascular procedures have revolutionized vascular disease treatment, yet their manual execution is challenged by the demands for high precision, operator fatigue, and radiation exposure. Robotic systems have emerged as transformative solutions to mitigate these inherent limitations. A pivotal moment has arrived, where a confluence of pressing clinical needs and breakthroughs in AI creates an opportunity for a paradigm shift toward Embodied Intelligence (EI), enabling robots to navigate complex vascular networks and adapt to dynamic physiological conditions. Data-driven approaches, leveraging advanced computer vision, medical image analysis, and machine learning, drive this evolution by enabling real-time vessel segmentation, device tracking, and anatomical landmark detection. Reinforcement learning and imitation learning further enhance navigation strategies and replicate expert techniques. This review systematically analyzes the integration of EI into endovascular robotics, identifying profound systemic challenges such as the heterogeneity in validation standards and the gap between human mimicry and machine-native capabilities. Based on this analysis, a conceptual roadmap is p
Real-time visual feedback from catheterization analysis is crucial for enhancing surgical safety and efficiency during endovascular interventions. However, existing datasets are often limited to specific tasks, small scale, and lack the comprehensive annotations necessary for broader endovascular intervention understanding. To tackle these limitations, we introduce CathAction, a large-scale dataset for catheterization understanding. Our CathAction dataset encompasses approximately 500,000 annotated frames for catheterization action understanding and collision detection, and 25,000 ground truth masks for catheter and guidewire segmentation. For each task, we benchmark recent related works in the field. We further discuss the challenges of endovascular intentions compared to traditional computer vision tasks and point out open research questions. We hope that CathAction will facilitate the development of endovascular intervention understanding methods that can be applied to real-world applications. The dataset is available at https://airvlab.github.io/cathaction/.
This research reports VascularPilot3D, the first 3D fully autonomous endovascular robot navigation system. As an exploration toward autonomous guidewire navigation, VascularPilot3D is developed as a complete navigation system based on intra-operative imaging systems (fluoroscopic X-ray in this study) and typical endovascular robots. VascularPilot3D adopts previously researched fast 3D-2D vessel registration algorithms and guidewire segmentation methods as its perception modules. We additionally propose three modules: a topology-constrained 2D-3D instrument end-point lifting method, a tree-based fast path planning algorithm, and a prior-free endovascular navigation strategy. VascularPilot3D is compatible with most mainstream endovascular robots. Ex-vivo experiments validate that VascularPilot3D achieves 100% success rate among 25 trials. It reduces the human surgeon's overall control loops by 18.38%. VascularPilot3D is promising for general clinical autonomous endovascular navigations.
Endovascular brain-computer interfaces (eBCIs) offer a minimally invasive way to connect the brain to external devices, merging neuroscience, engineering, and medical technology. Achieving wireless data and power transmission is crucial for the clinical viability of these implantable devices. Typically, solutions for endovascular electrocorticography (ECoG) include a sensing stent with multiple electrodes (e.g. in the superior sagittal sinus) in the brain, a subcutaneous chest implant for wireless energy harvesting and data telemetry, and a long (tens of centimetres) cable with a set of wires in between. This long cable presents risks and limitations, especially for younger patients or those with fragile vasculature. This work introduces a wireless and leadless telemetry and power transfer solution for endovascular ECoG. The proposed solution includes an optical telemetry module and a focused ultrasound (FUS) power transfer system. The proposed system can be miniaturised to fit in an endovascular stent. Our solution uses optical telemetry for high-speed data transmission (over 2 Mbit/s, capable of transmitting 41 ECoG channels at a 2 kHz sampling rate and 24-bit resolution) and the
Predicting the long-term success of endovascular interventions in the clinical management of cerebral aneurysms requires detailed insight into the patient-specific physiological conditions. In this work, we not only propose numerical representations of endovascular medical devices such as coils, flow diverters or Woven EndoBridge but also outline numerical models for the prediction of blood flow patterns in the aneurysm cavity right after a surgical intervention. Detailed knowledge about the post-surgical state then lays the basis to assess the chances of a stable occlusion of the aneurysm required for a long-term treatment success. To this end, we propose mathematical and mechanical models of endovascular medical devices made out of thin metal wires. These can then be used for fully resolved flow simulations of the post-surgical blood flow, which in this work will be performed by means of a Lattice Boltzmann method applied to the incompressible Navier-Stokes equations and patient-specific geometries. To probe the suitability of homogenized models, we also investigate poro-elastic models to represent such medical devices. In particular, we examine the validity of this modeling appr
Endovascular navigation is a crucial aspect of minimally invasive procedures, where precise control of curvilinear instruments like guidewires is critical for successful interventions. A key challenge in this task is accurately predicting the evolving shape of the guidewire as it navigates through the vasculature, which presents complex deformations due to interactions with the vessel walls. Traditional segmentation methods often fail to provide accurate real-time shape predictions, limiting their effectiveness in highly dynamic environments. To address this, we propose SplineFormer, a new transformer-based architecture, designed specifically to predict the continuous, smooth shape of the guidewire in an explainable way. By leveraging the transformer's ability, our network effectively captures the intricate bending and twisting of the guidewire, representing it as a spline for greater accuracy and smoothness. We integrate our SplineFormer into an end-to-end robot navigation system by leveraging the condensed information. The experimental results demonstrate that our SplineFormer is able to perform endovascular navigation autonomously and achieves a 50% success rate when cannulating
Accurate three-dimensional (3D) reconstruction of guidewire shapes is crucial for precise navigation in robot-assisted endovascular interventions. Conventional 2D Digital Subtraction Angiography (DSA) is limited by the absence of depth information, leading to spatial ambiguities that hinder reliable guidewire shape sensing. This paper introduces a novel multimodal framework for real-time 3D guidewire reconstruction, combining preoperative 3D Computed Tomography Angiography (CTA) with intraoperative 2D DSA images. The method utilizes robust feature extraction to address noise and distortion in 2D DSA data, followed by deformable image registration to align the 2D projections with the 3D CTA model. Subsequently, the inverse projection algorithm reconstructs the 3D guidewire shape, providing real-time, accurate spatial information. This framework significantly enhances spatial awareness for robotic-assisted endovascular procedures, effectively bridging the gap between preoperative planning and intraoperative execution. The system demonstrates notable improvements in real-time processing speed, reconstruction accuracy, and computational efficiency. The proposed method achieves a projec
Aims: To develop an in-silico model of the aorta and its spinal cord-supplying branches, and to characterise haemodynamic changes following aortic aneurysm (AA) repair with such a model. The work is motivated by the risk of spinal cord ischaemia (SCI) and paraplegia, serious complications that can arise from disruption of spinal cord perfusion during AA surgery. Methods: SimVascular was used to retrospectively create models of a 76 year old female patient's aorta pre- and post- uncomplicated endovascular AA repair. The full extent of the aorta and its branches, including vessels supplying the spinal cord, was segmented. Pulsatile flow simulations were conducted under the assumption of rigid vessel walls, with patient-specific inlet and three-element Windkessel models for the outlet boundary conditions on the SimVascular Gateway Cluster. Results: Postoperatively, segmental artery flow to the spinal cord decreased by 51.86% due to exclusion of lumbar and posterior intercostal arteries by the stent graft. Spinal cord-supplying arteries showed increased TAWSS (+5.2%) and reduced RRT and ECAP, with minimal change in OSI. Consistent with redistribution away from the spinal territory, mod
An Oculomotor Brain-Computer Interface (BCI) records neural activity from regions of the brain involved in planning eye movements and translates this activity into control commands. While previous successful oculomotor BCI studies primarily relied on invasive microelectrode implants in non-human primates, this study investigates the feasibility of an oculomotor BCI using a minimally invasive endovascular Stentrode device implanted near the supplementary motor area in a patient with amyotrophic lateral sclerosis (ALS). To achieve this, self-paced visually-guided and free-viewing saccade tasks were designed, in which the participant performed saccades in four directions (left, right, up, down), with simultaneous recording of endovascular EEG and eye gaze. The visually guided saccades were cued with visual stimuli, whereas the free-viewing saccades were self-directed without explicit cues. The results showed that while the neural responses of visually guided saccades overlapped with the cue-evoked potentials, the free-viewing saccades exhibited distinct saccade-related potentials that began shortly before eye movement, peaked approximately 50 ms after saccade onset, and persisted for
An ever-growing incorporation of AI solutions into clinical practices enhances the efficiency and effectiveness of healthcare services. This paper focuses on guidewire tip tracking tasks during image-guided therapy for cardiovascular diseases, aiding physicians in improving diagnostic and therapeutic quality. A novel tracking framework based on a Siamese network with dual attention mechanisms combines self- and cross-attention strategies for robust guidewire tip tracking. This design handles visual ambiguities, tissue deformations, and imaging artifacts through enhanced spatial-temporal feature learning. Validation occurred on 3 randomly selected clinical digital subtraction angiography (DSA) sequences from a dataset of 15 sequences, covering multiple interventional scenarios. The results indicate a mean localization error of 0.421 $\pm$ 0.138 mm, with a maximum error of 1.736 mm, and a mean Intersection over Union (IoU) of 0.782. The framework maintains an average processing speed of 57.2 frames per second, meeting the temporal demands of endovascular imaging. Further validations with robotic platforms for automating diagnostics and therapies in clinical routines yielded tracking