Controller for robotized catheter drive system

Abstract

A method of robotically controlling an interventional device includes: providing an interventional device assembly having a plurality of interventional devices; advancing, in a first mode of operation, a first subset of the plurality of interventional devices into the mouth of the descending aorta in response to movement of a control of the controller, where the first subset of the plurality of interventional devices is connected to the control in the first mode of operation; and switching from the first operating mode to the second operating mode in response to a user input using the controller. Switching from the first mode of operation to the second mode of operation causes a second subset of the plurality of interventional devices to be connected to the control of the controller. The method also includes advancing a second subset of the plurality of interventional devices to the treatment site in a second mode of operation.

Description

[0001] Cross Reference to Related Applications

[0002] Any and all applications for which priority is claimed under 37 C.F.R. 1.57 from a foreign or domestic priority application(s) are hereby incorporated by reference in their entirety as if fully set forth herein. This application claims priority to U.S. Provisional Application No. 63 / 429,502, filed December 1, 2022, entitled “CONTROLLER FOR ROBOTIC CATHETER DRIVE SYSTEM,” the entire contents of which are incorporated herein by reference for all purposes and made a part of the specification. TECHNICAL FIELD

[0003] The present application relates to neurovascular procedures, and more particularly, to catheter assemblies and roboticized control systems for neurovascular site access. BACKGROUND

[0004] Various neurovascular procedures can be accomplished via neurovascular access, including thrombectomy, diagnostic angiography, embolic coil deployment, and stent placement. However, the delivery of neurovascular care is limited or delayed by a variety of challenges. For example, there are not enough trained interventionalists and medical centers to meet the current demand for neurointervention. Neurointervention is difficult, placing complex conditions and requirements on the surgeon’s dexterity. The surgeon must precisely control 3 to 4 coaxial catheters with both hands while managing the fluoroscopy system and patient positioning. Long, curved anatomies require delicate, accurate manipulation. Unintended catheter motion can occur due to energy storage and release from frictional interactions between the concentric shafts and the patient’s vascular system. Achieving the necessary aortic supra-access to reach the neurovascular system is challenging, particularly for type III arches. When aortic supra-access is achieved, adapting the system to neurovascular therapy is time-consuming and requires removal of the guide wire and access catheter and addition of the procedural catheter (and possibly one or more additional catheters) to the stack.

[0005] Accordingly, there remains a need for aortic supra-access and neurovascular site access systems that address some or all of these challenges and increase the availability of neurovascular procedures. Preferably, the system additionally enables driving devices more distally through aortic supra-access to accomplish procedures in intracranial vessels. SUMMARY

[0006] According to an aspect of the present disclosure, a roboticized access over the aorta system is provided. The system includes a guidewire hub configured to adjust each of an axial position and a rotational position of a guidewire, a guide catheter hub configured to adjust a guide catheter in an axial direction, and an access catheter hub configured to adjust each of an axial position and a rotational position of an access catheter. The access catheter hub can also laterally deflect a distal deflection region of the access catheter. The guidewire hub can additionally be configured to laterally deflect a distal portion of the guidewire.

[0007] A surgical catheter hub can also be provided configured to manipulate a surgical catheter. After roboticized placement of the guidewire, access catheter, and guide catheter results in the guide catheter achieving access over the aorta, the guidewire and access catheter can be withdrawn proximally, and the surgical catheter is advanced through and beyond the guide catheter (with or without guidewire support (the guidewire can be of a smaller diameter and / or more flexible than the guidewire used to achieve access over the aorta)) to reach a more distal neurovascular treatment site. The surgical catheter can be an aspiration catheter; an embolization deployment catheter; a stent deployment catheter; a flow diverter deployment catheter, an access catheter; a diagnostic angiographic catheter; a guide catheter, an imaging catheter, a physiologic sensing / measuring catheter, an infusion or injection catheter, an ablation catheter, an RF ablation catheter or guidewire, a balloon catheter, or a microcatheter for delivery of a stentriever, balloon catheter, or stentriever.

[0008] The control system can also include a driven magnet on each of the guidewire hub, access catheter hub, and guide catheter hub configured to mate with a corresponding drive magnet such that the driven magnet moves in response to movement of the corresponding drive magnet. The drive magnets can each be independently axially moved by a support table. The drive magnets can be located outside of a sterile field, separated from the driven magnets by a barrier, and the driven magnets can be within the sterile field. The barrier can include a tray made of a thin polymer film or a film of any non-ferromagnetic material.

[0009] The control system can also include a console that can be connected to the support table or can be located remotely from the support table. The position of each driven magnet and corresponding hub can be moved in response to manual operation of a guidewire drive control, an access catheter drive control, or a surgical catheter drive control on the console or on a specific controller not associated with the console.

[0010] The control system can also include a processor for controlling the position of the drive magnets. The processor can be in wired communication with the console or in wireless communication with the console. The driven magnets can be configured to remain engaged with the corresponding drive magnets until an axial breakaway force of at least about 300 grams is applied.

[0011] Robotically operated interventional devices are also provided. The devices include an elongate flexible body having a proximal end and a distal end. A hub is provided on the proximal end. At least one rotatable roller is provided on a first surface of the hub; and at least one magnet is provided on the first surface of the hub. The roller can extend further from the first surface than the magnet. The hub can also be equipped with at least one second roller.

[0012] Any of the guidewire hub, the access catheter hub, and the procedural catheter hub can also be equipped with a rotational driver for rotating the corresponding interventional device relative to the hub. The hub can also be equipped with an axial drive mechanism to advance distally or retract proximally a control element extending axially through the interventional device to adjust a property of the interventional device, such as shape or flexibility. In some embodiments, the at least one control element can be an axially movable tube or fiber, ribbon, or wire, such as a wire extending through the interventional device to a distal deflection region, for example. In some embodiments, any number of control elements can be advanced, retracted, or otherwise moved in a similar manner.

[0013] A control system for controlling movement of an interventional device is also provided. In one configuration, the control system includes a guidewire control configured to control axial travel and rotation of a guidewire; an access catheter control configured to control axial and rotational movement of an access catheter; and a guide catheter control configured to control axial movement and / or rotation of a guide catheter.

[0014] The control system can also include a deflection control configured to control deflection of an access catheter or a procedural catheter, and can be configured for wired or wireless communication with a robotic catheter drive system.

[0015] The control system can be configured to independently control the three or more hubs in various modes. For example, two or more hubs can be selectively combined together so that they drive the corresponding devices simultaneously and have the same motion. Alternatively, the control system can be configured to drive the corresponding devices simultaneously but with different motions.

[0016] The control system can also include a physician interface for operating the control system. The physician interface can be carried by a support table having a robotic interventional device drive system. Alternatively, the physician interface for operating the control system can be carried on a portable, hand-held device or a desktop computer, and can be located in the same room as the patient, in the same facility as the patient, or in a remote facility.

[0017] The control system can also include a graphical user interface having at least one display for indicating a status of at least one device parameter, and / or indicating a status of at least one patient parameter.

[0018] Also provided are sterile packaging assemblies for transporting interventional devices to a roboticized surgical site. The packaging assemblies can include a base and a sterile barrier configured to enclose a sterile volume. At least one interventional device can be provided within the sterile volume, the device including a hub and an elongate flexible body. The hub can include at least one magnet and at least one roller configured to roll on the base.

[0019] In one embodiment, the sterile barrier is detachably attached to the base to define an enclosed volume between the sterile barrier and the base. In another embodiment, the sterile barrier is in the form of a tubular enclosure for enclosing the sterile volume. The tubular enclosure can surround the base and the at least one interventional device, and they are all within the sterile volume.

[0020] The hub can be oriented within the packaging such that the roller and the magnet face the base. Alternatively, the base can be in the form of a tray having an elongate central axis. The upper sterile area side of the tray can have an elongate support surface for supporting and allowing sliding movement of one or more hubs. At least one and optionally two elongate trays can be provided, extending parallel to the central axis. At least one hub and interventional device can be provided in the tray, and the sterile tray with the sterile hub and interventional device can be located in the sterile volume defined by the sterile barrier.

[0021] The base can be configured to be located on a support table adjacent to a patient, with an upper surface of the base being within a sterile field and a lower surface of the base being outside the sterile field.

[0022] Any of the hubs disclosed herein can also include a fluid injection port and / or a wireless RF transceiver for communication and / or power transfer. The hub can include a visual indicator for indicating the presence of a clot. In some embodiments, the hub can also include a wired electrical communication and power port. The visual indicator can include a clot chamber with a transparent window. A filter can be provided in the clot chamber.

[0023] Any of the hubs disclosed herein can also include a sensor for detecting a purpose parameter (e.g., the presence of a clot). In some cases, the sensor can be located on the flexible body. The sensor can include a pressure sensor or an optical sensor. In some embodiments, the sensor can include one or more of a force sensor, a position sensor, a temperature sensor, and / or an oxygen sensor. In some embodiments, the sensor can include a fiber Bragg grating sensor. For example, a fiber Bragg grating sensor (e.g., optical fiber) can detect strain locally, which can facilitate detection and / or determination of applied force. The device can also include a plurality of sensors. The plurality of sensors can each include one or more of any of the types of sensors disclosed herein. In some embodiments, a plurality (e.g., 3 or more) of sensors (e.g., fiber Bragg grating sensors) can be distributed around the perimeter to facilitate detection and / or determination of shape. In some cases, the position of the device can be determined by using one or more sensors to detect and / or determine position. For example, one or more optical encoders can be located in or near one or more motors that drive linear motion, such that the optical encoders can determine position.

[0024] Methods of performing neurovascular procedures are also provided, in which a first stage includes robotically effecting a supra-aortic access, and a second stage includes manually or robotically performing a neurovascular procedure via the supra-aortic access. The methods include the steps of providing an access catheter having an access catheter hub; connecting the access catheter hub to a hub adapter that is movably carried by a support table; driving the access catheter in response to movement of the hub adapter along the table until the access catheter is positioned to effect a supra-aortic access. The access catheter and access catheter hub can then be disconnected from the hub adapter; and a procedure catheter hub having a procedure catheter can subsequently be connected to the hub adapter.

[0025] The methods can additionally include advancing the procedure catheter hub to position a distal end of the procedure catheter at a neurovascular treatment site. The step of driving the access catheter can include driving the access catheter distally through a guide catheter. The step of driving the access catheter can include the step of laterally deflecting a distal region of the access catheter to effect a supra-aortic access. In some embodiments, the step of driving the access catheter can also include rotating the access catheter.

[0026] Methods of performing neurovascular surgery are also provided, including the step of providing an access assembly including a guidewire, an access catheter, and a guide catheter. The access assembly can be releasably connected to a robotic drive system. The access assembly can be driven by the robotic drive system to achieve access to a desired point, such as to achieve access over an aorta. The guidewire and access catheter can then be separated from the access assembly, leaving the guide catheter in place. A surgical assembly can be provided, including at least the guidewire and a first surgical catheter. The surgical assembly can be releasably connected to the robotic drive system; and the neurovascular surgery can be completed using the surgical assembly. A second surgical catheter can also be provided for extending through the first surgical catheter to a treatment site.

[0027] The step of connecting the access assembly can include magnetically connecting a hub on each of the guidewire, the access catheter, and the guide catheter to separate corresponding connectors that carry corresponding drive magnets movably carried independently by the drive stage. The surgical assembly can include the guidewire, the first catheter, and a second catheter. The guidewire and the first catheter can be concentrically located within the second catheter. The surgical assembly can be advanced as an assembly through at least a portion of a length of the guide catheter, and the surgery can include neurovascular thrombectomy.

[0028] Methods of performing neurovascular surgery are also provided. The method includes the steps of providing a multi-catheter assembly including an access catheter, a guide catheter, and a surgical catheter, connecting the assembly to a robotic drive system, driving the assembly to achieve access over an aorta, driving a subset of the assembly to a neurovascular site, where the subset includes the guide catheter and the surgical catheter, removing the access catheter proximally, and performing neurovascular surgery using the surgical catheter.

[0029] The neurovascular surgery can include neurovascular thrombectomy. The assembly can also include a guidewire, where each of the guidewire, the access catheter, the guidewire catheter, and the surgical catheter are configured to be adjusted by a respective hub. Connecting the assembly to the robotic drive system can include magnetically connecting a first hub of the guidewire to a first drive magnet, magnetically connecting a second hub of the access catheter to a second drive magnet, magnetically connecting a third hub of the guide catheter to a third drive magnet, and magnetically connecting a fourth hub of the surgical catheter to a fourth drive magnet. Each of the first drive magnet, the second drive magnet, the third drive magnet, and the fourth drive magnet can be movably carried independently by the drive stage. The surgical catheter can be an aspiration catheter. The surgical catheter can be an embolic deployment catheter. The surgical catheter can be a stent deployment catheter. The surgical catheter can be a shunt deployment catheter. The surgical catheter can be a diagnostic angiography catheter. The surgical catheter can be a stent retriever catheter. The surgical catheter can be a clot retriever. The surgical catheter can be a balloon catheter. The surgical catheter can be a catheter to facilitate percutaneous valve repair or replacement. The surgical catheter can be an ablation catheter.

[0030] Methods of performing intracranial procedures are also provided. The methods include the steps of providing an assembly including a guidewire, an access catheter, a guide catheter, and a procedural catheter, coaxially movably assembling the assembly into a single multi-catheter assembly, connecting the assembly to a drive system, driving the assembly to achieve an aortic access, driving a subset of the assembly to an intracranial site, wherein the subset includes the guidewire, the guide catheter, and the procedural catheter, and performing an intracranial procedure using the subset of the assembly.

[0031] The intracranial procedure can include an intracranial thrombectomy. Each of the guidewire, the access catheter, the guide catheter, and the procedural catheter can be configured to be adjusted by a respective hub. Connecting the assembly to the drive system can include magnetically connecting a first hub of the guidewire to a first drive magnet, magnetically connecting a second hub of the access catheter to a second drive magnet, magnetically connecting a third hub of the guide catheter to a third drive magnet, and magnetically connecting a fourth hub of the procedural catheter to a fourth drive magnet. The drive system can be a robotic drive system, and the first drive magnet, the second drive magnet, the third drive magnet, and the fourth drive magnet can each be independently movably carried by a drive stage associated with the robotic drive system. Each of the first drive magnet, the second drive magnet, the third drive magnet, and the fourth drive magnet can be independently movably carried by the drive stage.

[0032] Methods of performing neurovascular procedures are also provided. The methods can include the steps of providing an assembly including a guidewire, an access catheter, a guide catheter, and a procedural catheter, advancing the assembly to achieve an aortic access, advancing a subset of the assembly to a neurovascular site, wherein the subset includes the guidewire, the guide catheter, and the procedural catheter, and performing a neurovascular procedure using the subset of the assembly.

[0033] The neurovascular procedure can include a neurovascular thrombectomy. The procedural catheter can be an aspiration catheter. The procedural catheter can be an embolic deployment catheter. The procedural catheter can be a stent deployment catheter. The procedural catheter can be a shunt deployment catheter. The procedural catheter can be a diagnostic angiography catheter. The procedural catheter can be a stent retriever catheter. The procedural catheter can be a clot retriever. The procedural catheter can be a balloon catheter. The procedural catheter can be a catheter to facilitate a percutaneous valve repair or replacement. The procedural catheter can be an ablation catheter.

[0034] Methods of robotically controlling interventional devices are also provided. The methods include providing an interventional device assembly including a plurality of interventional devices, the plurality of interventional devices including a first interventional device and a second interventional device. The methods include advancing the first interventional device and the second interventional device from a first set of positions to a second set of positions in response to movement of a control of a controller, wherein a relative distance between a distal end of the first interventional device and a distal end of the second interventional device at the second set of positions is different than a relative distance between the distal end of the first interventional device and the distal end of the second interventional device at the first set of positions.

[0035] Methods of robotically controlling interventional devices are provided. The methods include providing an interventional device assembly including a plurality of interventional devices, the plurality of interventional devices including a first interventional device and a second interventional device, wherein the first interventional device is connected to a first control such that movement of the first control causes a responsive movement of the first interventional device, and the second interventional device is connected to a second controller such that movement of the second control causes a responsive movement of the second interventional device. The methods include associating movement of the second interventional device with movement of the first interventional device such that when movement of the first control causes a responsive movement of the first interventional device that would result in a separation distance between the first interventional device and the second interventional device that is greater than a separation distance allowed by a drivable surface of a drive stage, the second interventional device moves at the same speed in the same direction as the first interventional device.

[0036] In some embodiments, the methods can include determining, by the one or more hardware processors, that movement of the first control causes a responsive movement of the first interventional device that would result in a separation distance between the first interventional device and the second interventional device that is greater than a separation distance allowed by a drivable surface of a drive stage. In some embodiments, the first interventional device is a guide catheter and the second interventional device is a guidewire. In some embodiments, the methods can include disconnecting the second interventional device from the first interventional device in response to movement of the second control to cause a responsive movement of the second interventional device in a direction.

[0037] Methods of robotically controlling interventional devices are provided. The methods include providing an interventional device assembly including a plurality of interventional devices, the plurality of interventional devices including a first interventional device connected to a first hub and a second interventional device connected to a second hub, wherein the first hub is connected to a first control such that movement of the first control causes a responsive movement of the first hub, and the second hub is connected to a second control such that movement of the second control causes a responsive movement of the second hub. The methods include associating movement of the second hub with movement of the first hub such that when movement of the first control causes a responsive movement of the first hub, the second hub moves at the same speed in the same direction as the first hub, which would result in a separation distance between the first hub and the second hub that is greater than a separation distance allowed by a drivable surface of a drive stage.

[0038] In some embodiments, the method can include determining, by the one or more hardware processors, that movement of the first control will result in a responsive movement of the first hub that will result in a separation distance between the first hub and the second hub that is greater than a separation distance allowed by a drivable surface of the drive stage. In some embodiments, the first hub is a guide catheter hub and the second hub is a guidewire hub. In some embodiments, the method can include disconnecting the second hub from the first hub in response to movement of the second control to cause a responsive movement of the second hub in that direction.

[0039] Methods of robotically controlling interventional devices are provided. The methods include providing an interventional device assembly including a plurality of interventional devices, the plurality of interventional devices including a first interventional device connected to a first hub adapter and a second interventional device connected to a second hub adapter, wherein the first hub adapter is connected to a first control such that movement of the first control causes a responsive movement of the first hub adapter, and the second hub adapter is connected to a second control such that movement of the second control causes a responsive movement of the second hub adapter. The methods include connecting movement of the second hub adapter to movement of the first hub adapter such that when movement of the first control would cause a responsive movement of the first hub adapter that would result in a separation distance between the first hub adapter and the second hub adapter that is greater than a separation distance allowed by a drive surface of a drive stage, the second hub adapter moves in the same direction and at the same speed as the first hub adapter.

[0040] In some embodiments, the method can include determining, by the one or more hardware processors, that movement of the first control will result in a responsive movement of the first hub that will result in a separation distance between the first hub and the second hub that is greater than a separation distance allowed by a drivable surface of the drive stage. In some embodiments, the first interventional device is a guide catheter and the second interventional device is a guidewire. In some embodiments, the method can include disconnecting the second hub adapter from the first hub adapter in response to movement of the second control to cause a responsive movement of the second hub adapter in that direction. In some embodiments, the drive surface is a shuttle configured to move axially within the drive stage.

[0041] Robotic catheter control systems are also provided. A robotic catheter control system includes a first control associated with a first interventional device; and a second control associated with a second interventional device; wherein movement of the first control device in an axial direction from a starting axial position causes a responsive movement of the first interventional device in a corresponding axial direction, wherein an axial velocity of the first interventional device in the corresponding axial direction or an amount of axial movement of the first interventional device in the corresponding axial direction corresponds to an amount of axial movement of the first control in the axial direction; wherein movement of the first control in a rotational direction from a starting rotational position causes a responsive movement of the first interventional device in a corresponding rotational direction, wherein a rotational velocity of the first interventional device in the corresponding rotational direction or an amount of rotational movement of the first interventional device in the corresponding rotational direction corresponds to an amount of rotational movement of the first control in the rotational direction.

[0042] In some aspects, an axial arrangement of the first interventional device and the second interventional device can correspond to a respective axial arrangement of the first control and the second control. The second interventional device can be located distal to the first interventional device, and the second control can be located distal to the second control.

[0043] In some aspects, a robotic catheter control system can include one or more hardware processors configured to generate a user interface including information about the first interventional device and the second interventional device. In some aspects, the robotic catheter control system can further include at least one sensor configured to detect movement of at least one of the first interventional device and the second interventional device; and one or more hardware processors configured to receive motion data from the sensor. The motion data can indicate whether the first interventional device and the second interventional device are moving. In some aspects, the one or more hardware processors can be further configured to generate, based on the motion data, a user interface including a gauge window including a first representation of the first interventional device and a second representation of the second interventional device; and a first interventional device marker associated with the first representation and a second interventional device marker associated with the second representation. The first representation and the second representation can be configured to provide a visual indication of a position of the first interventional device and the second interventional device relative to each other.

[0044] Robotic catheter control systems are also provided. A robotic catheter control system includes a first control operable to control movement of a first interventional device, the first control including a unique first indicator identifying the first interventional device. The robotic catheter control system includes a second control operable to control movement of a second interventional device, the second control including a second indicator identifying the second interventional device. An axial arrangement of the first interventional device and the second interventional device corresponds to a respective axial arrangement of the first control and the second control.

[0045] In some aspects, a robotic catheter control system can include one or more hardware processors configured to generate a user interface interaction for generating information about a first interventional device and a second interventional device. In some aspects, the robotic catheter control system can further include at least one sensor configured to detect movement of at least one of the first interventional device and the second interventional device; and one or more hardware processors configured to receive motion data from the at least one sensor. The motion data can indicate whether the first interventional device and the second interventional device are moving. In some aspects, the one or more hardware processors can be further configured to generate, based on the motion data, a user interface including a gauge window including a first representation of the first interventional device and a second representation of the second interventional device; and a first interventional device marker associated with the first representation and a second interventional device marker associated with the second representation. The first representation and the second representation can be configured to provide a visual indication of a position of the first interventional device and the second interventional device relative to each other.

[0046] Robotic catheter user interface methods are also provided. The methods can include detecting, by a sensor, motion of a first control associated with a first interventional device; determining, using at least one processor, a first position of the first control; and presenting, in a first display view, a first position and a first orientation of the first interventional device based at least in part on the first position of the first control.

[0047] In some aspects, presenting the position of the first interventional device can include presenting an axial position bar including a first end, a second end, and a length extending between the first end and the second end. The methods can further include presenting a first axial position indicator in the axial position corresponding to a position of the first interventional device within a patient. The methods can further include presenting, in a second display view, at least one of a second position and a second orientation of the first interventional device corresponding to a second position of the first control, wherein the first control transitions from the first position to the second position when the first control is moved. The methods can further include generating, using at least one processor, a signal to cause the first interventional device to move in accordance with movement of the first interventional device. The methods can further include obtaining a fluoroscopy image representative of a patient vasculature and the first interventional device; and presenting, in the first display view, the fluoroscopy imaging.

[0048] Robotic catheter control systems are also provided. A robotic catheter control system includes a display; a first control associated with a first interventional device; at least one processor that causes display of at least one view on the display, the at least one view adapted to present data representative of a position of the first interventional device in a patient vasculature; and a first sensor configured to detect movement of the first control and determine a position of the first control. The first view presents a first position of the first interventional device, and the second view presents a second position of the first interventional device. The processor determines a change in position of the first control based on the position of the first control and causes the display to transition from the first view to the second view.

[0049] In some aspects, the position of the interventional device can be presented along an axial position bar that includes a first end, a second end, and a first position indicator. The first position indicator can be configured to move along the axial position bar when the display transitions from the first view to the second view. In some aspects, a rotational position of the first interventional device can be presented in a rotational position indicator. In some aspects, the processor can also be configured to receive a fluoroscopy image representative of the patient vasculature and the first interventional device and present the fluoroscopy image on the display.

[0050] Methods for generating a user interaction for a robotic catheter system are also provided. The method includes receiving a user input configured to move a first interventional device; detecting a first position of the first interventional device; and generating a first user interaction for display. The first user interaction includes an image feedback portion configured to display a visual representation of a region of interest; a positioning bar including a first end representative of a patient proximal direction and a second end representative of a patient proximal direction; and a first position indicator included in the positioning bar, the first position indicator corresponding to the detected first position of the first interventional device.

[0051] Methods of robotic control of interventional devices are also provided. The method includes providing an interventional device assembly including a plurality of interventional devices; in a first operational mode, advancing a first subset of the plurality of interventional devices into an ostium of a descending aorta in response to movement of a control of a controller, wherein in the first operational mode the first subset of the plurality of interventional devices is connected to the control; switching from the first operational mode to a second operational mode in response to user input using the controller, wherein switching from the first operational mode to the second operational mode causes a second subset of the plurality of interventional devices to be connected to the control of the controller, the second subset of the plurality of interventional devices being different than the first subset of the plurality of interventional devices; and in the second operational mode, advancing the second subset of the plurality of interventional devices to a treatment site in response to movement of the control of the controller.

[0052] In some aspects, the first subset of the plurality of interventional devices includes a guide catheter, a procedural catheter, and an access catheter. In some aspects, the guide catheter, the procedural catheter, and the access catheter can be configured to move simultaneously in response to movement of a control in a first mode of operation. In some aspects, the second subset of the plurality of interventional devices can include the guide catheter and the procedural catheter. In some aspects, the guide catheter and the procedural catheter can be configured to move simultaneously in a second mode of operation. In some aspects, the control includes a first control, the method further comprising advancing a guidewire into the ostium in response to movement of a second control of the controller in the first mode of operation. In some aspects, the first control can include a first joystick, and the second control can include a second joystick. In some aspects, the techniques described herein relate to a method further comprising, in response to a user input, connecting one of the guide catheter, the procedural catheter, and the access catheter to the second control such that movement of the second control causes movement of the one of the guide catheter, the procedural catheter, and the access catheter. In some aspects, in the first mode of operation, advancing the guidewire into the ostium in response to movement of the second control can include advancing the guidewire in response to movement of the second control along a first axis, the method further comprising rotating the guidewire in response to movement of the second control along a second axis perpendicular to the first axis. In some aspects, the method further comprises performing a neurovascular procedure at a treatment site through the procedural catheter in response to receiving a user input on the controller. In some aspects, performing the neurovascular procedure can include aspirating a clot. In some aspects, in the first mode of operation, movement of the control can be configured to cause responsive movement of the first subset of the plurality of interventional devices within a first range of speeds. In the second mode of operation, movement of the control can be configured to cause responsive movement of the second subset of the plurality of interventional devices within a second range of speeds different from the first range of speeds. In some aspects, the controller can be in communication with a control system having one or more hardware processors. The control system can also be in communication with a drive stage configured to drive movement of the plurality of interventional devices. The one or more hardware processors can control movement of the plurality of interventional devices in response to user input using the controller. The one or more hardware processors can additionally generate a user interface including information about the plurality of interventional devices. The control system can receive information about the plurality of interventional devices or the drive stage from one or more sensors of a sensor system. The one or more sensors can include sensors configured to detect movement of a first interventional device and a second interventional device and provide motion data to the control system. The one or more hardware processors can generate a user interface including a representation of the first interventional device and the second interventional device configured to provide an indication of a relative position of the first interventional device and the second interventional device based on the motion data.

[0053] Methods of robotically controlling an interventional device are also provided. The methods include providing a multi-catheter assembly including an access catheter, a guide catheter, and a procedural catheter; driving the multi-catheter assembly to achieve an access over the aorta in response to movement of a control of a controller; driving a subset of the multi-catheter assembly to a neurovascular site in response to movement of the control of the controller, wherein the subset includes the guide catheter and the procedural catheter; and performing a neurovascular procedure using the procedural catheter in response to user input on the controller.

[0054] In some aspects, driving the multi-catheter assembly to achieve an access over the aorta can include advancing the access catheter, the guide catheter, and the procedural catheter simultaneously in response to movement of a control of a controller. In some aspects, driving a subset of the multi-catheter assembly to a neurovascular site can include advancing the guide catheter and the procedural catheter simultaneously in response to movement of the control of the controller. In some aspects, the controller can include a first control, and the methods can include driving a guidewire to achieve an access over the aorta in response to movement of a second control of the controller. In some aspects, the first control can include a first joystick, and the second control can include a second joystick. In some aspects, the methods can further include connecting one of the access catheter, the guide catheter, and the procedural catheter to the second control in response to user input such that movement of the second control causes movement of the one of the guide catheter, the procedural catheter, and the access catheter. In some aspects, the neurovascular procedure can include aspirating a clot. In some aspects, the controller can be in communication with a control system having one or more hardware processors. The control system can also be in communication with a drive stage configured to drive movement of the multi-catheter assembly. The one or more hardware processors can control movement of the multi-catheter assembly in response to user input using the controller. The one or more hardware processors can additionally generate a user interface including information about the multi-catheter assembly. The control system can receive information about the multi-catheter assembly or the drive stage from one or more sensors of a sensor system. The one or more sensors can include sensors configured to detect movement of a first interventional device and a second interventional device and provide motion data to the control system. The one or more hardware processors can generate a user interface including a representation of the first interventional device and the second interventional device configured to provide an indication of a relative position of the first interventional device and the second interventional device based on the motion data.

[0055] Methods of robotically controlling an interventional device are also provided. The methods include driving a first interventional device of an interventional device assembly in response to movement of a joystick of a controller, wherein the first interventional device is connected to the joystick such that movement of the joystick causes responsive movement of the first interventional device; receiving user input; and connecting a second interventional device of the interventional device assembly to the joystick in response to receiving the user input such that movement of the joystick causes responsive movement of the second interventional device.

[0056] In some aspects, the method can further include, after connecting the second interventional device to the joystick, driving the second interventional device using the joystick. In some aspects, connecting the second interventional device to the joystick can include connecting the second interventional device to the joystick such that movement of the joystick causes simultaneous responsive movement of both the first interventional device and the second interventional device. In some aspects, the first interventional device can include a guidewire, and the second interventional device can include a guide catheter. In some aspects, the first interventional device can include a guide catheter or a surgical catheter, and the second interventional device can include an access catheter. In some aspects, the user input can include actuation of a button of the controller. The controller can be configured to connect the second interventional device to the joystick upon actuation of the button. In some aspects, driving the first interventional device of the interventional device assembly in response to movement of the joystick can include driving the first interventional device of the interventional device assembly in response to movement of the joystick along a first axis. The method can further include rotating the first interventional device of the interventional device assembly in response to movement of the joystick along a second axis different from the first axis. In some aspects, the second axis can be perpendicular to the first axis. In some aspects, the first interventional device can be a guidewire. In some aspects, the first interventional device can be an access catheter. In some aspects, driving the first interventional device of the interventional device assembly in response to movement of the joystick of the controller can include advancing the first interventional device to enable an upper aortic access. In some aspects, the method can further include, in response to movement of the joystick, driving the second interventional device to a treatment site for performing a neurovascular procedure. In some aspects, the method can further include performing the neurovascular procedure in response to user input on the controller. In some aspects, performing the neurovascular procedure can include aspirating a clot. In some aspects, the controller can be in communication with a control system having one or more hardware processors. The control system can also be in communication with a drive stage configured to drive movement of a plurality of interventional devices. The one or more hardware processors can control movement of the interventional devices in response to user input using the controller. The one or more hardware processors can additionally generate a user interface including information about the interventional devices. The control system can receive information about the interventional devices or the drive stage from one or more sensors of a sensor system. The one or more sensors can include sensors configured to detect movement of the first interventional device and the second interventional device and provide motion data to the control system. The one or more hardware processors can generate a user interface including a representation of the first interventional device and the second interventional device configured to provide an indication of a relative position of the first interventional device and the second interventional device based on the motion data.

[0057] Robotic device control systems are also provided. A robotic device control system includes a controller in communication with a plurality of hubs, each of the plurality of hubs connected to one of a plurality of interventional devices, the controller including a control and an operating mode actuator; wherein the controller is configured to transition between a first operating mode and a second operating mode in response to actuation of the operating mode actuator; wherein in the first operating mode, the control is connected to a first subset of the plurality of hubs such that movement of the control causes a responsive movement of the first subset of the plurality of hubs; and wherein in the second operating mode, the control is connected to a second subset of the plurality of hubs such that movement of the control causes a responsive movement of the second subset of the plurality of hubs, the second subset of the plurality of hubs being different from the first subset of the plurality of hubs.

[0058] In some aspects, a first subset of the plurality of hubs can include a guide catheter hub, a surgical catheter hub, and an access catheter hub. In some aspects, when the control is connected with the first subset of the plurality of hubs, movement of the control can be configured to simultaneously move each of the guide catheter hub, the surgical catheter hub, and the access catheter hub. In some aspects, when the control is connected with the first subset of the plurality of hubs, movement of the control can be configured to cause each of the guide catheter hub, the surgical catheter hub, and the access catheter hub to move the same distance sequentially. In some aspects, a second subset of the plurality of hubs can include the guide catheter hub and the surgical catheter hub. In some aspects, when the control is connected with the second subset of the plurality of hubs, movement of the control can be configured to simultaneously move each of the guide catheter hub and the surgical catheter hub. In some aspects, when the control is connected with the second subset of the plurality of hubs, movement of the control can be configured to cause each of the guide catheter hub and the surgical catheter hub to move the same distance sequentially. In some aspects, the control can include a first control, and the system can include a second control connected to a third subset of the plurality of hubs in the first mode of operation. In some aspects, the first subset of the plurality of hubs includes one or more of the guide catheter hub, the surgical catheter hub, and the access catheter hub. The third subset of the plurality of hubs can include a guidewire hub. In some aspects, the first control can include a first joystick, and the second control can include a second joystick. In some aspects, the control can be configured to move along a first axis and a second axis different from the first axis, movement of the control along the first axis can be configured to cause a responsive axial movement of a hub of the plurality of hubs connected to the control, and movement of the control along the second axis can be configured to cause a rotational movement of at least some of the interventional devices connected to the hub connected with the control. In some aspects, the controller can be in communication with a control system having one or more hardware processors. The control system can also be in communication with a drive stage configured to drive movement of the plurality of hubs. The one or more hardware processors can control movement of the plurality of hubs in response to user input using the controller. The one or more hardware processors can additionally generate a user interface including information about the plurality of interventional devices or hubs. The control system can receive information from one or more sensors of a sensor system about the plurality of interventional devices, the plurality of hubs, or the drive stage. The one or more sensors can include sensors configured to detect movement of a first hub connected to a first interventional device and a second hub connected to a second interventional device and provide motion data to the control system. The one or more hardware processors can generate a user interface including a representation of the first interventional device and the second interventional device configured to provide an indication of a relative position of the first interventional device and the second interventional device based on the motion data.

[0059] Robotic device control systems are also provided. A robotic device control system can include a controller connected in communication with a plurality of interventional devices, the controller including a control and an operating mode actuator; wherein the controller is configured to transition between a first operating mode and a second operating mode in response to actuation of the operating mode actuator; wherein in the first operating mode, the control is connected to a first subset of the plurality of interventional devices such that movement of the control causes responsive movement of the first subset of the plurality of interventional devices; and wherein in the second operating mode, the control is connected to a second subset of the plurality of interventional devices such that movement of the control causes responsive movement of the second subset of the plurality of interventional devices, the second subset of the plurality of interventional devices being different than the first subset of the plurality of interventional devices.

[0060] In some aspects, the first subset of the plurality of interventional devices can include a guide catheter, a procedural catheter, and an access catheter. In some aspects, when the control is connected to the first subset of the plurality of interventional devices, movement of the control can be configured to move each of the guide catheter, the procedural catheter, and the access catheter simultaneously. In some aspects, when the control is connected to the first subset of the plurality of interventional devices, movement of the control can be configured to move each of the guide catheter, the procedural catheter, and the access catheter the same distance sequentially. In some aspects, the second subset of the plurality of interventional devices can include the guide catheter and the procedural catheter. In some aspects, when the control is connected to the second subset of the plurality of interventional devices, movement of the control can be configured to move each of the guide catheter and the procedural catheter simultaneously. In some aspects, when the control is connected to the second subset of the plurality of interventional devices, movement of the control can be configured to move each of the guide catheter and the procedural catheter the same distance sequentially. In some aspects, the control can include a first control. The system can include a second control connected to a third subset of the plurality of interventional devices in the first operating mode. In some aspects, the first subset of the plurality of interventional devices can include one or more of a guide catheter hub, a procedural catheter, and an access catheter. The third subset of the plurality of interventional devices can include a guidewire. In some aspects, the first control can include a first joystick and the second control can include a second joystick. In some aspects, the control can be configured to move along a first axis and a second axis different from the first axis, wherein movement of the control along the first axis is configured to cause responsive axial movement of the plurality of interventional devices connected to the control, wherein movement of the control along the second axis is configured to cause rotational movement of at least some of the interventional devices connected to the control.

[0061] In some aspects, a controller can be in communication with a control system having one or more hardware processors. The control system can also be in communication with a drive stage configured to drive movement of a plurality of interventional devices. The one or more hardware processors can control movement of the plurality of interventional devices in response to user input using the controller. The one or more hardware processors can additionally generate a user interface including information about the plurality of interventional devices. The control system can receive information about the plurality of interventional devices or the drive stage from one or more sensors of a sensor system. The one or more sensors can include sensors configured to detect movement of a first interventional device and a second interventional device and provide motion data to the control system. The one or more hardware processors can generate a user interface including a representation of the first interventional device and the second interventional device configured to provide an indication of a relative position of the first interventional device and the second interventional device based on the motion data.

[0062] A robotic device control system is also provided. The robotic device control system can include a controller in communication with a plurality of hubs, each of the plurality of hubs connected to one of a plurality of interventional devices, the controller comprising: a joystick; and a plurality of hub actuators, wherein actuation of each of the plurality of hub actuators connects the joystick to one of the plurality of hubs such that movement of the joystick causes a corresponding responsive movement of one of the plurality of hubs.

[0063] In some aspects, simultaneous actuation of a first hub actuator of the plurality of hub actuators and a second hub actuator of the plurality of hub actuators can cause a joystick to be coupled with a first hub and a second hub, such that movement of the joystick causes corresponding responsive movement of the first hub and the second hub, the first hub being associated with the first hub actuator and the second hub being associated with the second hub actuator. In some aspects, the system can further include a speed actuator. Actuation of the speed actuator can change a range of axial speeds within which responsive movement of one of the plurality of hubs coupled to the joystick occurs in response to movement of the joystick. In some aspects, the system can further include a second joystick. The second joystick can be coupled to at least one of the plurality of hubs, such that movement of the second joystick causes responsive movement in the at least one of the plurality of hubs coupled to the second joystick. In some aspects, the system can further include at least one additional hub actuator. Actuation of the at least one additional hub actuator can be configured to couple the second joystick with a different hub of the plurality of hubs, such that movement of the second joystick causes responsive movement in the different hub of the plurality of hubs. In some aspects, the joystick can be configured to move along a first axis and a second axis different from the first axis. Movement of the joystick along the first axis can be configured to cause responsive axial movement of a hub coupled to the joystick. Movement of the joystick along the second axis can be configured to cause rotational movement of at least some interventional devices coupled to the hub coupled to the joystick. The plurality of hubs can include a guide catheter hub configured to be coupled to a guide catheter, an access catheter hub configured to be coupled to an access catheter, and a procedural catheter hub configured to be coupled to a procedural catheter. The plurality of hubs includes a guidewire hub configured to be coupled to a guidewire. In some aspects, the controller can be in communication with a control system having one or more hardware processors. The control system can also be in communication with a drive stage configured to drive movement of the plurality of hubs. The one or more hardware processors can control movement of the plurality of hubs in response to user input using the controller. The one or more hardware processors can additionally generate a user interface including information about the plurality of interventional devices or hubs. The control system can receive information from one or more sensors of a sensor system about the plurality of interventional devices, the plurality of hubs, or the drive stage. The one or more sensors can include sensors configured to detect movement of a first hub coupled to a first interventional device and a second hub coupled to a second interventional device and provide motion data to the control system. The one or more hardware processors can generate a user interface including a representation of the first interventional device and the second interventional device configured to provide an indication of a relative position of the first interventional device and the second interventional device based on the motion data.

[0064] Robotic device control systems are also provided. A robotic device control system includes a controller in communication with a plurality of interventional devices, the controller including: a joystick; and a plurality of interventional device actuators, wherein actuation of each of the plurality of interventional device actuators causes the joystick to be coupled to one of the plurality of interventional devices such that movement of the joystick causes a corresponding responsive movement of the one of the plurality of interventional devices.

[0065] In some aspects, simultaneous actuation of a first interventional device actuator of the plurality of interventional device actuators and a second interventional device actuator of the plurality of interventional device actuators can cause a joystick to be coupled to a first interventional device and a second interventional device, such that movement of the joystick causes corresponding responsive movement of the first interventional device and the second interventional device, the first interventional device being associated with the first interventional device actuator and the second interventional device being associated with the second interventional device actuator. In some aspects, the system can further include a velocity actuator. Actuation of the velocity actuator can change a range of axial velocities within which responsive movement of one of a plurality of hubs coupled to the joystick occurs in response to movement of the joystick. In some aspects, the system can further include a second joystick. The second joystick can be coupled to at least one of the plurality of interventional devices, such that movement of the second joystick causes responsive movement in the at least one of the plurality of interventional devices coupled to the second joystick. In some aspects, the system can further include at least one additional interventional device actuator. Actuation of the at least one additional interventional device actuator can be configured to couple the second joystick to a different interventional device of the plurality of interventional devices, such that movement of the second joystick causes responsive movement in the different interventional device of the plurality of interventional devices. In some aspects, the joystick can be configured to move along a first axis and a second axis different from the first axis. Movement of the joystick along the first axis can be configured to cause responsive axial movement of interventional devices coupled to the joystick. Movement of the joystick along the second axis can be configured to cause rotational movement of at least some of the interventional devices coupled to the joystick. The plurality of interventional devices can include a coupled guide catheter, a coupled access catheter, and a coupled procedural catheter. The plurality of interventional devices can include a coupled guidewire. In some aspects, the controller can be in communication with a control system having one or more hardware processors. The control system can also be in communication with a drive stage configured to drive movement of the plurality of interventional devices. The one or more hardware processors can control movement of the plurality of interventional devices in response to user input using the controller. The one or more hardware processors can additionally generate a user interface including information about the plurality of interventional devices. The control system can receive information about the plurality of interventional devices or the drive stage from one or more sensors of a sensor system. The one or more sensors can include sensors configured to detect movement of a coupled first interventional device and a coupled second interventional device and provide motion data to the control system. The one or more hardware processors can generate a user interface including a representation of the first interventional device and the second interventional device configured to provide an indication of a relative position of the first interventional device and the second interventional device based on the motion data.

[0066] Roboticized interventional device control systems are also provided. A roboticized interventional device control system can include a first interventional device having a first distal end; a second interventional device having a second distal end, wherein the first interventional device is configured to be concentrically nested within the second interventional device; a sensor system configured to detect a first position of the first interventional device and a second position of the second interventional device; one or more hardware processors configured to generate a user interaction portion, the user interaction portion including a gauge window, the gauge window including a first representation of the first interventional device and a second representation of the second interventional device, the first representation of the first interventional device including a first visual indication of the first distal end of the first interventional device; the second representation of the second interventional device including a second visual indication of the second distal end of the second interventional device, wherein based on the detected first position and the detected second position received from the sensor system, a position of the second visual indication of the second distal end relative to the first visual indication of the first distal end of the first interventional device is determined, such that the first visual indication and the second visual indication provide an indication on the user interaction portion of how far the first distal end of the first interventional device is from the second distal end of the second interventional device; and a display configured to display the user interaction portion.

[0067] In some aspects, the user interface portion can further include a first window configured to display a fluoroscopy image from a patient vasculature, a second window configured to display one or more messages indicative of an operational state of a roboticized interventional device control system, and a third window including live feedback. The gauge window can be positioned in a central portion of the user interface portion. In some cases, the user interface portion can include some, but not all, of the first window, the second window, and the third window. In some aspects, the first window, the second window, and the third window can be positioned around the gauge window. In some aspects, the first visual indication can correspond to a shape of a first distal end of a first interventional device. In some aspects, the shape of the first distal end of the first interventional device can include a beveled surface. In some aspects, the first visual indication can correspond to a first shape of a first distal end of a first interventional device. The second visual indication can correspond to a second shape of a second distal end of a second interventional device. The first shape and the second shape can be different from each other. In some aspects, the second visual indication can correspond to a shape of a second distal end of a second interventional device. In some aspects, the first representation of the first interventional device and the second representation of the second interventional device can extend along a central longitudinal axis. In some aspects, the first representation of the first interventional device can include a first shape. In some aspects, the first shape can correspond to a shape of a portion of the first interventional device. In some aspects, the first shape can include a cylindrical shape. In some aspects, the second representation of the second interventional device can include a second shape that is different from the first shape of the first representation. In some aspects, the second representation of the second interventional device can include a second shape. In some aspects, the second shape corresponds to a shape of a portion of the second interventional device. In some aspects, the first visual indication of the first distal end can include a beveled edge. In some aspects, the first visual indication of the first distal end can include a first point on a distal edge of the shape. In some aspects, the second visual indication can correspond to a second shape of a second distal end of a second interventional device, where the second visual indication of the second distal end includes a second point on a second distal edge of the second shape, and where a first distance between the first point and the second point provides a visual indication of a second distance between the first distal end of the first interventional device and the second distal end of the second interventional device. In some aspects, the first distance can include a proportional distance of the second distance. In some aspects, the first distance and the second distance can be the same. In some aspects, the system can further include a controller having one or more controls configured to cause movement of at least one of the first interventional device and the second interventional device in response to user input. In some aspects, the controller can be configured to transition between a first operational mode and a second operational mode in response to user input. In the first operational mode, one of the controls can be connected to a first subset of the plurality of interventional devices or interventional device hubs such that movement of the control causes a responsive movement of the first subset of the plurality of interventional devices or interventional device hubs.In the second mode of operation, the control can be connected to a second subset of the plurality of interventional devices or interventional device hubs such that movement of the control causes a responsive movement of the second subset of the plurality of interventional devices or interventional device hubs, the second subset being different from the first subset.

[0068] A robotic interventional device control system is also provided. The robotic interventional device control system can include an interventional device; a controller in communication with the interventional device, the controller including: a first control; and a second control; one or more hardware processors in communication with the interventional device and the controller, the one or more hardware processors configured to: selectively connect the interventional device to the first control or the second control such that movement of the selected control causes a corresponding responsive movement of the interventional device; generate a user interaction comprising a gauge window including a representation of the interventional device; and an interventional device marker positioned relative to the representation of the interventional device, wherein a position of the interventional device marker relative to the representation of the interventional device indicates whether the interventional device is connected to the first control or the second control; and a display configured to display the user interaction.

[0069] In some aspects, the controller can include a first side and a second side, the first control located on the first side of the controller and the second control located on the second side of the controller. In some aspects, the representation of the interventional device can extend along a central longitudinal axis. In some aspects, the interventional device marker can be configured to be located on a first side of the central longitudinal axis when the interventional device is connected to the first control, and wherein the interventional device marker is configured to be located on a second side of the central longitudinal axis when the interventional device is connected to the second control. In some aspects, the first side of the central longitudinal axis can be a mirror image of the first side of the controller, and wherein the second side of the central longitudinal axis is a mirror image of the second side of the controller. In some aspects, the gauge window can be configured to display an indicator at a top of the interventional device marker, the indicator configured to extend outside of the top of the interventional device marker when axial movement of the interventional device in a distal direction is limited. In some aspects, the gauge window can be configured to display an indicator at a bottom of the interventional device marker, the indicator configured to extend outside of the bottom of the interventional device marker when axial movement of the interventional device in a proximal direction is limited. In some aspects, the interventional device marker can include a first animated state and a second animated state. In some aspects, the interventional device marker can be configured to transition from the first animated state to the second animated state upon an interventional device event. In some aspects, the interventional device event can include an aspiration available at the interventional device. In some aspects, the interventional device event can include an aspiration not available at the interventional device. In some aspects, the interventional device event can include an aspiration active at the interventional device. In some aspects, the interventional device event can include a contrast injection available at the interventional device. In some aspects, the interventional device event can include a contrast injection not available at the interventional device. In some aspects, the interventional device event can include a contrast injection active at the interventional device. In some aspects, at least one of the first control and the second control of the controller can be configured to cause movement of the interventional device in response to user input. In some aspects, the controller can be configured to transition between a first operating mode and a second operating mode in response to user input. In the first operating mode, one of the controls can be connected to a first subset of the plurality of interventional devices or interventional device hubs such that movement of the control causes responsive movement of the first subset of the plurality of interventional devices or interventional device hubs. In the second operating mode, the control can be connected to a second subset of the plurality of interventional devices or interventional device hubs such that movement of the control causes responsive movement of the second subset of the plurality of interventional devices or interventional device hubs, the second subset different from the first subset.

[0070] Roboticized interventional device control systems are also provided. A roboticized interventional device control system can include an interventional device; a controller configured to control axial movement of the interventional device along a drive table; a sensor system configured to detect axial movement of the interventional device along the drive table; one or more hardware processors configured to receive motion data from the sensor system, the motion data indicating whether the interventional device is axially moved along the drive table; wherein the one or more hardware processors are further configured to generate, based on the motion data, a user interaction portion including a gauge window, the gauge window including a representation of the interventional device; and an interventional device marker associated with the representation of the interventional device, the interventional device marker configured to transition from a first configuration to a second configuration when the interventional device is axially moved along the drive table; and a display configured to display the user interaction portion.

[0071] In some aspects, the gauge window further includes a speed indicator configured to indicate a speed at which the interventional device is configured to move in the distal direction or the proximal direction. In some aspects, the representation of the interventional device can extend along the central longitudinal axis. In some aspects, in the first configuration, the interventional device marker can be in a first position. In the second configuration, the interventional device marker can be in a second position. In some aspects, the first position can be closer to the central longitudinal axis than the second position. In some aspects, the interventional device marker can be configured to be in the first configuration when the interventional device is not moving axially along the drive table. In some aspects, the representation of the interventional device can include a visual indication of a distal end of the interventional device. In some aspects, the visual indication can correspond to a shape of the distal end of the interventional device. In some aspects, the representation of the interventional device can extend along the central longitudinal axis. In some aspects, the representation of the interventional device can include a shape that corresponds to a shape of a portion of the interventional device. In some aspects, the gauge window can further include an interventional device marker positioned relative to the representation of the interventional device. A position of the interventional device marker relative to the representation of the interventional device can indicate whether the interventional device is connected to a first control or a second control of the controller. In some aspects, the controller can include a first side and a second side, the first control being located on the first side of the controller and the second control being located on the second side of the controller. In some aspects, the representation of the interventional device can extend along the central longitudinal axis. The interventional device marker can be configured to be located on a first side of the central longitudinal axis when the interventional device is connected to the first control. The interventional device marker can be configured to be located on a second side of the central longitudinal axis when the interventional device is connected to the second control. In some aspects, the gauge window can further include a pointer extending between the representation of the interventional device and the interventional device marker. In some aspects, the pointer can include a line. The line can include a first length when the interventional device marker is in the first configuration. The line can include a second length different from the first length when the interventional device marker is in the second configuration. In some aspects, the controller is further configured to control rotational movement of the interventional device about a longitudinal axis of the interventional device. In some aspects, the interventional device marker can further include a radial progress indicator configured to provide a visual indication of an angle of rotation of the interventional device about the longitudinal axis relative to a threshold. In some aspects, the controller can be configured to control axial movement of the interventional device along the drive table in response to user input. In some aspects, the controller can be configured to transition between a first operating mode and a second operating mode in response to user input. In the first operating mode, one of the controls can be connected to a first subset of the plurality of interventional devices or interventional device hubs such that movement of the control causes a responsive movement of the first subset of the plurality of interventional devices or interventional device hubs. In the second operating mode, the control can be connected to a second subset of the plurality of interventional devices or interventional device hubs different from the first subset such that movement of the control causes a responsive movement of the second subset of the plurality of interventional devices or interventional device hubs.

[0072] A robotic interventional device control system is also provided. The robotic interventional device control system includes an interventional device including a longitudinal axis and configured to rotate about the longitudinal axis; a controller configured to control rotational movement of the interventional device about the longitudinal axis; at least one sensor configured to detect rotational movement of the interventional device about the longitudinal axis; one or more hardware processors configured to receive motion data from the at least one sensor, the motion data indicating whether the interventional device is rotating about the longitudinal axis; wherein the one or more hardware processors are further configured to generate, based on the motion data, a user interaction comprising a gauge window including a representation of the interventional device; an interventional device marker associated with the representation of the interventional device, the interventional device marker including a radial progress indicator configured to provide a visual indication of a rotational angle of the interventional device about the longitudinal axis relative to a threshold value of the interventional device.

[0073] In some aspects, the threshold can represent a maximum rotation of the interventional device. In some aspects, the radial progress indicator can include an annular progress bar configured to fill. The annular progress bar can also be configured to be empty when the interventional device does not rotate. The annular progress bar can also be configured to be full when the interventional device completes a full rotation about the longitudinal axis. In some aspects, the radial progress indicator can include an annular progress bar configured to fill in at least one of a clockwise direction and a counterclockwise direction. A radial progress indicator that fills in a clockwise direction can provide a visual indication of the interventional device rotating in a clockwise direction. A radial progress indicator that fills in a counterclockwise direction can provide a visual indication of the interventional device rotating in a counterclockwise direction. In some aspects, the representation of the interventional device can extend along a central longitudinal axis. In some aspects, the controller can also be configured to control axial movement of the interventional device along the drive stage. The representation of the interventional device can be configured to transition along the central longitudinal axis from a first configuration to a second configuration when the interventional device is axially moved along the drive stage. In some aspects, in the first configuration, the representation of the interventional device can be at a first position. In the second configuration, the representation of the interventional device can be at a second position. In some aspects, the first position can be closer to a bottom end of the central longitudinal axis than the second position. In some aspects, the first position can be closer to a top end of the central longitudinal axis than the second position. In some aspects, the interventional device marker can include a first animated state and a second animated state. In some aspects, the interventional device marker can be configured to transition from the first animated state to the second animated state upon an interventional device event. In some aspects, the interventional device event can include an aspiration available at the interventional device. In some aspects, the interventional device event can include an aspiration not available at the interventional device. In some aspects, the interventional device event can include an aspiration active at the interventional device. In some aspects, the interventional device event can include a contrast injection available at the interventional device. In some aspects, the interventional device event can include a contrast injection not available at the interventional device. In some aspects, the controller can be configured to control rotational movement of the interventional device about the longitudinal axis in response to user input. In some aspects, the controller can be configured to transition between a first operating mode and a second operating mode in response to user input. In the first operating mode, one of the controls can be connected to a first subset of the plurality of interventional devices or interventional device hubs such that movement of the control causes a responsive movement of the first subset of the plurality of interventional devices or interventional device hubs. In the second operating mode, the control can be connected to a second subset of the plurality of interventional devices or interventional device hubs such that movement of the control causes a responsive movement of the second subset of the plurality of interventional devices or interventional device hubs, the second subset being different from the first subset.

[0074] Roboticized interventional device control systems are also provided. A roboticized interventional device control system includes a roboticized drive system; and an interventional device assembly including a plurality of interventional devices configured to connect to the roboticized drive system, each of the plurality of interventional devices including an identifier; a plurality of sensors, each of the plurality of sensors configured to identify one of the plurality of interventional devices based on the identifier when the one of the plurality of interventional devices is connected to the roboticized drive system; one or more hardware processors configured to receive interventional device identity data from the plurality of sensors and generate, based on the interventional device identity data, a user interaction portion including a gauge window, the gauge window including a plurality of interventional device representations, each of the plurality of interventional device representations representing one of the plurality of interventional devices; a plurality of interventional device indicia, each of the plurality of interventional device indicia associated with one of the plurality of interventional device representations and configured to indicate a type of the interventional device represented by the one of the plurality of interventional device representations; and a display configured to display the user interaction portion. The one or more controls can include a first control connected to a first interventional device such that movement of the first control causes a responsive movement of the first interventional device; and a second control connected to a second interventional device such that movement of the second control causes a responsive movement of the second interventional device. The first interventional device can be a guide catheter and the second interventional device can be a guidewire. The controller can further include an interventional device actuator, wherein actuation of the interventional device actuator connects the first interventional device with the second control such that movement of the second control causes a responsive movement of the first interventional device. The one or more controls can include a first control operable in a first drive mode and a second drive mode, wherein movement of the first control is configured to cause a responsive movement of a first subset of the plurality of interventional devices in the first drive mode and operation of the first control is configured to cause a responsive movement of a second subset of the plurality of interventional devices in the second drive mode. The first subset of the plurality of interventional devices can be a guide catheter, a procedural catheter, and an access catheter. The second subset of the plurality of interventional devices can include a guide catheter and a procedural catheter.

[0075] In some aspects, the user interaction portion can further include a window configured to display a fluoroscopy image from a patient vasculature. In some aspects, the user interaction portion can further include a window configured to display one or more messages indicative of an operational state of the robotic interventional device control system. In some aspects, the user interaction portion can further include a window configured to display live feedback. In some aspects, the gauge window can be located in a central portion of the user interaction portion. In some aspects, each of the plurality of interventional device markers can be configured to transition from a first configuration to a second configuration as the plurality of interventional devices move axially along the drive table. In some aspects, in the first configuration, each of the plurality of interventional device markers can be in a first position. In the second configuration, each of the plurality of interventional device markers can be in a second position. In some aspects, the first position can be closer to a central longitudinal axis of the plurality of interventional device representations than the second position. In some aspects, the plurality of interventional device markers can be configured to be in the first configuration when the plurality of interventional devices do not move axially along the drive table. In some aspects, the system can further include a plurality of interventional device hubs, each of the plurality of interventional devices connected to one of the plurality of interventional device hubs; a plurality of hub adapters, wherein each of the plurality of interventional device hubs is configured to connect to one of the plurality of hub adapters; and a support table, wherein the plurality of hub adapters are configured to move along the support table to drive the interventional device assembly. In some aspects, the plurality of interventional device representations can be arranged based on an arrangement of the plurality of hub adapters on the support table. In some aspects, the system can further include a controller having one or more controls configured to cause movement of at least one of the plurality of interventional devices in response to user input. In some aspects, the controller can be configured to transition between a first operational mode and a second operational mode in response to user input. In the first operational mode, one of the controls can be connected to a first subset of the plurality of interventional devices or interventional device hubs such that movement of the control causes a responsive movement of the first subset of the plurality of interventional devices or interventional device hubs. In the second operational mode, the control can be connected to a second subset of the plurality of interventional devices or interventional device hubs such that movement of the control causes a responsive movement of the second subset of the plurality of interventional devices or interventional device hubs, the second subset different from the first subset.

[0076] Methods of robotically controlling an interventional device are also provided. The methods include driving a first hub adapter of a first interventional device connected to an interventional device assembly in response to movement of a control of a controller, where the first hub adapter is connected to the control such that movement of the control causes responsive movement of the first hub adapter, where a second hub adapter connected to a second interventional device is not connected to the first control, where the first hub adapter and the second hub adapter are axially moveably connected to a shuttle configured to move axially within a drive table, where driving the first hub adapter in response to movement of the control includes driving the shuttle to move in a first direction a first distance to move the first hub adapter, where in response to movement of the control a first distance in the first direction, the second hub adapter is configured to move a second distance in a second direction opposite the first direction equal to the first distance.

[0077] A robotic interventional device control system can include one or more features described above.

[0078] A method of using a robotic interventional device control system can include one or more features described above.

[0079] An interventional device controller can include one or more features described above.

[0080] A method of using an interventional device controller can include one or more features described above.

[0081] A robotic interventional device control system can include one or more features described above for cardiovascular procedures.

[0082] A method of using a robotic interventional device control system can include one or more features described above for cardiovascular procedures.

[0083] An interventional device controller can include one or more features described above for cardiovascular procedures.

[0084] Any feature, component, or any arrangement or embodiment detail disclosed in this application, including but not limited to any controller, control member, and user interaction disclosed below, can be combined interchangeably with any other feature, component, or any arrangement or embodiment detail disclosed herein to form new arrangements and embodiments. BRIEF DESCRIPTION OF DRAWINGS

[0085] FIG. 1 is a schematic perspective view of an interventional setup with an imaging system, a patient support table, and a robotic drive system according to the present disclosure.

[0086] FIG. 2is a longitudinal cross-section showing the concentric relationship between a guidewire having two degrees of freedom, an access catheter having 3 degrees of freedom, and a guide catheter having one degree of freedom.

[0087] FIG. 3A is an exploded view of an interventional device hub separated from a support table by a sterile barrier.

[0088] FIG. 3B to FIG. 3F shows an alternative sterile barrier in the form of a transport tray having one or more storage channels for carrying interventional devices.

[0089] FIG. 3G to FIG. 3K shows an embodiment of an alternative sterile barrier having a convex drive surface.

[0090] FIG. 3L and FIG. 3M depicts an example of a hub that can be used with the sterile barrier of FIG. 3G to FIG. 3K .

[0091] FIG. 4 is a schematic elevation cross-section through a hub adapter having a drive magnet separated from an interventional device hub and a driven magnet by a sterile barrier.

[0092] FIG. 5A and FIG. 5B schematically illustrates a three interventional device and a four interventional device assembly.

[0093] FIG. 6 is a perspective view of a support table.

[0094] FIG. 7 is a close-up view of the engine drive end of a support table.

[0095] FIG. 8 is an elevation cross-section through an engine and belt drive assembly.

[0096] FIG. 9 is a close-up view of the pulley end of a support table.

[0097] FIG. 10 is an elevation cross-section through a pulley.

[0098] FIG. 11 is an elevation cross-section through a distal end portion of a catheter such as those shown in FIG. 5A and FIG. 5B .

[0099] FIG. 12A and FIG. 12B schematically illustrates a force sensor integrated into the sidewall of a catheter.

[0100] FIG. 13A and FIG. 13BA sensor for measuring the elastic force of the magnetic connection between a hub and a corresponding trolley is schematically shown.

[0101] FIG. 14 A dual encoder torque sensor for use with the catheter of the present disclosure is schematically shown.

[0102] FIG. 15 A clot capture and visualization device that can be integrated into a hub and / or connected to a suction line is shown.

[0103] FIG. 16A to FIG. 16C An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0104] FIG. 17 A side elevation view schematic of an interventional device assembly for a supra-aortic access and neuro-interventional procedure is shown.

[0105] FIG. 18A to FIG. 18E An exemplary sequence of steps for introducing a catheter assembly configured to enable supra-aortic access and neurovascular site access is depicted.

[0106] FIG. 19A to FIG. 19C An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0107] FIG. 20 to FIG. 21 An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0108] FIG. 22A to FIG. 22C An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0109] FIG. 23A to FIG. 23C An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0110] FIG. 24A to FIG. 24E An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0111] FIG. 25A to FIG. 25E An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0112] FIG. 25B to FIG. 25D An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown. FIG. 25A A cross-sectional view of the control mechanism shown.

[0113] FIG. 25E An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown. FIG. 25A to FIG. 25D An alternative embodiment of the controller shown.

[0114] FIG. 26A to FIG. 26C An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0115] FIG. 27 An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0116] FIG. 28A to FIG. 28C An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0117] FIG. 29A A simplified block diagram of a medical device operating environment.

[0118] FIG. 29B An embodiment of a procedure for displaying the position and movement of an interventional device is shown.

[0119] FIG. 30A to FIG. 30K An embodiment of a user interaction section for controlling an interventional device is shown.

[0120] FIG. 31 to FIG. 42 An alternative embodiment of a user interaction section for controlling an interventional device is shown.

[0121] FIG. 43A to FIG. 43C An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0122] FIG. 44A to FIG. 44C An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0123] FIG. 45A to FIG. 45B An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0124] FIG. 46A to FIG. 46B An exemplary control mechanism for manipulating an interventional device driven by a corresponding hub is shown.

[0125] FIG. 47 to FIG. 59 Another additional embodiment of a user interaction section for controlling an interventional device is shown.

[0126] FIG. 60A to FIG. 60D An embodiment of a telescoping drive stage is shown.

[0127] FIG. 61 A system diagram of an embodiment of a control system is shown.

[0128] FIG. 62 An embodiment of a mechanical connection between a drive mechanism and a driven mechanism is shown schematically. DETAILED DESCRIPTION

[0129] In certain embodiments, a system is provided for advancing a guide catheter from a femoral or radial artery into the ostium of one of the large vessels at the top of the aortic arch, thereby enabling supra-aortic access. The surgeon can then take over the intervention device via the robotically placed guide catheter and advance it into the cerebral vasculature.

[0130] In some implementations, the system can additionally be configured to robotically achieve intracranial vascular access and perform aspiration thrombectomy or other neurovascular procedures.

[0131] The drive stage can be located above or to the side of the patient and configured to axially advance, retract, and in some cases rotate and / or laterally deflect two or three or more different (e.g., concentrically or side-by-side oriented) endovascular devices. Hubs can be moved along paths along the surface of the drive stage to advance or retract the intervention devices as needed. Each hub can also contain the mechanics to rotate or deflect the device as desired and be connected to fluid delivery tubes (not shown) of the type conventionally attached to catheter hubs. Each hub can be in electrical communication with the electronic control system via a hardwired connection, an RF wireless connection, or a combination of the two.

[0132] Each hub can be independently moved along the surface of a sterile field barrier membrane carried by the drive stage. Each hub can be releasably magnetically connected to a unique drive sled on the stage side of the sterile field barrier. The drive system independently moves each hub in the proximal or distal direction of the surface of the barrier to move the corresponding intervention device proximally or distally within the patient's vasculature.

[0133] The sleds on the drive stage that the hubs magnetically connect to for providing linear movement actuation are generic. The functionality of the catheter / guide wire is provided based on what is contained in the hub and shaft design. This allows for flexible configuration of the system to use a wide variety of intervention devices on the same drive stage to perform a wide range of procedures. Moreover, the intervention devices and methods disclosed herein can be readily adapted for use with a wide variety of other drive systems (e.g., any of a wide variety of robotic surgical drive systems).

[0134] FIG. 1 is a schematic perspective view of an intervention device 10 having a patient support stage 12 for supporting a patient 14. An imaging system 16 can be provided with a robotic intervention device drive system 18 in accordance with the present disclosure.

[0135] The drive system 18 can include a support table 20 for supporting, for example, the guidewire hub 26, the access catheter hub 28, and the guide catheter hub 30. In the context herein, the term "access" catheter can be any catheter having a lumen with at least one distal opening facing distally or laterally, which can be used to aspirate thrombus, provide a passageway for additional devices to pass through or be advanced along, or to inject saline or contrast or therapeutic agents.

[0136] More or fewer interventional device hubs can be provided, depending on the clinical procedure desired. For example, in certain embodiments, a diagnostic angiography procedure can be performed using only the guidewire hub 26 and the access catheter hub 28 for driving a guidewire and an access catheter (in the form of a diagnostic angiography catheter). The plurality of interventional devices 22 extend between the support table 20 and a femoral access point 24 on the patient 14 (in the example shown). Depending on the procedure desired, access can be achieved through a percutaneous or open approach into any of a variety of arteries or veins, such as the femoral or radial artery. Although primarily disclosed herein in the context of neurovascular access and procedures, the robotic drive system and associated interventional devices can readily be configured for a wide variety of additional medical interventions in peripheral and coronary arterial and venous vasculature, the gastrointestinal system, the lymphatic system, the cerebrospinal fluid space or spaces (e.g., the spinal canal, cardiac chambers, and subarachnoid space), the pulmonary airways, treatment sites reached via transureteral or urethral or fallopian tube navigation, or other hollow organs or structures in the body (e.g., within the heart or structural heart applications, such as valve repair or replacement, or in any lumenal procedure).

[0137] A display 23 (e.g., for viewing fluoroscopic images, catheter data (e.g., fiber Bragg grating fiber sensor data or other force or shape sensing data), or other patient data) can be carried by the support table 20 and / or the patient support 12. Alternatively, a physician input / output interface including the display 23 can be remote from the patient, such as behind a radiation shield, in a different room from the patient, or in a different facility from the patient.

[0138] In the example shown, the guidewire hub 26 is carried by the support table 20 and is movable along the table to advance the guidewire into and out of the patient 14. The access catheter hub 28 is also carried by the support table 20 and is movable along the table to advance the access catheter into and out of the patient 14. The access catheter hub can also be configured to rotate the access catheter in response to operation of a rotation control, and can also be configured to laterally deflect a deflectable portion of the access catheter in response to operation of a deflection control.

[0139] FIG. 2is a longitudinal cross-section schematically showing the movement relationship between the guidewire 27 having two degrees of freedom (axial and rotational), the access catheter 29 having three degrees of freedom (axial, rotational, and lateral deflection), and the guide catheter 31 having one degree of freedom (axial).

[0140] With reference to FIG. 3A The support table 20 includes drive mechanisms described in greater detail below to independently drive the guidewire hub 26, the access catheter hub 28, and the guide catheter hub 30. An anti-kink feature 34 can be provided in a proximal anti-kink region to resist kinking of portions of the interventional device spanning the distance between the support table 20 and the femoral access point 24. The anti-kink feature 34 can include a plurality of concentrically extendable and collapsible tubes through which the interventional device extends.

[0141] Alternatively, a proximal section of one or more device shafts can be configured to have enhanced rigidity to reduce kinking when compressed. For example, a proximally reinforced section can extend distally from the hub to a distance of at least about 5 cm or 10 cm, but typically no more than about 120 cm or 100 cm, to support the device between the hub and the access point 24 on the patient. Reinforcement can be achieved by using a metallic or polymeric tube or embedding at least one or two or more axially extending elements, such as long wires or bands, into the wall of the device shaft. In some embodiments, the extending elements can be hollow and prevent wear, kinking, or damage at the input and output of the hub. In some embodiments, the hollow extending elements can be a hollow and flexible covering layer attached to the hub. The hollow extending elements (e.g., the hollow and flexible covering layer) can cover a portion of the device shaft as it passes through the hub. In some embodiments where the hollow extending elements are a covering layer, the coating can be attached to a portion of the hub such that passing the catheter device through the hub 26, 28, or 30 also passes the catheter device through the covering layer. In some embodiments, an anti-kink device can be mounted on or around the device shaft to avoid misalignment or insertion angle errors between the hubs or between the hubs and the insertion point. The anti-kink device can be a laser-cut hypotube, a spring, a telescoping tube, a split tube with tension, etc.

[0142] In some embodiments, multiple deflection sensors can be placed along the catheter length to identify kinking. Identifying kinking can be done by sensing that the hub is being advanced distally while the distal tip of the catheter or interventional device is not moving. In some embodiments, kinking can be detected by sensing that energy load has occurred between the catheter shafts (e.g., due to friction).

[0143] Alternatively, a thin tubular reinforcing structure can be embedded in the device wall or continue outside the device wall, such as a tubular polymer extrusion or a section of hypotube. Alternatively, a removable reinforcing mandrel can be placed within the lumen in the proximal section of the device shaft and removed from the proximal end after distal advancement of the hub toward the patient entry position to prevent buckling of the proximal shaft during distal advancement of the hub. Alternatively, the proximal section of one or more device shafts can be configured as a tubular hypotube, which can be machined (e.g., with a laser) such that its mechanical properties vary along its length. The proximal section can be formed of stainless steel, nitinol, and / or cobalt-chrome alloy, optionally in combination with a polymer component that can provide lubricity and hydraulic sealing. In some embodiments, the proximal section can be formed of a polymer, such as polyether ether ketone (PEEK). Alternatively, the wall thickness or diameter of the interventional device can be increased in the anti-buckling region.

[0144] In certain embodiments, a device shaft with advanced stiffness (e.g., axial and torsional) can provide improved movement transmission from the proximal end of the device shaft to the distal end of the device shaft. For example, the device shaft can be more responsive to movement applied at the proximal end. Such embodiments can be advantageous for roboticized driving without haptic feedback to the user.

[0145] In some embodiments, a flexible covering can be applied to the device shaft and / or hub to reduce frictional forces between the device shaft and / or hub and a second device shaft as the second device shaft passes through the device shaft and / or hub and the second device shaft.

[0146] The interventional device hub can be separated from the support table 20 by a sterile barrier 32. The sterile barrier 32 can comprise a thin plastic film, such as polyethylene terephthalate (PET), polyethylene terephthalate glycol (PETG), polyethylene terephthalate (PETE), high-density polyethylene (HDPE), polyvinyl chloride (PVC), low-density polyethylene (LDPE), polypropylene (PP), polystyrene (PS), or styrene. This allows the support table 20 and associated drive systems to be located on the non-sterile (lower) side of the sterile barrier 32. The guide wire hub 26, the access catheter hub 28, the guide catheter hub 30, and the associated interventional devices are all on the sterile (upper) side of the sterile barrier 32. The sterile barrier is preferably water-resistant and can also be used as a tray for use in packaging of the interventional devices, which will be discussed further below. The interventional devices can be provided individually or as a co-axial pre-assembled kit, which is transported and stored in the tray and packaged in a sterile package.

[0147] FIG. 3B to FIG. 3FAn optional sterile barrier, shown schematically, is placed over the support table during an interventional procedure in the form of a dual function sterile barrier, and a transport tray having one or more storage channels for carrying sterile interventional devices. The sterile barrier can also be used as a sterile work surface for preparation of catheters or other devices during the procedure.

[0148] Referring to FIG. 3B and FIG. 3C a sterile barrier 32 is shown in the form of a preformed tray for mounting over the elongate support table 20. In use, the elongate support table 20 will be positioned beneath the sterile barrier 32. The sterile barrier 32 extends between a proximal end 100 and a distal end 102 and includes an upper support surface 104 for supporting the hub of an interventional device. In one embodiment, in a linear drive configuration, the support surface 104 has an axial length greater than the length of the intended interventional device.

[0149] The length of the support surface 104 will typically be at least about 100 centimeters and in the range of about 100 centimeters to about 2.7 meters. Shorter lengths can be used in systems configured to advance the drive connector along an arcuate path. In some embodiments, two or more support surfaces can be used in place of a single support surface 104. The two or more support surfaces can have a combined length of 100 centimeters to about 2.7 meters. The width of the linear drive table is preferably no more than about 30 centimeters to about 80 centimeters.

[0150] At least a first channel 106 can be provided which extends axially at least part of the length of the support table 20. In the embodiment shown, the first channel 106 extends the entire length of the support table 20. Preferably, the first channel 106 has sufficient length to accommodate an interventional device and has sufficient width and depth to accommodate the corresponding hub (e.g., by providing lateral support to prevent the hub from being dislodged when force is applied to the hub). The first channel 106 is defined within a floor 108, an outer sidewall 110 and an inner sidewall 111, forming an upwardly facing concavity. Optionally, a second channel 112 can be provided. The second channel 112 can be located on the same side or the opposite side of the upper support surface 104 as the first channel 106. Two or three or more additional recesses (e.g., additional channels or holes) can be provided to accommodate additional medical devices or supplies useful during an interventional procedure, as well as to collect fluids and serve as a wash basin for catheters and related devices.

[0151] Referring to FIG. 3DThe guide catheter hub 30 is shown positioned on the upper support surface 104 and magnetically connected to the corresponding connector that houses the drive magnet, which is positioned below the sterile barrier 32. The access catheter hub 28 and access catheter 29, as well as the guidewire hub 26 and guidewire 27 are shown positioned within the first channel 106, for example, prior to introduction through the guide catheter 31 or after removal from the guide catheter 31.

[0152] The interventional devices can be positioned within the channel 106 and enclosed within the sterile barrier for transport. At the clinical site, the upper panel of the sterile barrier can be removed, or the tubular sterile barrier package can be opened and removed axially from the support table 20 and sterile barrier assembly 32, exposing the sterile top side of the sterile barrier tray and any included interventional devices. The interventional devices can be carried individually in the channel, or pre-assembled into an access assembly or a procedure assembly, which will be discussed in additional detail below.

[0153] FIG. 3D to FIG. 3F The support table is shown with the sterile barrier in place, and the interventional devices are shown positioned within the channel 106, for example, prior to introduction through the guide catheter 31 or after removal from the guide catheter 31. FIG. 3E In the embodiment shown in FIG. 6, the interventional devices are configured in an access assembly for aortic access after the access assembly is connected to the corresponding sled below the sterile barrier. The access assembly can be pre-assembled with the guidewire fully advanced through the access catheter, which in turn is fully advanced through the guide catheter. In embodiments where the access catheter or other catheter is pre-shaped (i.e., pre-curved or not straight), the guidewire and / or outer catheter can be positioned such that the relatively stiff portion does not overlap the curved, stiffer portion of the pre-shaped catheter, for example, to avoid kinking or straightening of the pre-shaped catheter and / or to introduce a curve into other straight catheters. This access assembly can be lifted out of the channel 106 and positioned on the support surface 104 for connection to the corresponding drive magnet and introduction into the patient. The guide catheter hub 30 is the distal-most hub. The access catheter hub 28 is positioned proximal of the guide catheter hub such that the access catheter 29 can extend distally through the guide catheter. The guidewire hub 26 is positioned proximally to allow the guidewire 27 to be advanced through the access catheter 29 and the guide catheter 31.

[0154] FIG. 3F The procedure assembly is shown after the procedure assembly has been introduced through the guide catheter 31 for implementation of a suprarenal aortic procedure. In this embodiment, the guide catheter 31 remains the distal-most interventional device. The first procedure catheter 120 and corresponding hub 122 are shown extending through the guide catheter 31. The optional second procedure catheter 124 and corresponding hub 126 are shown extending through the first procedure catheter 120. The guidewire 27 extends through at least a portion of the second procedure catheter 124 in a rapid exchange version of the second procedure catheter 124, or through the entire length of the second procedure catheter 124 in a wire-over-wire embodiment.

[0155] As discussed in connection withFIG. 17 In more detail, access and intravascular procedures can be implemented with a multi-catheter stack without the need to change catheters. This can be done in manually or robotically operated procedures. In one example, the guide catheter 31 can comprise a catheter having an inner diameter of at least about 0.08 inches, and in one embodiment, about 0.088 inches. The first procedural catheter 120 can comprise a catheter having about 0.065 inches to about 0.075 inches, and in one embodiment, the catheter 120 has an inner diameter of about 0.071 inches. The second procedural catheter 124 can be an access catheter having an OD size that allows advancement through the first procedural catheter 120. The second procedural catheter can be steerable, having a deflection control 2908 configured to laterally deflect the distal end of the catheter. The second procedural (access) catheter can also have a lumen sized to allow a properly sized guidewire to be held inside the second procedural catheter while contrast injection is made through the second procedural catheter.

[0156] In certain embodiments, the catheter 31 can be a "large bore" access or guide catheter having a diameter of at least about 0.075 inches or at least about 0.080 inches. The catheter 120 can be a suction catheter having a diameter of about 0.060 to about 0.075 inches. The catheter 124 can be a steerable catheter having a deflectable distal tip having a diameter of about 0.025 inches to about 0.050 inches. The guidewire 27 can have a diameter of about 0.014 to about 0.020 inches. In one example, the catheter 31 can have a diameter of about 0.088 inches, the catheter 120 can have a diameter of about 0.071 inches, the catheter 124 can have a diameter of about 0.035 inches, and the guidewire 27 can have a diameter of about 0.018 inches.

[0157] In one commercial implementation, a pre-assembled access assembly (guide catheter, access catheter, and guidewire) can be carried in a first channel on a sterile barrier tray, and a pre-assembled procedural assembly (one or two procedural catheters and one guidewire) can be carried in the same or a different second channel on the sterile barrier tray. One or two or more additional catheters or interventional tools can also be provided, depending on potential needs during an interventional procedure.

[0158] FIG. 3G to FIG. 3K An alternative sterile barrier embodiment is shown having a convex drive surface (e.g., a convex, hump road-like drive surface). FIG. 3Gis a cross-sectional view of a sterile barrier 232. The sterile barrier 232 includes a convex upper support surface 204. Fluid channels 205 and 207 are located laterally to and below the support surface 204 for automatic purging or draining of fluid from the support surface 204 (e.g., during an interventional procedure). The fluid channels 205 and 207 can extend axially along at least a portion of the length of the sterile barrier.

[0159] FIG. 3I 、 FIG. 3J and FIG. 3K respectively show a cross-sectional perspective view, a cross-sectional view, and a top cross-sectional view of a proximal end of the sterile barrier 232. As shown in FIG. 3I to FIG. 3K the sterile barrier 232 can include a trough 240 in communication with the fluid channels 205 and 207. The trough 240 can receive fluid from the channels 205 and 207 (e.g., during an interventional procedure). The trough 240 can be at least partially located below the fluid channels 205 and 207 such that fluid within the channels 205 and 207 flows into the trough 240. In certain embodiments, the fluid channels 205 and 207 can be angled relative to horizontal (e.g., can slope from an end of the channels furthest from the trough 240 to the trough 240) such that fluid within the channels 205 and 207 is directed to the trough 240. For example, the depth of the channels 205 and 207 can increase from an end of the channels furthest from the trough 240 to the trough 240. Alternatively, the sterile barrier 232 and / or the support table can be positioned at an angle relative to horizontal during a portion or the entirety of an interventional procedure such that an end of the channels 205 and 207 furthest from the trough 240 is positioned higher than the trough 240. For example, the sterile barrier 232 and / or the support table can be configured or arranged at an angle such that an end of the sterile barrier 232 and / or the support table opposite the trough 240 is positioned higher than the trough 240. Alternatively or additionally, a drive mechanism can temporarily tilt the sterile barrier 232 and / or the support table such that an end of the sterile barrier 232 and / or the support table opposite the trough 240 is positioned higher than the trough 240 (e.g., by raising an end of the sterile barrier 232 and / or the support table opposite the trough 240 or lowering an end of the sterile barrier 232 and / or the support table at the location of the trough 240) such that fluid within the channels 205 and 207 flows into the trough 240.

[0160] The trough 240 can include a drain 242. The trough 240 can be configured in shape, size, and / or other ways as desired such that fluid within the trough 240 drains to the drain 242. The drain 242 can include a tube, a barbed fitting, and / or a shut-off valve for removing fluid from the trough 240. As shown in FIG. 3I to FIG. 3KAs shown, the slot 240 can be located at the proximal end of the sterile barrier 232. In alternative embodiments, the slot 240 can be located at the distal end of the sterile barrier 232. In some embodiments, the sterile barrier 232 can include a first slot 240 at the proximal end and a second slot 240 at the distal end. In some embodiments, the slot 240 can also be used as a wash basin.

[0161] The first channel 206 can extend axially at least a portion of the length of the sterile barrier 232. The channel 206 can have a length sufficient to accommodate an interventional device and a width and depth sufficient to accommodate a corresponding hub (e.g., by providing support to prevent dislodging of the hub when force is applied to the hub). Optionally, a second channel 212 can be provided. The second channel 212 can be located on the same side or opposite side of the first channel 206 of the upper support surface 204. FIG. 3G A channel 212 is shown on the opposite side of the support surface 204 from the channel 206. FIG. 3H is a cross-sectional view showing an alternative embodiment of the sterile barrier 232 in which the channel 212 is on the same side of the support surface 204 as the channel 206.

[0162] As shown in FIG. 3G and FIG. 3H The channels 206 and 212 can have a generally triangular, wedge-shaped, or other angular cross-section, as shown, to accommodate the hub at an angle relative to horizontal. Accommodating the hub at an angle relative to horizontal can allow for a smaller width of the sterile barrier 232.

[0163] Two or three or more additional recesses (e.g., additional channels or holes) can be provided to accommodate additional medical devices or supplies that can be useful during an interventional procedure, as well as to collect fluids and serve as a wash basin for catheters and related devices.

[0164] In some embodiments, the sterile barrier 232 can include one or more structural ribs 236. The sterile barrier 232 can also include one or more frame support protrusions 228 and 238.

[0165] In the embodiment of the sterile barrier 232 shown, FIG. 3G The width xi can be 14 in, about 14 in, 12 in to 16 in, 10 in to 18 in, or any other suitable width. In the embodiment of the sterile barrier 232 shown, FIG. 3HIn the illustrated embodiment of the sterile barrier 232, the width x1 can be 15 in, about 15 in, 13 in to 17 in, 11 in to 19 in, or any other suitable width. The height y1 of the support surface 204 can be 0.125 in, about 0.125 in, 0.1 in to 0.15 in, or any other suitable height. In some embodiments, the support surface 204 can be recessed from the top surface 233 of the sterile barrier 232. The height y2 between the bottom of the support surface 204 and the top surface 233 can be 0.5 in, about 0.5 in, 0.25 in to 0.75 in, or any other suitable height. The width x2 from the lateral edge of the channel 205 to the lateral edge of the channel 207 can be 5 in, about 5 in, 4 in to 6 in, or any other suitable width. The width x3 of the support surface 204 can be 4 in, about 4 in, 3 in to 5 in, or any other suitable width. The height y3 of the channel 206 and / or the channel 212 can be 1.5 in, about 1.5 in, 1 in to 2 in, or any other suitable height. The width x4 of the channel 206 and / or the channel 212 can be 3 in, about 3 in, 2 in to 4 in, or any other suitable width. The channel 206 and / or the channel 212 can be defined by an arc angle a of 90°, about 90°, 80° to 100°, or any other suitable angle, and a radius of curvature of 0.125 in, about 0.125 in, 0.1 in to 0.15 in, or any other suitable radius of curvature. In certain embodiments, an arc angle a of 90° or about 90° can be used to accommodate a hub having a rectangular or generally rectangular cross-section. The support surface 204 can be defined by a radius of curvature of 13 in, about 13 in, 11 in to 15 in, or any other suitable radius of curvature. The channel 205 and / or the channel 207 can be defined by a radius of curvature of 0.25 in, about 0.25 in, 0.15 in to 0.35 in, or any other suitable radius of curvature.

[0166] FIG. 3L and FIG. 3M depicted can be used in conjunction with the systems and methods as described herein FIG. 3G to FIG. 3KThe illustrated sterile barrier 232 together with the hub 250. The hub 250 can be any hub described herein. In certain embodiments, the hub 250 can have a width wl of 3.75 in, about 3.75 in, 3.25 in to 4.25 in, or any other suitable width. The hub 250 can have a height hi of 1.5 in, about 1.5 in, 1.25 in to 1.75 in, or any other suitable height. Alternatively, the hub 250 can have a height h2 of 2 in, about 2 in, 1.75 in to 2.25 in, or any other suitable height. In some embodiments, the hub 250 can have a length LI of 2.5 in, about 2.5 in, 2 in to 3 in, or any other suitable length. Alternatively, the hub 250 can have a length L2 of 4 in, about 4 in, 3.5 in to 4.75 in, or any other suitable length.

[0167] In some embodiments, the top surface of the support table can include surface features that generally correspond to the surface features of the sterile barrier 232. For example, the support table can include a raised surface configured to correspond to the shape, size, and position of the support surface 204 and / or one or more recesses configured to correspond to the shape, size, and position of the channels 205 and 207.

[0168] In alternative embodiments, a planar support surface (e.g., the support surface 104 of the sterile barrier 32) can be positioned at an angle to the horizontal to facilitate drainage of fluid. In some embodiments, the sterile barrier and / or support table can be positioned at an angle to the horizontal to facilitate drainage of fluid during a portion or the entire course of an interventional procedure. For example, the sterile barrier and / or support table can be configured or arranged in an angled arrangement (e.g., such that one lateral side of the planar support surface is positioned higher than another lateral side of the planar support surface, the proximal end is positioned higher than the distal end, or the distal end is positioned higher than the proximal end) to facilitate drainage of fluid. Alternatively or additionally, the drive mechanism can temporarily tilt the sterile barrier and / or support table (e.g., such that one lateral side of the planar support surface is positioned higher than another lateral side of the planar support surface, the proximal end is positioned higher than the distal end, or the distal end is positioned higher than the proximal end) to facilitate drainage of fluid. For example, the drive mechanism can raise or lower one lateral side of the sterile barrier and / or support table, the proximal end of the sterile barrier and / or support table, and / or the distal end of the sterile barrier and / or support table.

[0169] In certain embodiments, the support surface (e.g., the support surface 104 of the sterile barrier 32) can be positioned in a vertical configuration, rather than, for example FIG. 3A to FIG. 3FThe horizontal configuration is shown. For example, the support surface 104 can be positioned at about 90 degrees (or any other suitable angle) to the horizontal plane (e.g., relative to the FIG. 3A to FIG. 3F The vertical configuration is shown. For example, the support surface 104 can be positioned at about 90 degrees (or any other suitable angle) to the horizontal plane (e.g., relative to the

[0170] In some embodiments, the drive system 18 can be positioned at an angle to the horizontal plane during a portion or the entire interventional procedure to facilitate drainage of fluids. For example, the drive system 18 can be configured or arranged in an angled arrangement (e.g., such that one lateral side of the planar support surface is higher than another lateral side of the planar support surface, the proximal end is higher than the distal end, or the distal end is higher than the proximal end positioned) to facilitate drainage of fluids. Alternatively or additionally, the drive mechanism can temporarily tilt the drive system 18 (e.g., such that one lateral side of the drive system 18 is higher than another lateral side of the drive system 18, the proximal end is higher than the distal end, or the distal end is higher than the proximal end positioned) to facilitate drainage of fluids. For example, the drive mechanism can raise or lower one lateral side of the system 18, the proximal end of the drive system 18, and / or the distal end of the drive system 18. In some embodiments, the drive system 18 can be angled such that it extends at an angle away from the axis point 24 (e.g., such that the proximal end is higher than the distal end), for example, to reserve clearance for the patient's feet.

[0171] Reference is made to FIG. 4 The hub 36 can represent any hub previously. The hub 36 includes a housing 38 extending between a proximal end 40 and a distal end 42. An interventional device 44, which can be any interventional device disclosed herein, extends distally from the hub 36 and into the patient 14 (not shown). A hub adapter 48 or sled advances proximally or distally along a track in response to operator instructions or controller operation as a shuttle. The hub adapter 48 includes at least one drive magnet 67 configured to connect with a driven magnet 69 carried by the hub 36. This provides a magnetic connection between the drive magnet 67 and the driven magnet 69 through the sterile barrier such that the hub 36 moves on top of the sterile barrier 32 in response to movement of the hub adapter 48 outside the sterile field. Movement of the hub adapter is driven by a drive system carried by the support table and described in additional detail below. The hub adapter can act as a roboticized driver for the interventional device connected therewith.

[0172] To reduce friction in the system, the hub 36 can be equipped with at least first and second rollers 53, 55, which can be in the form of wheels or rotatable balls or drums. The rollers space the sterile barrier at least about 0.02 centimeters (about 0.008 inch) from the surface of the driven magnet 69, and typically no more than about 0.08 centimeters (about 0.03 inch). In some embodiments, the gap is in the range of about 0.03 centimeters (about 0.010 inch) to about 0.041 centimeters (about 0.016 inch). The gap between the drive magnet 67 and the driven magnet 69 is typically no more than about 0.38 centimeters (about 0.15 inch), and in some embodiments no more than about 0.254 centimeters (about 0.10 inch), for example in the range of about 0.216 centimeters (about 0.085 inch) to about 0.229 centimeters (about 0.090 inch). The hub adapter 48 can similarly be equipped with at least first and second hub adapter rollers 59, 63, which can be positioned opposite the respective first and second rollers 53, 55, as FIG. 4 shown.

[0173] Referring to FIG. 6 FIG. 1, one example of a low-profile linear drive support table 20 is shown schematically. The support table 20 includes an elongated frame 51 extending between a proximal end 52 and a distal end 54. At least one support member 56 is provided to stabilize the support table 20 relative to a patient (not shown). The support member 56 can include one or more legs, or preferably a jointed arm configured to allow the frame 51 to be moved and positioned above or adjacent to the patient.

[0174] FIG. 7 The example of the linear drive table 20 shown includes three different drives. However, two drives or four or more drives (e.g., up to eight drives) can be included depending on the desired clinical performance. A first drive pulley 58 is engaged with a first drive belt 60. A first trolley carriage 61 is fixed to the first drive belt 60 such that rotation of the first drive pulley 58 causes the first drive belt 60 to rotate through an elongated closed loop path. Depending on the direction of rotation of the drive pulley 58, the first trolley carriage 61 can be advanced in either a proximal or distal direction along the longitudinal axis of the support table 20. In the embodiment shown, the drive pulley 58 is equipped with a surface structure, such as a plurality of drive pulley teeth 62, for engagement with complementary teeth on the first drive belt 60.

[0175] A second drive pulley 64 can be engaged with a second drive belt 66 configured to axially move a second trolley carriage 68 along an axial path on the support table 20. A third drive pulley 70 can be configured to drive a third drive belt 72 to axially advance a third trolley carriage 73 along the support table 20. Each trolley carriage can be equipped with the previously discussed but not shown sterile barrier 74, which can be in the form of a sterile drape or a sterile sleeve. The sterile barrier 74 can be configured to be removable and replaceable, for example by a sterile drape or sleeve that is disposable or reusable. FIG. 7The drive magnet assembly shown in FIG. 1 is configured to form a connector for magnetically connecting to a corresponding driven magnet within a hub of an interventional device, as already discussed.

[0176] FIG. 8 A detailed view of the drive system is shown schematically. A drive support 74 can be carried by the frame 51 for supporting the drive assembly. The second drive pulley 64 is shown in elevation cross-section as being rotationally driven by a motor 75 via a rotatable shaft 76. The rotatable shaft 76 can be rotationally carried by the support 74 via a first bearing 78, a shaft connection 80, and a second bearing 79. The motor 75 can be stabilized by a motor mount 82 connected to the drive support 74 and / or the frame 51. The belt drive assembly for the first drive belt 60 and the third drive belt 72 can be similarly configured, and are not otherwise described in further detail herein. In some embodiments, the drive system described herein can be a rack and pinion drive table system that is foldable. In such embodiments, the motor 75 can be attached to and move with the trolley.

[0177] Reference is made to FIG. 9 and FIG. 10 Each of the first, second, and third drive belts extends around a corresponding first idler 84, second idler 86, and third idler 88. Each idler can be equipped with a corresponding tension mount 90 configured to adjust the idler in a proximal or distal direction in order to adjust the tension of the respective belt. Accordingly, each tension mount 90 is equipped with a tension adjustment 92, such as a rotatable screw.

[0178] As shown in FIG. 10 , for example, the second idler 86 can be carried by a rotatable shaft 94 rotatably fixed relative to the mounting bracket by a first bearing 96 and a second bearing 98.

[0179] Any catheter (e.g., as shown in FIG. 5A , FIG. 5B or FIG. 11 typically includes an elongate tubular body extending between a proximal end and a distal functional tip. The length and diameter of the tubular body depend on the desired application. For example, a length of about 90 centimeters to about 195 centimeters or more is typically used for femoral access percutaneous transluminal coronary artery applications. Intracranial or other applications can require different catheter shaft lengths depending on the vascular access site.

[0180] Any catheter disclosed herein can be equipped with a beveled distal tip. Reference is made to FIG. 11The distal catheter tip 1150 includes a tubular body 1152 that includes a push section 1154, a marker band 1156, and a proximal section 1158. An inner tubular liner 1160 can extend through the entire length of the distal catheter tip 1150 and can include an impregnated or extruded PTFE or other lubricious material.

[0181] A reinforcing element 1162, such as a braid and / or spring coil, is embedded into an outer jacket 1164, which can extend the entire length of the catheter.

[0182] The push section 1154 terminates at a distal end in a beveled face 1166 to provide a front sidewall portion 1168 having a length measured between a distal end 130 of the marker band 1156 and a distal tip 1172. In some embodiments, the entire distal tip can have a shape that avoids the tip from catching in the arterial bifurcation area. A back sidewall portion 1174 of the push section 1154 has, in the illustrated embodiment, an axial length approximately equal to the axial length of the front sidewall portion 1168, which is measured from the front sidewall portion 1168 around the catheter approximately 180 degrees. The axial length of the front sidewall portion 1168 can be from about 0.1 mm to about 5 mm, and typically from about 1 mm to 3 mm. The back sidewall portion 1174 can be equal to the axial length of the front sidewall portion 1168 or at least about 0.1 mm or 0.5 mm or 1 mm or 2 mm or more shorter than the axial length of the front sidewall portion 1168, depending on the desired performance.

[0183] The beveled face 1166 is inclined at an angle A of from about 45 degrees to about 80 degrees from the longitudinal axis of the catheter. For certain embodiments, the angle is from about 55 degrees to about 65 degrees from the longitudinal axis of the catheter. In one embodiment, the angle A is about 60 degrees. One result of the angle A of less than 90 degrees is an elongation of the long axis of the area of the distal port, which increases the surface area of the port and can enhance clot aspiration or retention. The area of the beveled port is typically at least about 105% and no more than about 130% of the surface area of a circular port (angle A of 90 degrees), in some embodiments, from about 110% to about 125%, and in one example, about 115% of the area of a corresponding circular port (angle A of 90 degrees).

[0184] In the illustrated embodiment, the axial length of the push section remains constant around the circumference of the catheter such that the ramped face 1166 is generally parallel to the distal surface 1176 of the marker band 1156. The marker band 1156 has a proximal surface that is generally transverse to the longitudinal axis of the catheter, resulting in an interior elevational view of the marker band 1156 having a right-triangular configuration. The short side wall 1178 is in rotational alignment with the back side wall portion 1174 and has an axial length of about 0.2 mm to about 4 mm, and typically about 0.5 mm to about 2 mm. The opposing long side wall 1180 is in rotational alignment with the front side wall portion 1168. The long side wall 1180 of the marker band 1156 is typically at least about 10% or 20% longer than the short side wall 1178, and can be at least about 50% or 70% or 90% or more longer than the short side wall 1178, depending on the desired performance. Typically, the long side wall 1180 will have a length of at least about 0.5 mm or 1 mm and less than about 5 mm or 4 mm.

[0185] The marker band can be a continuous annular structure, or can have at least one and optionally two or three or more axially extending slits throughout its entire length. The slits can be located on the short side wall 1178 or the long side wall 1180 or between the two, depending on the desired bending characteristics. The marker band can include any of a variety of radiopaque materials, such as platinum / iridium alloy, and have a wall thickness preferably no more than about 0.003 inches, and in one embodiment about 0.001 inches.

[0186] When multiple catheters are used, the radiographic appearance of the marker band can be unique or different for each catheter size or type, such that the marker bands can be distinguished from one another by a software algorithm. It can be advantageous to distinguish the marker bands of multiple catheters when the multiple catheters are used together, such as in a multi-catheter assembly or stack as described herein. In some embodiments, the marker band of the catheter can be configured to enable a software algorithm to detect movement of the catheter tip.

[0187] The marker band region of the assembled catheter can have a relatively high bending stiffness and a high crushing strength, such as at least about 50% or at least about 100% less than the proximal section 18, but typically no more than about 200% less than the proximal section 1158. The high crushing strength can provide radial support to the adjacent push section 1154, and in particular to the front side wall portion 1168, to facilitate the function of the distal tip 1172 as an atraumatic bumper during transluminal advancement and to prevent collapse under vacuum. The proximal section 1158 preferably has a lower bending stiffness than the marker band region, and the push section 1154 preferably has an even lower bending stiffness and crushing strength than the proximal section 1158.

[0188] The push segment 1154 can include a distal extension of the outer tubular sheath 1164 and optional inner liner 1160 without other internal support structures distal of the marker band 1156. The outer sheath 1164 can comprise an extruded polyurethane, such as Tecothane®. The push segment 1154 can have a bending stiffness and radial crush stiffness of no more than about 50% and in some embodiments no more than about 25% or 15% or 5% or less of the corresponding values of the proximal segment 1158.

[0189] The catheter can also include an axial tension element or support, such as a band or one or more filaments or fibers, for increasing the tension resistance and / or affecting the bending properties in the distal region. The tension support can include one or more axially extending single or multi-strand filaments. The one or more tension elements 1182 can be placed axially within the catheter wall proximate the distal end of the catheter. The one or more tension elements 1182 can act as a tension support and resist tip disengagement or elongation of the catheter wall under tension (e.g., when the catheter is proximally retracted through a kinked outer catheter or tortuous or narrowing vasculature).

[0190] At least one of the one or more tension elements 1182 can extend proximally from within about 1.0 centimeter of the distal end of the catheter to less than about 10 centimeters of the distal end of the catheter, to less than about 20 centimeters of the distal end of the catheter, to less than about 30 centimeters of the distal end of the catheter, to less than about 40 centimeters of the distal end of the catheter, or to less than about 50 centimeters of the distal end of the catheter.

[0191] The one or more tension elements 1182 can have a length greater than or equal to about 40 centimeters, greater than or equal to about 30 centimeters, greater than or equal to about 20 centimeters, greater than or equal to about 10 centimeters, or greater than or equal to about 5 centimeters.

[0192] At least one of the one or more tension elements 1182 can extend at least about the distal 50 centimeters of the catheter length, at least about the distal 40 centimeters of the catheter length, at least about the distal 30 centimeters or 20 centimeters or 10 centimeters of the catheter length.

[0193] In some embodiments, the tension element extends proximally along the length of the coil 24 from the distal end of the catheter and terminates proximally on both sides of the transition between the distal coil and the proximal braid about 5 centimeters or 2 centimeters or less. The tension element can terminate at the transition without overlapping the braid.

[0194] One or more tension elements 1182 can be placed near or radially inside the inner liner 1160. One or more tension elements 1182 can be placed near or radially inside the braid and / or coil. One or more tension elements 1182 can be carried between the inner liner 1160 and the helical coil and can be secured to the inner liner or other underlying surface by adhesive before the next outer adjacent layer (e.g., coil) is added. Preferably, the tension elements 1182 are secured to the marker band 1156, e.g., by adhesive or by mechanical interference. In one embodiment, the tension elements 1182 extend distally beyond the marker band on a first (e.g., inner) surface of the marker band, then wrap around the distal end of the marker band and extend proximally on a second (e.g., outer) surface in one or both of a circumferential and a radial direction to completely wrap around the marker band.

[0195] When more than one tension element 1182 or filament bundle is spaced circumferentially in the catheter wall, the tension elements 1182 can be placed in a radially symmetric manner. For example, the angle between two tension elements 1182 relative to the radial center of the catheter can be about 180 degrees. Alternatively, the tension elements 1182 can be placed in a radially asymmetric manner depending on the desired clinical performance (e.g., flexibility, trackability). The angle between any two tension elements 1182 relative to the radial center of the catheter can be less than about 180 degrees, less than or equal to about 165 degrees, less than or equal to about 135 degrees, less than or equal to about 120 degrees, less than or equal to about 90 degrees, less than or equal to about 45 degrees, or less than or equal to about 15 degrees.

[0196] One or more tension elements 1182 can comprise, for example, Vectran®, Kevlar®, Polyester®, Spectra®, Dyneema®, Meta-Para-Aramide®, or any combination thereof. At least one of the one or more tension elements 1182 can comprise a single fiber or a multi-fiber bundle, and the fiber or bundle can have a circular or rectangular (e.g., ribbon) cross-section. The terms fiber or filament do not express composition, and they can comprise any of a variety of high tensile strength polymers, metals or alloys depending on design considerations such as the desired tensile failure limit and wall thickness. The cross-sectional dimension of the one or more tension elements 1182, measured in the radial direction, can be no more than about 2%, 5%, 8%, 15%, or 20% of the cross-sectional dimension of the catheter 10.

[0197] The cross-sectional dimension of one or more tension members 1182 measured in a radial direction can be no more than about 0.03 millimeters (about 0.001 inch), no more than about 0.0508 millimeters (about 0.002 inch), no more than about 0.1 millimeters (about 0.004 inch), no more than about 0.15 millimeters (about 0.006 inch), no more than about 0.2 millimeters (about 0.008 inch), or about 0.38 millimeters (about 0.015 inch).

[0198] One or more tension members 1182 can increase the tensile strength of the distal end region of the catheter to at least about 1 pound, at least about 2 pounds, at least about 3 pounds, at least about 4 pounds, at least about 5 pounds, at least about 6 pounds, at least about 7 pounds, at least about 8 pounds, or at least about 10 pounds or more before failing (e.g., the marker band detaches) under tension.

[0199] Depending on the data desired, any of a variety of sensors can be provided on any of the catheter, hub, sled, or worktable. For example, in some embodiments, it can be desirable to measure the axial tension or compression force applied to the catheter, for example, along the force sensing region. The distal end of the catheter will be fabricated to have a similar structure as shown in FIG. 11 Instead of using a single helical coil of nitinol wire, the first and second conductors 140 and 142 are wound into a helical coil that is intertwined with itself, and are electrically insulated from each other, for example, by the plastic / resin of the tubular body. See FIG. 12A Each coil is in electrical communication with the proximal hub by a unique electrical conductor, such as a conductive wire or proximal extension of the wire.

[0200] This structure of a dual electrically isolated helical coil creates a capacitor. This is roughly equivalent to two plates of nitinol with a layer of plastic between them, as shown in FIG. 12B The capacitance is inversely proportional to the distance between the wires. The only variable that will change is d, the distance between the plates. If an axial compressive force is applied to the catheter, the wires (e.g., conductors 140 and 142) will move closer together, increasing the capacitance. If an axial tensile force is applied, the wires will move further apart, decreasing the capacitance. This capacitance can be measured at the proximal end of the catheter, giving a measurement of the force at the helical capacitor. Although referred to as a capacitor, this sensor measures the electrical interaction between the coils of the two wires. There can be a measurable change in inductance or other resulting changes due to the applied axial force.

[0201] At least the first spiral capacitor can have at least one or five or ten or more complete turns of wire per filament. The capacitor can be located within 5 cm or 10 cm or 20 cm of the distal end of the catheter body to sense forces experienced at the distal end. At least one second capacitor can be provided within 5 cm or 10 cm or 20 cm of the proximal end of the catheter body to sense forces experienced at the proximal end of the catheter.

[0202] It can also be desirable to use the natural elasticity (compliance) of the magnetic connection between the hub and the corresponding trolley to measure the elastic force across the magnetic connection between the hub and the corresponding trolley to measure the force applied to the hub. The magnetic connection between the hub and the trolley creates a spring. When a force is applied to the hub, the hub will move a small amount relative to the trolley. See FIG. 13A In robotic chemistry, this is referred to as a series elastic actuator. This property can be used to measure the force applied to the hub from the trolley. To measure the force, the relative distance between the hub and the trolley is determined (dx as shown), and some effective spring constant k between the two components is characterized. See FIG. 13A FIG. 13B .

[0203] The relative distance can be measured in a number of different ways. One method for measuring the relative distance between the hub and the trolley is a magnetic sensor (e.g., a Hall effect sensor between the hub and the trolley). A magnet is mounted to the hub or the trolley, and a corresponding magnetic sensor is mounted on the other device (trolley or hub). The magnetic sensor can be a Hall effect sensor, a magnetoresistive sensor, or other type of magnetic field sensor. In general, multiple sensors can be used to increase the reliability of the measurement. This reduces noise and reduces interference from external magnetic fields.

[0204] Other non-contact distance sensors can also be used. These include optical sensors, inductive sensors, and capacitive sensors. Optical sensors will preferably be configured in a manner that avoids the accumulation of blood or other fluids in the interface between the hub trolley. In some embodiments, for example, wireless (i.e., inductive) power sources can be used to convert movement and / or transmit information across the sterile barrier between the drive trolley and the hub.

[0205] The magnetic connection between the hub and the trolley has a shear or axial breakage threshold, which can be about 300 grams or 1000 grams or more. The processor can be configured to compare the axial force applied to the catheter to a preset axial trigger force, which is perceived as posing a risk to the patient if it is applied to the catheter. If the trigger force is reached, the processor can be configured to produce a response to the physician (e.g., visual, audible, or tactile feedback), and / or intervene and shut down further advancement of the catheter until the reset is complete. An override function can be provided so that the physician can choose to continue advancing the catheter at a force higher than the trigger force if the physician deems that the increased force is justified.​

[0206] Force and / or torque sensing optical fibers (e.g., Fiber Bragg Grating (FBG) sensors) can be built into the catheter sidewall to measure force and / or torque at different locations along the shaft of the catheter, or alternatively can be integrated into the guidewire. The fibers measure axial strain, which can be converted to axial force or torque (when helically wound). At least a first FBG sensor can be integrated into the distal sensing region, the proximal sensing region, and / or the intermediate sensing region on the catheter or guidewire to measure force and / or torque in the vicinity of the sensor.

[0207] It can also be desirable to understand the three-dimensional configuration of the catheter or guidewire during and / or after transvascular placement. Shape sensing fibers, such as arrays of FBG fibers, are used to sense the shape of the catheter and guidewire. By using multiple force sensing fibers at known distances from each other, the shape along the length of the catheter / guidewire can be determined.

[0208] Resistive strain gauges can be integrated into the body of the catheter or guidewire to measure force or torque. For example, at the distal tip and / or proximal end of the device.

[0209] Measurement of force and / or torque applied to the catheter or guidewire shaft can be used to determine applied force and / or torque above a safety threshold. When the applied force and / or torque exceeds the safety threshold, a warning can be provided to the user. The applied force and / or torque measurement can also be used to provide feedback related to better catheter operation and control. The applied force and / or torque measurement can also be used with processed fluoroscopic imaging information to determine or characterize distal tip movement.

[0210] The absolute position of the hubs (and corresponding catheters) along the length of the table can be determined in various ways. For example, non-contact magnetic sensors can be configured to directly measure the position of the hubs through the sterile barrier. Sensors of the same type can also be configured to measure the position of the trolleys. Each hub can have at least one magnet attached to it. The roboticized table will have a linear array of corresponding magnetic sensors across the length of the table. A processor can be configured to determine the position of the magnets along the length of the linear sensor array and display axial position information to the physician.

[0211] Alternatively, the above purpose can be accomplished using non-contact inductive sensors to directly measure the position of the hubs through the sterile barrier. Each hub or trolley can be equipped with an inductive "target" therein. The roboticized table can be equipped with an inductive sensing array across the working length of the table. As another alternative, absolute linear encoders can be used to directly measure the linear position of the hubs or trolleys. The encoders can use any of a variety of different technologies, including optical, magnetic, inductive, and capacitive methods.

[0212] In one embodiment, a passive (no electrical connection) target coil can be carried by each hub. A linear printed circuit board (PCB) can run the entire working length of the worktable (e.g., at least about 1.5 meters to about 1.9 meters), the linear printed circuit board configured to interrogate for an interrogator signal that elicits a return signal from the passive coil. The PCB is configured to identify the return signal and its location.

[0213] The axial position of the trolley can be determined using a multi-turn rotary encoder to measure the rotational position of the pulley, which is directly related to the linear position of the trolley. Alternatively, direct measurement of the trolley position can be accomplished by counting the number of steps that the command stepper motor measures to move the pulley, the rotational position of which is directly related to the linear position of the trolley.

[0214] The position of the catheter and guidewire within the anatomy can also be determined by processing fluoroscopic images with machine vision, such as to determine distal tip position, distal tip orientation, and / or guidewire shape. Comparing distal tip position or movement or lack thereof to commanded or actual proximal catheter or guidewire movement at the hub can be used to detect loss of relative movement, which can indicate device shaft buckling, prolapse, kinking, or similar results (e.g., along the length of the device shaft inside the body (e.g., in the aorta) or outside the body between the hubs. The processing can be done in real time to provide position / orientation data up to 30 hertz, although such techniques can only provide data when fluoroscopy is turned on. In some embodiments, machine vision algorithms can be used to generate and suggest optimal catheter operations to approach or reach anatomical landmarks, similar to driver assistance. Machine vision algorithms can utilize data to automatically drive the catheter according to the anatomy presented by the fluoroscopic exam.

[0215] Proximal torque applied to a catheter or guidewire shaft can be determined using a dual encoder torque sensor. Referring to FIG. 14 , a first encoder 144 and a second encoder 146 can be axially spaced apart along a shaft 148 for measuring the angular difference over the length of the flexible catheter / tube. Since the catheter / tube has a known torsional stiffness, the angular difference is interpolated to the torque. When torque is applied to the shaft, the slightly flexible portion of the shaft will twist. The difference between the angles measured by the encoders (dQ) tells us the torque. T = k dQ, where k is the torsional stiffness.

[0216] Confirming that there are no air bubbles in the fluid line can also be accomplished using a bubble sensor, particularly in situations where the physician is remote from the patient. This can be accomplished using a non-contact ultrasonic sensor that measures the intensity and Doppler shift of reflected ultrasound through the sidewall of the fluid conduit to detect air bubbles and measure fluid flow rate or fluid level. The ultrasonic or optical sensor can be located near the entry fluid flow path within the hub or in the supply line leading to the hub. To detect the presence of air bubbles in the infusion line (formed of ultrasonically or optically transparent material), the sensor can include a signal source on a first side of the flow path and a receiver on a second side of the flow path to detect bubbles by measuring transmission through the liquid in the tube. Alternatively, reflected ultrasound signals can be detected from the same side of the flow path as the source due to the relatively high echogenicity of air bubbles.

[0217] Preferably, the air bubble removal system is activated automatically upon detection of air bubbles in the line. The processor can be configured to activate a valve in the flow path downstream of the air bubble detector upon detection of air bubbles. The valve diverts a column of fluid from the flow path to the patient and into the reservoir. When no air bubbles are detected in the flow path, and the volume of fluid in the flow path between the detector and the valve has passed through the valve, the valve can be activated to reconnect the fluid source to the patient through the flow path. In other embodiments, the air bubble removal system can include a pump and control system upstream of the air bubble detector for removing air bubbles in the line. The processor can be configured to activate the pump upon detection of air bubbles to reverse the flow of fluid and purge the air bubbles into a waste reservoir before reestablishing air bubble free forward flow.

[0218] Further, it is desirable for the physician to be able to view the aspirated clot at one location within the sterile field, and preferably as close to the patient as possible for fluid management purposes. This can be accomplished by providing a clot retrieval device mounted on the hub, or by providing a clot retrieval device mounted in the aspiration line distally of the pump direction from the hub. With reference to FIG. 15 One example of a clot retrieval device 370 can include a body 380 enclosing a chamber 381 in communication with the first port 310 and the second port 320.

[0219] In some embodiments, the body 380 includes a housing having a top portion 382 and a bottom portion 384. The body 380 can include a filter 330 positioned in the chamber 381 between the top portion 382 and the bottom portion 384. In some examples, the first port 310 is configured to connect to a first end of a first tube 340 fluidly connected to a proximal end of the aspiration catheter.

[0220] In embodiments configured to connect downstream from the hub, the first tube 340 includes a connection 342 at the second end of the first tube 340 configured to engage or mate with a corresponding connection on the hub, or configured to engage or mate with a corresponding connection in communication with the hub. The first port 310 is in direct communication with a chamber on the upstream (e.g., top side) of the filter, and the second port 320 is in direct communication with a chamber on the downstream (e.g., bottom side) of the filter to facilitate direct visualization of material captured on the upstream side of the filter.

[0221] In embodiments configured for remote operation, any of a variety of sensors can be provided to detect clots passing through the aspiration line and / or trapped in the filter, such as optical sensors, pressure sensors, flow rate sensors, ultrasonic sensors, or other sensors known in the art.

[0222] In some embodiments, the second port 320 is configured to connect to a first end of a second tube 350 that is in fluid connection with an aspiration source (e.g., a pump). In some embodiments, the second tube 350 includes a connection 352 at a second end of the second tube 350 configured to engage or mate with a corresponding connection on the pump.

[0223] In some examples, the system 300 can include a switch valve 360, such as a clamp. The clamp can be located between the filter 330 and the patient, such as on the first tube 340, to allow a user to engage the clamp and provide flow control by isolating the patient from the clot removal device 370. Closing the valve 360 and operating a remote vacuum pump (not shown) causes a canister associated with the vacuum pump and the chamber 381 to reach the same low pressure. Due to the short distance of the lumen between the chamber 381 and the distal end of the catheter and the small volume of the line, a sharp negative pressure spike is experienced at the distal end of the catheter upon opening the valve 360. Additional details are disclosed in U.S. Patent No. 11,259,821, entitled “Aspiration System with Accelerated Response,” issued to Buck et al. on March 1, 2022, which is hereby expressly incorporated by reference in its entirety. In some embodiments, a vacuum can be cycled on the clot to recover the clot. The vacuum can be controlled automatically and robotically to remove the clot.

[0224] The body 380 can have a top surface spaced apart from a bottom surface by a tubular sidewall. In the illustrated embodiment, the top and bottom surfaces are substantially circular and are spaced apart by a cylindrical sidewall. The top surface can have a diameter that is at least about three times, or five times or more, the axial length of the sidewall (transverse to the top and bottom surfaces) to produce a generally disc-shaped housing. Preferably, at least a portion of the top wall is optically transparent to improve clot visualization after a clot is captured in the clot recovery device 370. Additional details can be found in U.S. Patent Application No. 63 / 256,743, which is hereby incorporated by reference in its entirety.

[0225] In some examples, the body 380 can include a flush port (not shown) configured to allow injection of an optically transparent medium, such as air, saline, or other fluid, into the chamber 381 to clear the optical path between the window and the filter, improving clot visualization after a clot is trapped in the filter 330.

[0226] The foregoing represents certain specific embodiments of drive tables and associated components and catheters. A wide variety of different drive table structures can be made for supporting and axially advancing and retracting two or three or four or more drive magnet assemblies to robotically operate an interventional device, fluidic element, and electrical umbilical element for communicating electrical signals and fluid to a catheter hub, as will be appreciated by those skilled in the art in view of the disclosure herein. Additional details can be found in U.S. Patent Application No. 17 / 527,393, which is hereby incorporated by reference in its entirety.

[0227] While the foregoing describes robotically operated interventional devices and manually driven interventional devices, the devices can be manually driven, robotically operated, or a combination of manually and robotically operated interventional devices, as will be appreciated by those skilled in the art in view of the disclosure herein.

[0228] In manual catheter procedures, a physician often stands to the right of the patient and inserts an interventional device from the physician’s right side to the physician’s left side when facing the patient. Certain embodiments of the robotic control handles described herein can be configured to mimic the movements made by a physician in a manual catheter procedure. For example, certain embodiments of the robotic control handles described herein include a control that is operated by left / right motion from the perspective of a user (e.g., a physician) operating the control to command insertion / retraction of an interventional device. Certain embodiments of the robotic control handles described herein include a control that is operated by roll or rotation motion from the perspective of a user (e.g., a physician) operating the control to command roll or rotation of an interventional device.

[0229] FIG. 16A to FIG. 16CAn example control console 2200 is shown for manipulating the interventional devices driven by (or otherwise associated with) the respective hubs. For example, each hub can be manipulated and / or otherwise moved using at least one control installed in the control console 2200. Each control can be adapted to move the interventional device associated with the unique hub during an interventional procedure.

[0230] As shown, the control console 2200 includes a first control 2202, a second control 2204, a third control 2206, and a fourth control 2208. More or fewer controls can be provided depending on the intended interventional device configuration. Each control 2202-2208 is movably carried on a shaft 2210, which is connected to a distal bracket 2212 and a proximal bracket 2214. The controls 2202-2208 can be advanced distally or retracted proximally on the shaft 2210, as indicated by arrows 2218 and 2216. In addition, each control 2202-2208 can also be rotated about the shaft 2210, as indicated by arrow 2220. Each control movement can trigger a responsive movement in the corresponding sled on the support table, which in turn can drive a movement of the corresponding hub, as already discussed. FIG. 16A

[0231] The control console 2200 can be located on or near a patient support table having a set of hubs and catheters / interventional devices. In some embodiments, the control console 2200 can be positioned away from the support table, for example behind a radiation shield or in a different room or a different geographical location in a telemedicine implementation.

[0232] Each control 2202-2208 can correspond to a hub and / or a combination of a hub and an interventional device and drive movement thereof. For example, the control 2202 can be configured to drive the hub 30 FIG. 3F ) to move an interventional device, for example a 0.088 inch guide catheter corresponding to the hub 30. Similarly, the control 2204 can be configured to drive the hub 28 (122) to move an interventional device, for example a 0.071 inch procedure catheter. The control 2206 can be configured to drive the hub 126 to move an interventional device, for example a steerable access catheter. The control 2208 can be configured to drive the hub 26 to move an interventional device, for example a guidewire, axially and rotationally.

[0233] FIG. 16B ​An example of a control 2202 on a manual steering control 2200 is shown. In operation, if a user 2230 moves the control 2202 axially and distally along the axis 2210, as indicated by arrow 2232, the corresponding connected hub and / or interventional device can be responsively moved the same or a scaled amount in the same direction. If the user 2230 rotates the control 2202 about the axis 2210 and advances the control proximally, as indicated by arrow 2234, the corresponding connected interventional device will be responsively rotated and moved proximally the same or a scaled amount. If the user 2230 rotationally moves the control 2202 about the axis 2210, as indicated by arrow 2236 or arrow 2238, the corresponding connected hub will rotationally drive the corresponding interventional device in the same direction and / or in the same or a scaled amount.

[0234] Other axes and degrees of freedom can be defined to enable the control 2202 to make movements that can be translated into movements of the hub and / or interventional device. For example, the control can be equipped with one or more deflection controls configured to initiate lateral deflection in a deflection region on the corresponding interventional device. The control can also be equipped with one or more fluid controls for controlling components of a fluid system, for example, to initiate and / or terminate the introduction of fluid (e.g., saline, contrast, etc.) to the catheter and / or to initiate and / or terminate the aspiration of fluid from the catheter.

[0235] Axial movement of the control can be configured to move the connected hub on a 1 : 1 basis or on a non-1 : 1 scaled basis. For example, if the user 2230 advances the control 2202 distally along the axis 2210 by about 5 millimeters, the corresponding hub can be responsively moved 5 millimeters in the distal direction.

[0236] If the user 2230 rotates the control 2022 about its axis of rotation by 5 degrees, the connected hub will cause the corresponding interventional device to rotate on a 1 : 1 basis or on a non-1 : 1 scaled basis. The amount of scaling can be selected to reduce or increase the distance and amount of rotation that the hub and / or interventional device moves in response to movement of the control.

[0237] In some embodiments, a scaling factor can be used to determine the amount of scaling described herein. The scaling factor can be applied to one or both of translational and rotational movement. In some embodiments, a first scaling factor is selected for translational movement and a second scaling factor, different from the first scaling factor, is selected for rotational movement. For a given proximal or distal operation of the control, the axial scaling factor can drive proximal catheter movement at a faster rate than distal catheter movement.

[0238] The rotational scaling factor can be 1 : 1, while the axial scaling factor can move the hub a greater distance than the movement of the control, such that the hub travels at least about 2: 1 or 5: 1 or 10: 1 or greater relative to the control travel, depending on the desired axial length of the control assembly.

[0239] The control machine 2200 can be configured to enable the clinician to adjust the scaling factor for different portions of the procedure. For example, the advancement of the surgical catheter and access catheter through the guide catheter and distal to the selected ostium can desirably be accomplished in a "fast" mode. But the more distal advancement into the neurovasculature can desirably be accomplished in a relatively slow mode with speed-controlled actuation.

[0240] In another implementation, one or more controls can be configured to progressively drive the advancement or retraction speed of the corresponding hub and associated catheter. For example, a distal control 2202 can drive the guide catheter. A slight distal movement of the control 2202 can advance the guide catheter distally at a slower speed, while increasing the distance of the control 2202 distal advancement increases the rate of distal travel of the guide catheter.

[0241] Controlling the speed of the corresponding hub axially or axially and rotationally can increase the overall speed of the procedure. For example, the advancement of various devices from the femoral access point to the aortic arch can desirably be accomplished at a faster rate than the distal navigation closer to the treatment site. Also, the proximal retraction of various devices, particularly the guidewire, access catheter, and surgical catheter, can desirably be accomplished at a relatively higher speed than the distal advancement.

[0242] FIG. 16C Another example of manually operating controls on the control machine 2200 to move hubs and / or other interventional devices is shown. In some implementations, two or more controls 2202-2208 can be moved in combination to trigger movement of one or more hubs and / or associated interventional devices. In the depicted example, a user 2230 moves control 2204 and control 2206 in combination (e.g., sequentially, simultaneously) to move the 0.088 guide catheter and the 0.071 aspiration catheter as a combined piece simultaneously. An example movement of control 2204 can include an axial proximal movement in the direction shown by arrow 2250. Sequentially or simultaneously, the user 2230 can move the control 2206 axially in either direction shown by arrows 2254 and 2256, and also rotationally in either direction shown by arrows 2258 and 2260. In some implementations, components of a jetting system (e.g., for introducing fluid and / or aspiration) can be controlled simultaneously with the axial and / or rotational movement of the control catheter.

[0243] FIG. 19A to FIG. 19CAnother example of a control mechanism for manipulating an interventional device driven (or otherwise associated with) a corresponding hub is shown. In some embodiments, at least one control element mounted in the control mechanism may be used to manipulate and / or otherwise move each hub and / or interventional device. Each control element may be adapted to move a unique hub and / or interventional device during the interventional procedure. For example, movement of each control element may trigger a responsive movement in the corresponding hub and / or interventional device. In some embodiments, at least some movements of each control element may trigger a responsive movement in a corresponding trolley on a support platform, which in turn may drive movement of the corresponding hub.

[0244] like FIG. 19A As shown, control unit 2200a may include a first control unit 2202a, a second control unit 2204a, a third control unit 2206a, and a fourth control unit 2208a. Depending on the intended interventional device configuration, more or fewer control units may be provided. Each control unit 2202a to 2208a is movably supported on a shaft 2210a connected to a distal support 2212a and a proximal support 2214a. Control units 2202a to 2208a may be advanced distally or retracted proximally along shaft 2210a, as indicated by arrows 2218a and 2216a, respectively. Additionally or alternatively, each control unit 2202a to 2208a may be rotatable about shaft 2210a, as indicated by arrow 2220a.

[0245] Each control element 2202a to 2208a may have an initial axial and / or rotational position. The control mechanism may be configured such that when the control elements 2202a to 2208a are not operated by the user, each control element 2202a to 2208a returns to its initial axial and / or rotational position.

[0246] The control unit 2200a may be located on or near a patient support table having a set of hubs and catheter / interventional devices. In some embodiments, the control unit 2200a may be located remotely from the support table, for example, behind radiation shielding or in a different room or geographical location in a telemedicine embodiment.

[0247] Each control 2202a-2208a can correspond to and drive movement of a hub and / or an interventional device. In certain embodiments, control 2202a can be configured to move an interventional device, such as a 0.088 inch guide catheter (e.g., guide catheter 31 or guide catheter 2906), for example, by driving a hub (e.g., hub 30 or hub 2914) associated with the interventional device (e.g., axially and / or rotationally). Similarly, control 2204a can be configured to move an interventional device, such as a 0.071 inch procedural catheter (e.g., catheter 29, catheter 120, or catheter 2904), for example, by driving a hub (e.g., hub 28, hub 122, or hub 2912) associated with the interventional device (e.g., axially and / or rotationally). Control 2206a can be configured to move an interventional device, such as a steerable access catheter (e.g., catheter 124 or catheter 2902), for example, by driving a hub (e.g., hub 126 or hub 2910) associated with the interventional device (e.g., axially and / or rotationally). Control 2208a can be configured to move an interventional device, such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example, by driving a hub (e.g., hub 26 or hub 2909) associated with the interventional device (e.g., axially and / or rotationally).

[0248] In operation, if the user moves control 2202a axially and distally along axis 2210a, as indicated by arrow 2218a, or proximally, as indicated by arrow 2116a, the corresponding connected hub and / or interventional device can be responsively moved in the same direction at a predetermined axial or linear velocity. The corresponding connected hub and / or interventional device can continue to move in the same direction at the predetermined linear velocity until the user releases (e.g., stops manipulating) control 2202a or moves the control further. When the user stops manipulating control 2202a, control 2202a can return to its starting axial position. If the user moves control 2202a rotationally around axis 2210a (e.g., clockwise or counterclockwise), as indicated by arrow 2220a, the corresponding interventional device can be rotationally driven (e.g., by the corresponding hub) in the same direction at a predetermined angular velocity. When the user stops manipulating control 2202a, control 2202a can return to its starting rotational position. If the user rotates control 2202a around axis 2210a and axially (distally or proximally) advances the control, the corresponding connected interventional device can be responsively rotationally moved proximally at a predetermined angular velocity and at a predetermined linear velocity. The corresponding connected interventional device can continue to rotationally move at the predetermined angular velocity and can continue to axially move at the predetermined linear velocity until the user releases (e.g., stops manipulating) control 2202a or moves the control further. When the user stops manipulating control 2202a, control 2202a can return to its starting axial and rotational positions.

[0249] One or more linear position sensors can be used to measure the axial movement of each control 2202a-2208a relative to the starting position of each control. For example, one or more linear sensors can be configured to measure the distance (e.g., 5 mm) that a control travels from its starting position. In some embodiments, the predetermined linear velocity at which the corresponding hub and / or interventional device will move can depend on the measurement of the one or more linear position sensors. The one or more linear position sensors can include, for example, linear potentiometers. In some cases, control machine 2200a can include a linear position sensor for each control.

[0250] Similarly, one or more rotational sensors can be used to measure rotational movement of each control 2202a-2208a relative to a starting position of each control. For example, one or more rotational sensors can be configured to measure rotational movement (e.g., 5 degrees) of a control from its starting position. A predetermined angular velocity of movement of a corresponding interventional device can depend on the measurement of the one or more rotational sensors. The one or more rotational sensors can include, for example, encoders, potentiometers, Hall effect sensors, or combinations thereof. In some cases, the control mechanism 2200a can include a rotational sensor for each control.

[0251] Axial movement of a control can be configured to move a corresponding hub and / or interventional device at a predetermined linear velocity. For example, if a user advances a control 2202a about 5 millimeters along the axis 2210a distally, a corresponding hub and / or interventional device can responsively move distally at a linear velocity of 5 mm / second. The predetermined linear velocity can vary depending on the control movement of the user. For example, if the user advances the control 2202a about 10 millimeters along the axis 2210a proximally, the corresponding hub and / or interventional device can responsively move proximally at a linear velocity of 10 mm / second. As long as the user maintains the control in the same axial position, the corresponding hub and / or interventional device can continue to move at the predetermined linear velocity in the direction of the axial movement of the control 2202a. When the user stops manipulating the control and returns the control to its starting axial position, the corresponding hub and / or interventional device can stop moving.

[0252] Axial movement of a control can be configured to move a corresponding hub and / or interventional device at a predetermined linear velocity. For example, if a user advances a control 2202a about 5 millimeters along the axis 2210a distally, a corresponding hub and / or interventional device can responsively move distally at a linear velocity of 5 mm / second. The predetermined linear velocity can vary depending on the control movement of the user. For example, if the user advances the control 2202a about 10 millimeters along the axis 2210a proximally, the corresponding hub and / or interventional device can responsively move proximally at a linear velocity of 10 mm / second. As long as the user maintains the control in the same axial position, the corresponding hub and / or interventional device can continue to move at the predetermined linear velocity in the direction of the axial movement of the control 2202a. When the user stops manipulating the control and returns the control to its starting axial position, the corresponding hub and / or interventional device can stop moving.

[0253] Rotational movement of a control can be configured to move a connected hub at a predetermined rotational velocity. For example, if a user rotates a control 2202a about 5 degrees clockwise around the axis 2210a, a corresponding interventional device can responsively rotate clockwise at an angular velocity of 5 degrees / second. The predetermined angular velocity can vary depending on the control movement of the user. For example, if the user rotates the control 2202a about 10 degrees counterclockwise around the axis 2210a, the corresponding interventional device can responsively rotate counterclockwise at an angular velocity of 10 degrees / second. As long as the user maintains the control in the same rotational position, the corresponding interventional device can continue to move at the predetermined angular velocity in the direction of the rotational movement of the control 2202a. When the user stops manipulating the control and returns the control to its starting rotational position, the interventional device can stop moving.

[0254] Rotational movement of the control can be configured to move the connected interventional device on a 1 : 1 basis or on a scaled basis that is not 1 : 1. For example, if the user rotates the control 2202a 5 degrees about its axis of rotation, the corresponding interventional device can be responsively moved at a predetermined angular velocity of 5 degrees / second.

[0255] The control 2200a can be configured to enable the clinician to adjust the predetermined linear velocity and / or the predetermined angular velocity. For example, as described herein, advancement of the surgical catheter and access catheter through the guide catheter and distal to a selected ostium can desirably be accomplished in a "fast" mode. Further distal travel into the neurovasculature can desirably be accomplished in a relatively slow mode with velocity controlled actuation. For example, for a surgical phase that the clinician wishes to proceed in a "fast" mode, the clinician can adjust the predetermined linear velocity to 10 mm / second when the control is moved 5 mm axially distally or proximally. For a surgical phase that the clinician wishes to proceed in a relatively slow mode, the clinician can adjust the predetermined linear velocity to 2 mm / second when the control is moved 5 mm axially distally or proximally.

[0256] While the foregoing describes exemplary operation of the control 2202a, one skilled in the art will appreciate that any of the controls 2204a, 2206a, and 2208a can operate in the same manner. In certain embodiments, each of the controls 2202a, 2204a, 2206a, and 2208a can control both axial and rotational movement of the corresponding interventional device. In other embodiments, one or more of the controls 2202a, 2204a, 2206a, and 2208a can control only axial movement of the corresponding interventional device or only rotational movement of the corresponding interventional device.

[0257] FIG. 20 Another embodiment of a control console 2200b is shown that is used to manipulate interventional devices that are driven by (or otherwise associated with) respective hubs is shown. FIG. 20 The control console can include any of the same or similar features and / or functionality as any other control console described herein. For example, each hub and / or interventional device can be manipulated and / or otherwise moved using at least one control mounted in the control console. Each control can include a joystick (e.g., a dual axis joystick). In certain embodiments, the joystick can provide improved grip and more precise movement as compared to other controls. The joystick can be sized and textured to suit the particular needs of the physician. For example, some physicians can prefer a larger or smaller joystick. Each control can be adapted to move a unique hub and / or interventional device during an interventional procedure.

[0258] As FIG. 20As shown, the control machine 2200b can include a first control 2202b, a second control 2204b, a third control 2206b, and a fourth control 2208b. Depending on the intended interventional device configuration, more or fewer controls can be provided. Each control 2202b-2208b can be rotatable about a first axis 2217b, as indicated by arrow 2216b, to cause a corresponding hub and / or interventional device axial movement. In addition, each control 2202b-2208b can be rotatable about a second axis 2219b, as indicated by arrow 2220b, to cause a corresponding hub and / or interventional device rotational movement. The second axis 2219b can be the same axis for each control 2202b-2208b. The first axis 2217b for each control 2202b-2208b can be transverse to the second axis 2219b. Each control movement can trigger a responsive movement in the corresponding hub and / or interventional device. In certain embodiments, at least some of each control movement can trigger a responsive movement in the corresponding trolley on the support table, which in turn can drive a movement of the corresponding hub.

[0259] Each control 2202b-2208b can have a home position. The control machine can be configured to return each control 2202b-2208b to its home position when the control is not being manipulated by a user.

[0260] The control machine 2200b can be located on or near a patient support table with a set of hubs and catheter / interventional devices. In some implementations, the control machine 2200b can be located remotely from the support table, for example in a radiation shielded back room or in a different room or different geographical location in a telemedicine implementation.

[0261] Each control 2202b-2208b can correspond to and drive movement of a hub and / or an interventional device. In certain embodiments, control 2202b can be configured to move an interventional device, such as a 0.088 inch guide catheter (e.g., guide catheter 31 or guide catheter 2906), for example, by driving a hub (e.g., hub 30 or hub 2914) associated with the interventional device (e.g., axially and / or rotationally). Similarly, control 2204b can be configured to move an interventional device, such as a 0.071 inch procedural catheter (e.g., catheter 29, catheter 120, or catheter 2904), for example, by driving a hub (e.g., hub 28, hub 122, or hub 2912) associated with the interventional device (e.g., axially and / or rotationally). Control 2206b can be configured to move an interventional device, such as a steerable access catheter (e.g., catheter 124 or catheter 2902), for example, by driving a hub (e.g., hub 126 or hub 2910) associated with the interventional device (e.g., axially and / or rotationally). Control 2208b can be configured to move an interventional device, such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example, by driving a hub (e.g., hub 26 or hub 2909) associated with the interventional device (e.g., axially and / or rotationally).

[0262] In operation, if the user rotates control 2202b about axis 2217b (counterclockwise or clockwise), as indicated by arrow 2116b, the corresponding connected hub and / or interventional device can be responsively moved at a predetermined linear velocity (e.g., counterclockwise movement of control 2202b proximally, and clockwise movement of control 2217b distally). The corresponding connected hub and / or interventional device can continue to move in the same direction at the predetermined linear velocity until the user releases (e.g., stops manipulating) control 2202b or further moves control 2202b. When the user stops manipulating control 2202b, control 2202b can return to its starting position. If the user rotationally moves control 2202b about axis 2219b (e.g., clockwise or counterclockwise), as indicated by arrow 2220b, the corresponding interventional device can be rotationally driven (e.g., by the corresponding hub) in the same direction at a predetermined angular velocity. When the user stops manipulating control 2202b, control 2202b can return to its starting position. If the user rotationally moves control 2202b about axis 2217b, the corresponding connected interventional device can be responsively rotationally moved at a predetermined angular velocity (in response to movement of control 2202b about axis 2219b) and axially moved at a predetermined linear velocity (in response to movement of control 2202b about axis 2217b). The corresponding connected interventional device can continue to rotationally move at the predetermined angular velocity and can continue to axially move at the predetermined linear velocity until the user releases (e.g., stops manipulating) control 2202b or further moves control 2202b. When the user stops manipulating control 2202b, control 2202b can return to its starting position.

[0263] One or more rotational sensors can be used to measure rotational movement of each control 2202b-2208b about axis 2217b and / or axis 2219b relative to a starting position of each control. For example, one or more rotational sensors can be configured to measure rotational movement (e.g., 5 degrees) of a control from its starting position. The linear velocity and / or predetermined angular velocity of movement of the corresponding interventional device can depend on the measurement of the one or more rotational sensors. The one or more rotational sensors can include, for example, an encoder, a potentiometer, a Hall effect sensor, or a combination thereof. In some cases, control machine 2200b can include one or more rotational sensors for each control. In some embodiments, control machine 2200b can include separate rotational sensors for measuring rotation about axis 2217b and rotation about axis 2219b.

[0264] Rotational movement of the control 2202b about the axis 2217b, as indicated by arrow 2216b, can be configured to move the corresponding hub and / or interventional device at a predetermined linear velocity. For example, if the user moves the control 2202b about the axis 2217b (e.g., counterclockwise) by about 5 degrees, the corresponding hub and / or interventional device can responsively move at a linear velocity of 5 mm / second (e.g., proximally). The predetermined linear velocity can vary according to the user-controlled movement. For example, if the user moves the control 2202b about the axis 2217b by about 10 degrees, the corresponding hub can responsively move axially at a linear velocity of 10 mm / second. As long as the user holds the control in the same rotational position, the corresponding hub and / or interventional device can continue to move axially at the predetermined linear velocity. Upon the user ceasing to manipulate the control, the corresponding hub can stop moving, and the control can return to its starting position.

[0265] Rotational movement of the control 2202b about the axis 2217b can be configured to move the corresponding hub and / or interventional device on a 1 : 1 basis or on a scaled basis that is not 1 : 1. For example, if the user moves the control 2202b about the axis 2217b by about 5 degrees in the direction of arrow 2216b, the corresponding hub can responsively move in the corresponding direction at a predetermined linear velocity of 5 mm / second.

[0266] Rotational movement of the control 2202b about the axis 2219b can be configured to move the connected hub at a predetermined rotational velocity. For example, if the user rotates the control 2202b about the axis 2219b clockwise by about 5 degrees, the corresponding interventional device can responsively rotate clockwise at an angular velocity of 5 degrees / second. The predetermined angular velocity can vary according to the user-controlled movement. For example, if the user rotates the control 2202b about the axis 2219b counterclockwise by about 10 degrees, the corresponding interventional device can responsively rotate counterclockwise at an angular velocity of 10 degrees / second. As long as the user holds the control in the same rotational position, the corresponding interventional device can continue to move in the direction of the rotational movement of the control 2202b at the predetermined angular velocity. Upon the user ceasing to manipulate the control and returning the control to its starting rotational position, the interventional device can stop moving.

[0267] Rotational movement of the control 2202b about the axis 2219b can be configured to rotate the corresponding interventional device on a 1 : 1 basis or on a scaled basis that is not 1 : 1. For example, if the user moves the control 2202b about the axis 2219b by about 5 millimeters, the corresponding interventional device can responsively move at a predetermined angular velocity of 5 degrees / second.

[0268] The control component 2200b can be configured to allow the clinician to adjust predetermined linear and / or angular velocities. For example, as described herein, the advancement of the surgical catheter and access catheter by guiding the catheter to the selected port may ideally be accomplished in a “fast” mode. Distal access to the neurovascular system may ideally be accomplished in a relatively slow mode by speed-controlled actuation. For example, for a surgical phase where the clinician wishes to perform in a “fast” mode, the predetermined linear velocity can be adjusted to 10 mm / s when the control component moves 5 degrees about axis 2217b. For a surgical phase where the clinician wishes to perform in a relatively slow mode, the predetermined linear velocity can be adjusted to 2 mm / s when the control component moves 5 mm about axis 2217b.

[0269] While exemplary operation of control element 2202b has been described above, those skilled in the art will understand that any of controls 2204b, 2206b, and 2208b can operate in the same manner. In some embodiments, each of controls 2202b, 2204b, 2206b, and 2208b can control both axial and rotational movement of the corresponding interventional device. In other embodiments, one or more of controls 2202b, 2204b, 2206b, and 2208b can control only axial movement of the corresponding interventional device or only rotational movement of the corresponding interventional device.

[0270] FIG. 21 The diagram shows the manipulation by FIG. 20 An alternative embodiment of the control mechanism 2200b of the corresponding hub drive (or otherwise associated with the corresponding hub) intervention device shown. FIG. 21 The control components may include those described herein and FIG. 20 Any features and / or functions identical or similar to any other control element shown. For example, at least one control element mounted in the control element can be used to manipulate and / or otherwise move each hub and / or interventional device. Each control element may include a joystick (e.g., a dual-axis joystick). In some embodiments, the joystick may provide improved grip and more precise movement compared to other controls. The size and feel of the joystick can be customized to suit the specific needs of a physician. For example, some physicians may prefer a larger or smaller joystick. Each control element may be adapted to move a single hub and / or interventional device during the interventional procedure.

[0271] like FIG. 21As shown, the control console 2200c can include a first control 2202c, a second control 2204c, a third control 2206c, and a fourth control 2208c. More or fewer controls can be provided depending on the intended interventional device configuration. Each control 2202c-2208c can be rotatable about a first axis 2217c, as indicated by arrow 2216c, to cause a corresponding hub and / or interventional device axial movement. In addition, each control 2202c-2208c can be rotatable about a second axis 2219c, as indicated by arrow 2220c, to cause a corresponding hub and / or interventional device rotational movement. The second axis 2219c can be the same axis for each control 2202c-2208c. The first axis 2217c for each control 2202c-2208c can be transverse to the second axis 2219c. Each control movement can trigger a responsive movement in the corresponding hub and / or interventional device. In certain embodiments, at least some movements of each control can trigger a responsive movement in the corresponding sled on the support table, which in turn can drive movement of the corresponding hub.

[0272] FIG. 22A to FIG. 22C Another example of a control console for manipulating interventional devices driven by (or otherwise associated with) respective hubs is shown. FIG. 22A The control console as 22C can include any features and / or functionality the same as or similar to any other control console described herein. In certain embodiments, each hub and / or interventional device can be manipulated and / or otherwise moved using at least one control mounted in the control console. Each control can be adapted to move a unique hub and / or interventional device during an interventional procedure. For example, each control movement can trigger a responsive movement in the corresponding hub and / or interventional device. In certain embodiments, at least some movements of each control can trigger a responsive movement in the corresponding sled on the support table, which in turn can drive movement of the corresponding hub.

[0273] As FIG. 22A As shown, the control console 2200d can include a first control 2202d, a second control 2204d, a third control 2206d, and a fourth control 2208d. More or fewer controls can be provided depending on the intended interventional device configuration. Each control 2202d-2208d can be movably carried on a support structure 2210d. The controls 2202d-2208d can be advanced distally or retracted proximally, as indicated by arrow 2216d. Additionally or alternatively, each control 2202d-2208d can be rotatable within the support structure 2210d, as indicated by arrow 2220d.

[0274] Each control 2202d-2208d can have a home axial position. The control mechanism can be configured such that each control 2202d-2208d returns to its home axial position when the control 2202d-2208d is not advanced along the support structure 2210d.

[0275] The control mechanism 2200d can be located on or near a patient support table having a set of hubs and catheter / interventional devices. In some embodiments, the control mechanism 2200d can be positioned away from the support table, for example behind a radiation shield or in a different room or different geographic location in a telemedicine implementation.

[0276] Each control 2202d-2208d can correspond to and drive movement of a hub and / or and / or a hub interventional device. In certain embodiments, the control 2202d can be configured to move an interventional device, such as a 0.088 inch guide catheter (e.g., guide catheter 31 or guide catheter 2906), for example by driving a hub (e.g., hub 30 or hub 2914) associated with the interventional device (e.g., axially and / or rotationally). Similarly, the control 2204d can be configured to move an interventional device, such as a 0.071 inch procedure catheter (e.g., catheter 29, catheter 120, or catheter 2904), for example by driving a hub (e.g., hub 28, hub 122, or hub 2912) associated with the interventional device (e.g., axially and / or rotationally). The control 2206d can be configured to move an interventional device, such as a steerable access catheter (e.g., catheter 124 or catheter 2902), for example by driving a hub (e.g., hub 126 or hub 2910) associated with the interventional device (e.g., axially and / or rotationally). The control 2208d can be configured to move an interventional device, such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example by driving a hub (e.g., hub 26 or hub 2909) associated with the interventional device (e.g., axially and / or rotationally).

[0277] In operation, if the user moves the control 2202d axially along the support structure 2210d (e.g., proximal or distal), as indicated by arrow 2116d, the corresponding connected hub and / or intervention device can responsively move in the same direction at a predetermined linear velocity. The corresponding connected hub and / or intervention device can continue to move in the same direction at a predetermined linear velocity until the user releases (e.g., stops manipulating) the control 2202d or moves the control further. When the user stops manipulating the control 2202d, the control 2202d can return to its initial axial position. If the user rotates the control 2202d within the support structure 2210d (e.g., clockwise or counterclockwise), as indicated by arrow 2220d, the corresponding intervention device can be rotated in the same direction by the same or proportional amount (e.g., driven responsively by the hub). If the user rotates the control element 2202d within the support structure 2210d and advances it axially (towards the distal or proximal end), the corresponding connected intervention device can responsively rotate and move by the same or proportional amount, and move axially at a predetermined linear velocity. The corresponding connected intervention device can continue to move axially at the predetermined linear velocity until the user releases (e.g., stops manipulating) the control element 2202d or moves it further. When the user stops manipulating the control element 2202d, the control element 2202d can return to its initial axial position.

[0278] like FIG. 22C As shown, control element 2200d may include at least one linear position sensor (also referred to herein as a linear sensor) and at least one rotation sensor. One or more linear position sensors may be used to measure the axial movement of each control element 2202d to 2208d relative to the starting position of each control element. For example, one or more linear sensors may be configured to measure the distance (e.g., 5 mm) traveled by the control element from its starting position. The linear position sensors may command the speed of the corresponding hub and / or intervention device. For example, in some embodiments, the predetermined linear velocity at which the corresponding hub and / or intervention device will move may depend on the measurements of one or more linear position sensors. One or more linear position sensors may include, for example, a linear potentiometer. In some cases, control element 2200d may include a linear position sensor for each control element.

[0279] Similarly, one or more rotation sensors 2215d can be used to measure the rotational movement of each control element 2202d to 2208d relative to the starting position of each control element. In some cases, such as FIG. 22CAs shown, one or more rotation sensors can be supported by the support structure, such as support structure 2210d. The one or more rotation sensors can be configured to measure rotational movement of the control from its starting position (e.g., 5 degrees). The rotation sensors can command the orientation of the corresponding hub and / or interventional device. For example, in some embodiments, the angular distance that the corresponding hub will move is dependent on the measurement of the one or more rotation sensors. The one or more rotation sensors can include, for example, an encoder, a potentiometer, a Hall effect sensor, or a combination thereof. In some cases, the control mechanism 2200d can include a rotation sensor for each control.

[0280] Axial movement of the control can be configured to move the corresponding hub and / or interventional device at a predetermined linear velocity. For example, if the user advances the control 2202d about 5 millimeters distally along the support structure 2210d, the corresponding hub and / or interventional device can responsively move distally at a linear velocity of 5 mm / second. The predetermined linear velocity can vary depending on the user’s control movement. For example, if the user advances the control 2202d about 10 millimeters proximally along the support structure 2210d, the corresponding hub and / or interventional device can responsively move proximally at a linear velocity of 10 mm / second. As long as the user manipulates the control to maintain the same axial position, the corresponding hub and / or interventional device can continue to move axially at the predetermined linear velocity. When the user stops manipulating the control, the corresponding hub can stop moving, and the control will return to its starting axial position.

[0281] Axial movement of the control can be configured to move the corresponding hub and / or interventional device on a 1 : 1 basis or on a non-1 : 1 scaled basis. For example, if the user advances the control 2202d about 5 millimeters distally along the support structure 2210d, the corresponding hub and / or interventional device can responsively move in the distal direction at a predetermined linear velocity of 5 mm / second.

[0282] Rotational movement of the control can be configured to move the corresponding interventional device on a 1 : 1 basis or on a non-1 : 1 scaled basis. For example, if the user rotates the control 2202d about its axis of rotation by 5 degrees, the corresponding interventional device can responsively move an angular distance of 5 degrees. In certain embodiments, when the user stops rotating the control, the control maintains its position and does not return to the previous initial rotational position. In certain embodiments, each rotational position of the control can correspond to a unique rotational position of the corresponding interventional device.

[0283] The control 2200d can be configured to enable the clinician to adjust the predetermined linear velocity and / or the distance or position of rotation. For example, as described herein, advancement of the surgical catheter and access catheter through the guide catheter and distal to the selected ostium can desirably be accomplished in a "fast" mode. Further distal travel into the neurovasculature can desirably be accomplished in a relatively slow mode with actuation of the velocity control. For example, for a surgical phase that the clinician wishes to proceed in a "fast" mode, the clinician can adjust the predetermined linear velocity to 10 mm / second when the control is moved 5 mm distally or proximally along the shaft. For a surgical phase that the clinician wishes to proceed in a relatively slow mode, the clinician can adjust the predetermined linear velocity to 2 mm / second when the control is moved 5 mm distally or proximally along the shaft.

[0284] While the foregoing describes exemplary operation of the control 2202d, those skilled in the art will appreciate that any of the controls 2204d, 2206d, and 2208d can operate in the same manner. In certain embodiments, each of the controls 2202d, 2204d, 2206d, and 2208d can control both axial and rotational movement of the corresponding interventional device. In other embodiments, one or more of the controls 2202d, 2204d, 2206d, and 2208d can control only axial movement of the corresponding interventional device or only rotational movement of the corresponding interventional device.

[0285] FIG. 23A to FIG. 23C Another example of a control for manipulating interventional devices driven by (or otherwise associated with) corresponding hubs is shown. FIG. 23A to FIG. 23C The control 2200d can be configured to enable the clinician to adjust the predetermined linear velocity and / or the distance or position of rotation. For example, as described herein, advancement of the surgical catheter and access catheter through the guide catheter and distal to the selected ostium can desirably be accomplished in a "fast" mode. Further distal travel into the neurovasculature can desirably be accomplished in a relatively slow mode with actuation of the velocity control. For example, for a surgical phase that the clinician wishes to proceed in a "fast" mode, the clinician can adjust the predetermined linear velocity to 10 mm / second when the control is moved 5 mm distally or proximally along the shaft. For a surgical phase that the clinician wishes to proceed in a relatively slow mode, the clinician can adjust the predetermined linear velocity to 2 mm / second when the control is moved 5 mm distally or proximally along the shaft.

[0286] As FIG. 23AAs shown, the control unit 2200e may include a first control unit 2202e, a second control unit 2204e, a third control unit 2206e, and a fourth control unit 2208e. Depending on the intended intervention device configuration, more or fewer control units may be provided. Each control unit 2202e to 2208e may be movably mounted on the shaft assembly 2210e. The control units 2202e to 2208e may be advanced distally or retracted proximally within the shaft assembly 2210e, as indicated by arrow 2216e. Additionally or alternatively, each control unit 2202e to 2208e may be rotatable within the shaft assembly 2210e, as indicated by arrow 2220e.

[0287] Each control element 2202e to 2208e may have a starting axial position. The control mechanism may be configured such that when the control elements 2202e to 2208e are not advanced or retracted within the shaft assembly 2210e, each control element 2202e to 2208e returns to its starting axial position.

[0288] like FIG. 23A to FIG. 23B As shown, control elements 2202e to 2208e can be arranged coaxially. Each control element 2202e to 2208e can be carried on a single shaft of assembly 2210e. In some embodiments, shaft assembly 2210e may have one or more shafts with different diameters, thereby allowing, for example, at least one shaft associated with the single control element to mate and extend through another shaft associated with the single control element. For example, as FIG. 23A As shown, the first shaft 2210e' may be associated with control element 2202e, the second shaft 2210e'' may be associated with control element 2204e'', the third shaft 2210e''' may be associated with control element 2206e, and the fourth shaft 2210e'''' may be associated with control element 2208e. Shafts 2210e' to 2210e''' can be configured to move axially and / or rotationally together with their associated control elements. For example, the second shaft 2210e'' may have a smaller diameter than the first shaft 2210e', thereby allowing the second shaft 2210e'' to extend at least partially within and move within the first shaft 2210e'. In some embodiments, each control element 2202e to 2208e may be associated with a unique shaft having a different diameter from each other. The smaller shaft may extend at least partially within and move / rotate within the larger shaft, thereby allowing telescopic movement of two or more shaft portions. The shaft assembly 2210e may also include shaft 2210e''''', which extends through each of shafts 2210e' to 2210e'''' to provide structural support.

[0289] The control machine 2200e can be located on or near a patient support table with a set of hubs and interventional devices. In some embodiments, the control machine 2200e can be located away from the support table, for example behind a radiation shield or in a different room or different geographic location in a telemedicine implementation.

[0290] Each control 2202e-2208e can correspond to a hub and / or interventional device and drive movement of the hub and / or interventional device. In certain embodiments, the control 2202e can be configured to move an interventional device, such as a 0.088 inch guide catheter (e.g., guide catheter 31 or guide catheter 2906), for example by driving a hub (e.g., hub 30 or hub 2914) associated with the interventional device (e.g., axially and / or rotationally). Similarly, the control 2204e can be configured to move an interventional device, such as a 0.071 inch working catheter (e.g., catheter 29, catheter 120, or catheter 2904), for example by driving a hub (e.g., hub 28, hub 122, or hub 2912) associated with the interventional device (e.g., axially and / or rotationally). The control 2206e can be configured to move an interventional device, such as a steerable access catheter (e.g., catheter 124 or catheter 2902), for example by driving a hub (e.g., hub 126 or hub 2910) associated with the interventional device (e.g., axially and / or rotationally). The control 2208e can be configured to move an interventional device, such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example by driving a hub (e.g., hub 26 or hub 2909) associated with the interventional device (e.g., axially and / or rotationally).

[0291] In operation, if the user moves (e.g., proximally or distally) the control 2202e axially within the shaft assembly 2210e (and causes movement of the shaft 2210e') as indicated by arrow 2216e, the corresponding connected hub and / or interventional device can responsively move in the same direction at a predetermined linear velocity. The corresponding connected hub and / or interventional device can continue to move in the same direction at the predetermined linear velocity until the user releases (e.g., stops manipulating) the control 2202e or moves the control further. When the user stops manipulating the control 2202e, the control 2202e can return to its starting axial position. If the user moves the control 2202e rotationally within the shaft assembly 2210e (e.g., clockwise or counterclockwise) as indicated by arrow 2220e, the corresponding interventional device can be rotationally driven (e.g., by the corresponding hub) in the same direction and / or by the same or proportional amount. If the user rotates the control 2202e within the shaft assembly 2210e and axially (distally or proximally) advances the control, the corresponding connected interventional device will responsively move rotationally by the same or proportional amount and axially at a predetermined linear velocity. The corresponding connected interventional device can continue to move axially at the predetermined linear velocity until the user releases (e.g., stops manipulating) the control 2202e or moves the control 2202e axially further. When the user stops manipulating the control 2202e, the control 2202e can return to its starting axial position.

[0292] In some embodiments, as shown in FIG. 22E, the control machine 2200e can include a first housing portion 2241e and a second housing portion 2243e. The first housing portion 2241e and the second housing portion 2243e can each house and support one or more shafts 2210e' through 2210e'". For example, in certain embodiments, the housing portion 2241e can house and support the shafts 2210e' and 2210e", and the housing portion 2243e can house and support the shafts 2210e'" and 2210e"". FIG. 23A

[0293] FIG. 23B ​​As shown, one or more linear position sensors 2213e can be used to measure the axial movement of each control 2202e-2208e relative to a starting position of each control (e.g., by measuring the axial movement of the corresponding shaft 2210e’-2210e’’’’ relative to their starting position). The one or more linear position sensors can be included as part of the first housing portion 2241e and the second housing portion 2243e. In some embodiments, the one or more linear sensors 2213e can be configured to measure the distance (e.g., 5 mm) that the control travels from its starting position. In some embodiments, the predetermined linear velocity at which the corresponding hub will move can depend on the measurement of the one or more linear position sensors. The one or more linear position sensors can include, for example, a linear potentiometer. In some cases, the control mechanism 2200e can include a linear position sensor 2213e for each control.

[0294] Similarly, as shown, one or more rotary sensors 2215e can be used to measure the rotational movement of each control 2202e-2208e relative to a starting position of each control (e.g., by measuring the rotational movement of the corresponding shaft 2210e’-2210e’’’’ relative to their starting position). For example, the one or more rotary sensors can be configured to measure the rotational movement (e.g., 5 degrees) of the control from its starting position. The angular distance that the corresponding hub will move depends on the measurement of the one or more rotary sensors. The one or more rotary sensors can include, for example, an encoder, a potentiometer, a Hall effect sensor, or a combination thereof. In some cases, the control mechanism 2200e can include a rotary sensor for each control. FIG. 23B

[0295] The axial movement of the control can be configured to move the corresponding hub and / or interventional device at a predetermined linear velocity. For example, if the user advances the control 2202e distally within the shaft assembly 2210e by about 5 millimeters, the corresponding hub and / or interventional device can responsively move distally at a linear velocity of 5 mm / second. The predetermined linear velocity can vary depending on the user’s control movement. For example, if the user advances the control 2202e proximally within the shaft assembly 2210e by about 10 millimeters, the corresponding hub and / or interventional device can responsively move proximally at a linear velocity of 10 mm / second. As long as the user manipulates the control to maintain the same axial position, the corresponding hub and / or interventional device can continue to move axially at the predetermined linear velocity. When the user stops manipulating the control, the corresponding hub and / or interventional device can stop moving, and the control can return to its starting axial position. In some embodiments, as shown, the control mechanism 2200e can include a spring 2216e that biases the control 2202e to its starting axial position. FIG. 23B ​As shown, the centering machine 2211e can help return the control to its starting axial position. For example, the centering machine 2211e can be configured to move the control in the distal or proximal direction (by moving the corresponding shaft) depending on whether the user moves the control in the distal or proximal direction, and return to its starting axial position when the user stops manipulating the control.

[0296] Axial movement of the control can be configured to move the corresponding hub and / or interventional device on a 1 : 1 basis or on a non-1 : 1 scaled basis. For example, if the user moves the control 2202e distally by about 5 mm, the corresponding hub and / or interventional device can be responsively moved in the distal direction at a predetermined linear velocity of 5 mm / sec.

[0297] Rotational movement of the control can be configured to move the corresponding interventional device on a 1 : 1 basis or on a non-1 : 1 scaled basis. For example, if the user rotates the control 2202 around its axis of rotation by 5 degrees, the corresponding interventional device can be responsively moved by an angular distance of 5 degrees. In certain embodiments, when the user stops rotating the control, the control maintains its position and does not return to a previous initial rotational position. In certain embodiments, each rotational position of the control can correspond to a unique rotational position of the corresponding interventional device.

[0298] The control machine 2200e can be configured to enable the clinician to adjust the predetermined linear velocity and / or the distance or position of rotation. For example, as described herein, distal advancement of the procedural catheter and access catheter through the guide catheter and up to the selected ostium can desirably be accomplished in a "fast" mode. Further distal travel into the neurovascular system can desirably be accomplished in a relatively slow mode with speed-controlled actuation. For example, for a procedural phase that the clinician wishes to perform in a "fast" mode, the clinician can adjust the predetermined linear velocity to 10 mm / sec when the control is moved 5 mm distally or proximally. For a procedural phase that the clinician wishes to perform in a relatively slower mode, the clinician can adjust the predetermined linear velocity to 2 mm / sec when the control is moved 5 mm distally or proximally.

[0299] While the foregoing describes exemplary operation of control 2202e, one skilled in the art will appreciate that any of controls 2204e, 2206e, and 2208e can operate in the same manner. In certain embodiments, each of controls 2202e, 2204e, 2206e, and 2208e can control both axial and rotational movement of the corresponding interventional device. In other embodiments, one or more of controls 2202e, 2204e, 2206e, and 2208e can control only axial movement of the corresponding interventional device or only rotational movement of the corresponding interventional device.

[0300] FIG. 23C Another embodiment of a control mechanism 2200e is shown, in which each of 2210e’ through 2210e’’’’ is housed and supported within a single housing portion 2241e. Housing portion 2241e can include a linear sensor 2213e and a rotational sensor 2215e for each control.

[0301] In certain embodiments, shafts 2210e’ through 2210e’’’’ and / or controls 2202e, 2204e, 2206e, and 2208e are removably housed within housing portion 2241e. Shafts 2210e’ through 2210e’’’’ and / or controls 2202e, 2204e, 2206e, and 2208e can be single-use and / or disposable components. Housing portion 2241e and internal components, such as sensors 2213e, 2215e, and centering mechanism 2211e can be configured for multiple uses and can be connected to multiple shafts 2210e’ through 2210e’’’’ and / or controls 2202e, 2204e, 2206e, and 2208e.

[0302] FIG. 24A to FIG. 24E Other examples of control mechanisms for manipulating interventional devices driven by (or otherwise associated with) corresponding hubs are shown. FIG. 24A to FIG. 24E The control mechanism of FIG. 22 can include any features and / or functionality identical or similar to any other control mechanism described herein. In certain embodiments, at least one control mechanism installed in the control mechanism can be used to manipulate and / or otherwise move each hub. Each control mechanism can be adapted to move a unique hub and / or interventional device during an interventional procedure. For example, movement of each control mechanism can trigger a responsive movement in the corresponding hub and / or interventional device. In certain embodiments, at least some movement of each control mechanism can trigger a responsive movement in the corresponding sled on the support table, which in turn can drive movement of the corresponding hub.

[0303] As FIG. 24AAs shown, the control console 2200f can include a first control 2202f, a second control 2204f, a third control 2206f, and a fourth control 2208f. Depending on the intended interventional device configuration, more or fewer controls can be provided. Each control 2202f-2208f can include a capacitive screen, a resistive screen, a touchpad, or other touch-based sensing device.

[0304] The control console 2200f can be located on or near a patient support table having a set of hubs and catheters / interventional devices. In some embodiments, the control console 2200f can be located remotely from the support table, for example behind a radiation shield or in a different room or different geographical location in a telemedicine implementation.

[0305] In certain embodiments, the control 2202f can be configured to move an interventional device, such as a 0.088 inch guide catheter (e.g., guide catheter 31 or guide catheter 2906), for example by driving a hub (e.g., hub 30 or hub 2914) associated with the interventional device (e.g., axially and / or rotationally). Similarly, the control 2204f can be configured to move an interventional device, such as a 0.071 inch procedure catheter (e.g., catheter 29, catheter 120, or catheter 2904), for example by driving a hub (e.g., hub 28, hub 122, or hub 2912) associated with the interventional device (e.g., axially and / or rotationally). The control 2206f can be configured to move an interventional device, such as a steerable access catheter (e.g., catheter 124 or catheter 2902), for example by driving a hub (e.g., hub 126 or hub 2910) associated with the interventional device (e.g., axially and / or rotationally). The control 2208f can be configured to move an interventional device, such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example by driving a hub (e.g., hub 26 or hub 2909) associated with the interventional device (e.g., axially and / or rotationally).

[0306] In operation, if a user slides a finger along a horizontal axis (proximally or distally) on the touchpad of control 2202f (as shown by axis X), the corresponding connected hub and / or interventional device can move axially in the same direction by the same or a proportional amount. If a user slides a finger along a vertical axis on the touchpad of control 2202f (as shown by axis Y), the corresponding connected hub and / or interventional device can move rotationally by the same or a proportional amount. For example, if a user slides a finger on the touchpad in a vertically upward direction, the interventional device can rotate in a clockwise direction, and if a user slides a finger on the touchpad in a vertically downward direction, the interventional device can rotate in a counterclockwise direction.

[0307] If the user 2230 slides a finger on the touchpad of the control 2202f in a direction having a horizontal component and a vertical component (e.g., along a substantially diagonal axis, as shown by axis D), the corresponding connected hub and / or interventional device can be moved axially in the same direction in an amount that is the same or proportional to the horizontal component and rotated in an amount that is the same or proportional to the vertical component. When the user slides a finger on the touchpad along the diagonal axis D, the axial and rotational movement of the corresponding connected hub and / or interventional device can depend on the horizontal distance the user’s finger travels along axis X and the vertical distance the user’s finger travels along axis Y on the touchpad. In certain embodiments, the user can slide a finger on the touchpad along a non-linear path to adjust the axial and rotational movement at different rates at different portions of the procedure.

[0308] In other embodiments, rotational control of the corresponding interventional device can be achieved by making a substantially circular motion on the touchpad. For example, but not limited to, if the user makes a circular motion (e.g., clockwise or counterclockwise) on the touchpad, the interventional device can be moved rotationally in the same direction in an amount that is the same or proportional. That is, if the user makes three circular motions in a clockwise direction, the corresponding hub and / or interventional device can be rotated in the clockwise direction three times. As another example, if the user makes a half-circle motion (i.e., 180 degrees) in a counterclockwise direction, the corresponding hub and / or interventional device can be rotated in the counterclockwise direction 180 degrees.

[0309] In some embodiments, if the user taps the surface of the touchpad of the control 2202 along an edge of the touchpad, the corresponding connected hub and / or interventional device can be moved responsively at a predetermined linear velocity. The corresponding connected hub and / or interventional device can continue to move at the predetermined linear velocity until the user taps the surface of the touchpad again.

[0310] The touchpad of each control 2202f-2208f can be configured to move the connected hub at a predetermined linear velocity. For example, if the user taps the touchpad along an edge of the touchpad, the corresponding hub can be moved responsively distally or proximally at a linear velocity of 5 mm / second. For example, tapping the left edge of the control 2202f can cause the connected hub to advance distally at the predetermined linear velocity. Similarly, tapping the right edge of the control 2202f can cause the connected hub to advance proximally at the predetermined linear velocity. The predetermined linear velocity can be adjusted by the clinician. For example, but not limited to, tapping the edge of the touchpad can cause the corresponding hub to move at a linear velocity of about 5 mm / second, 6 mm / second, 8 mm / second, 10 mm / second, 12 mm / second, 14 mm / second, etc. The corresponding hub can continue to move distally or proximally at the predetermined linear velocity until the user taps the surface of the touchpad again.

[0311] The controls can be configured to move the connected hubs axially on a 1 : 1 basis or on a non- 1 : 1 scaled basis. For example, if a user slides a finger 10 mm along the axis X on the touchpad, the corresponding hub can responsively move a distance of 10 mm proximally or distally.

[0312] The controls can be configured to move the connected hubs rotationally on a 1 : 1 basis or on a non- 1 : 1 scaled basis. For example, if a user slides a finger 10 mm along the axis Y on the touchpad, the corresponding hub can responsively move rotationally 10 degrees.

[0313] The control 2200f can be configured to enable the clinician to adjust a predetermined linear velocity. For example, advancement of the surgical catheter and access catheter through the guide catheter and up to the distal end of the selected ostium can desirably be accomplished in a "fast" mode. But travel further into the neurovasculature can desirably be accomplished in a relatively slow mode with velocity-controlled actuation. For example, for a surgical phase that the clinician wishes to proceed in a "fast" mode, the clinician can adjust the predetermined linear velocity to 10 mm / second when the user taps the edge of the touchpad. For a surgical phase that the clinician wishes to proceed in a relatively slow mode, the clinician can adjust the predetermined linear velocity to 2 mm / second when the user taps the edge of the touchpad.

[0314] In some cases, the touchpad of each control 2202f-2208f can include one or more guide regions to help the clinician operate each control 2202f-2208f. For example, as shown in FIG. 22, the touchpad of the control 2202f can include a guide region 2202g that is configured to guide the user's finger to the left or right along the axis X. The guide region 2202g can be a raised region, a textured region, a region of different color, or any other suitable guide region. FIG. 24BAs shown, the touchpad of each control 2202f-2208f can include two guide regions 2239f, 2240f and one non-guide region 2242f. The first guide region 2239f and the second guide region 2240f can provide visual and tactile assistance to the clinician when the clinician operates each control 2202f-2208f. The first guide region 2239f can include a substantially horizontal region. The horizontal region of the first guide region 2239f can advantageously prevent the clinician from accidentally sliding a finger in a vertical direction. The second guide region 2240f can include a substantially vertical region. The vertical region of the second guide region 2240f can advantageously prevent the clinician from accidentally sliding a finger in a horizontal direction. In operation, the clinician can slide a finger on the first guide region 2239f or the second guide region 2240f to control the corresponding hub and / or interventional device in a particular direction. For example, the clinician can slide a finger on the first guide region 2239f to axially move the corresponding hub and / or interventional device. Because the first guide region restricts the clinician's ability to slide a finger in a vertical direction, the likelihood that the clinician will accidentally or erroneously control the hub and / or interventional device in an undesirable manner (e.g., rotate instead of axially advance or retract) can be reduced. Similarly, because the second guide region restricts the clinician's ability to slide a finger in a horizontal direction, the likelihood that the clinician will accidentally or erroneously control the hub and / or interventional device in an undesirable manner (e.g., axially advance or retract instead of rotate) can be reduced.

[0315] In some cases, the touchpad can also include a non-guide region 2242f, as shown in FIG. 24B and FIG. 24C The non-guide region can be used by the clinician to simultaneously control axial and rotational movement of the corresponding hub and / or interventional device. For example, if the clinician desires to axially and rotationally move the corresponding hub and / or interventional device, the clinician can perform a swiping gesture on the non-guide region of the touchpad. A diagonal swiping gesture will cause the corresponding hub and / or interventional device to move in an axial direction and rotate. However, in some cases, the clinician can use two fingers to simultaneously perform a swiping gesture on the first guide region 2239f and the second guide region 2240f, which can cause the corresponding hub and / or interventional device to axially and rotationally move.

[0316] In some cases, the touchpad can include a circular guide region 2244f, as shown in FIG. 24C The circular guide region can improve the accuracy of the user when operating controls 2202f-2208f that are configured to rotationally move the corresponding hub and / or interventional device when a substantially circular gesture is performed on the touchpad.

[0317] FIG. 24D Additional examples of touchpad arrangements and swipe gestures that can cause corresponding hub and / or interventional device axial and rotational movement are limited. In some embodiments, vertical, circular, or semi-circular gestures can cause corresponding hub and / or interventional device rotation. The control can include guide regions that include vertical, circular, and semi-circular regions. In some embodiments, vertical or horizontal gestures can cause corresponding hub and / or interventional device movement in an axial direction. The control can include guide regions that include vertical and / or horizontal regions.

[0318] FIG. 24E Additional examples of control configurations are shown. The control can include guide regions 2251f that include horizontal regions. The control can also include guide regions 2253f that include vertical, circular, or semi-circular regions. In some embodiments, the control can include one or more parallel ridges. Each parallel ridge can be used to control movement of a different interventional device.

[0319] While the foregoing describes exemplary operation of control 2202f, one of skill in the art will appreciate that any of controls 2204f, 2206f, and 2208f can operate in the same manner. In certain embodiments, each of controls 2202f, 2204f, 2206f, and 2208f can control axial and rotational movement of a corresponding interventional device. In other embodiments, one or more of controls 2202f, 2204f, 2206f, and 2208f can control only axial movement of a corresponding interventional device or only rotational movement of a corresponding interventional device.

[0320] FIG. 25A to FIG. 25D Another example of a control for manipulating an interventional device driven by (or otherwise associated with) a corresponding hub is shown. FIG. 25A to FIG. 25C The control can include any features and / or functionality the same as or similar to any other control described herein. In certain embodiments, at least one control mounted in the control can be used to manipulate and / or otherwise move each hub. Each control can be adapted to move a unique hub and / or interventional device during an interventional procedure. For example, movement of each control can trigger a responsive movement in the corresponding hub and / or interventional device. In certain embodiments, at least some movement of each control can trigger a responsive movement in a corresponding sled on the support table, which in turn can drive movement of the corresponding hub.

[0321] As FIG. 25BAs shown, the control machine 2200g can include a first control 2202g, a second control 2204g, a third control 2206g, and a fourth control 2208g. More or fewer controls can be provided depending on the intended interventional device configuration. Each control 2202g-2208g can include a surface 2258g with a capacitive screen, a resistive screen, a touchpad, or other touch-based sensing device. The control machine 2200g can be located on or near a patient support table with a set of hubs and catheters / interventional devices. In some embodiments, the control machine 2200g can be located away from the support table, for example behind a radiation shield or in a different room or different geographic location in a telemedicine implementation.

[0322] Each control 2202g-2208g can correspond to and drive movement of a hub and / or interventional device. In certain embodiments, the control 2202g can be configured to move an interventional device, such as a 0.088 inch guide catheter (e.g., guide catheter 31 or guide catheter 2906), for example by driving a hub (e.g., hub 30 or hub 2914) associated with the interventional device (e.g., axially and / or rotationally). Similarly, the control 2204g can be configured to move an interventional device, such as a 0.071 inch procedure catheter (e.g., catheter 29, catheter 120, or catheter 2904), for example by driving a hub (e.g., hub 28, hub 122, or hub 2912) associated with the interventional device (e.g., axially and / or rotationally). The control 2206g can be configured to move an interventional device, such as a steerable access catheter (e.g., catheter 124 or catheter 2902), for example by driving a hub (e.g., hub 126 or hub 2910) associated with the interventional device (e.g., axially and / or rotationally). The control 2208g can be configured to move an interventional device, such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example by driving a hub (e.g., hub 26 or hub 2909) associated with the interventional device (e.g., axially and / or rotationally).

[0323] In operation, if a user slides a finger on the surface 2258g of the control 2202g (e.g., distally or proximally), as indicated by the direction of arrow 2216g, the corresponding connected hub and / or interventional device can move the same or a proportional amount in the same direction. If a user rotates the control 2202g as indicated by arrow 2220g (e.g., clockwise or counterclockwise), the corresponding interventional device can be rotationally driven (e.g., by the corresponding hub) and / or driven in the same or a proportional amount in the same direction. If a user rotates the control 2202g about the control’s axis as indicated by arrow 2220g and slides a finger on the capacitive touch area of the control 2202g as indicated by arrow 2216g, the corresponding connected interventional device can responsively move the same or a proportional amount rotationally and the same or a proportional amount axially.

[0324] Each control 2202g-2208g can include a slip ring 2257g and a fixed barrel 2251g. Advantageously, the slip ring 2257g can allow each of the controls 2202g-2208g to rotate infinitely relative to the fixed barrel 2251g. The fixed barrel 2251g of each of the controls 2202g-2208g can include a diameter that is less than the diameter of the controls 2202g-2208g. In operation, when a user rotates the control 2202g, the control 2202g can rotate relative to the fixed barrel 2251g.

[0325] The controls can be configured to move a connected hub axially on a 1:1 basis or on a non-1:1 scaled basis. For example, if a user slides a finger 10 mm on the capacitive touch area of a control, the corresponding hub can responsively move a distance of 10 mm proximally or distally.

[0326] The controls can be configured to move a connected hub rotationally on a 1:1 basis or on a non-1:1 scaled basis. For example, if a user rotates the control 2202g about the fixed barrel 2251g by 5 degrees, the corresponding hub can responsively move an angular distance of 5 degrees.

[0327] The control mechanism can be configured to allow clinicians to adjust linear displacement and / or rotational distance. For example, the advancement of surgical catheters and access catheters by guiding the catheter and proceeding distally to the selected orifice may ideally be accomplished in a "fast" mode. However, further distal access to the neurovascular system may ideally be accomplished in a relatively slow mode through speed-controlled actuation. For example, for a surgical phase that the clinician wishes to perform in a "fast" mode, the clinician can adjust the control mechanism such that a 5 mm slide on the capacitive touch area of ​​the control mechanism causes the corresponding hub and / or interventional device to move 10 mm in the same direction. For a surgical phase that the clinician wishes to perform in a relatively slow mode, the clinician can adjust the control mechanism such that a 5 mm slide on the capacitive touch area of ​​the control mechanism causes the corresponding hub and / or interventional device to move 1 mm in the same direction. In some embodiments, one or more of the control elements 2202g, 2204g, 2206g, and 2208g may be mounted together on a platform (e.g., a sled) that is axially movable so that each of the corresponding interventional devices translates together in a “fast” mode during insertion or retraction. In such embodiments, the capacitive touch areas of the individual controls can be used to move their corresponding interventional devices in a “slow” mode.

[0328] like FIG. 25B to 25D As shown, one or more rotation sensors 2253g can be used to measure the rotational movement of a control element relative to a fixed cylinder 2251g. Each control element 2202g to 2208g may include a fixed cylinder 2251g. One or more rotation sensors 2253g can be configured to measure the rotational movement (e.g., 5 degrees) of the control element relative to the fixed cylinder 2251g corresponding to the individual control element. Among other factors, the rotational distance by which the corresponding intervention device will move may depend on the rotational movement measurement performed by the one or more rotation sensors. The one or more rotation sensors may include, for example, a magnet 2255g (such as...). FIG. 25D (As shown), magnetoresistive elements, encoders, potentiometers, Hall effect sensors, or combinations thereof. Control components 2200g may include rotary sensors for each control component.

[0329] While the foregoing describes exemplary operation of control 2202g, one of skill in the art will appreciate that any of controls 2204g, 2206g, and 2208g can operate in the same manner. In certain embodiments, each of controls 2202g, 2204g, 2206g, and 2208g can control axial and rotational movement of the corresponding interventional device. In other embodiments, one or more of controls 2202g, 2204g, 2206g, and 2208g can control only axial movement of the corresponding interventional device or only rotational movement of the corresponding interventional device.

[0330] FIG. 25E Control 2202g’ shown in FIG. 22G’ is an alternative embodiment of one of controls 2202g-2208g shown in FIG. 22G. Similarly, control 2202g’ can include surface 2258g’ having a capacitive screen, a resistive screen, a touchpad, or other touch-based sensing device. FIG. 25A to 25D

[0331] FIG. 26A to FIG. 26B Another example of control mechanisms for manipulating interventional devices driven by (or otherwise associated with) corresponding hubs is shown. FIG. 26A to FIG. 26C The control mechanisms of FIG. 22G can include any features and / or functionality identical or similar to any other control mechanisms described herein. In certain embodiments, at least one control mechanism can be used to manipulate and / or otherwise move each hub. Each control mechanism can be adapted to move a unique hub and associated interventional device during an interventional procedure. For example, movement of each control mechanism can trigger a responsive movement in the corresponding hub and / or interventional device. In certain embodiments, at least some movement of each control mechanism can trigger a responsive movement in the corresponding sled on the support table, which in turn can drive movement of the corresponding hub.

[0332] As shown in FIG. 22G, each control mechanism can include a surface 2258g adapted to be manipulated by a user during an interventional procedure. In certain embodiments, surface 2258g can be adapted to be manipulated by a user’s hand, a user’s finger, a user’s thumb, or other user input device. In certain embodiments, surface 2258g can be adapted to be manipulated by a user’s hand and a user’s finger, a user’s hand and a user’s thumb, or other user input devices. FIG. 26A ​As shown, the control console 2200h can include a first control 2202h, a second control 2204h, a third control 2206h, and a fourth control 2208h. Depending on the intended interventional device configuration, more or fewer controls can be provided. Each control can include a rotary wheel 2270h and a plurality of knobs 2272ah, 2272bh. The plurality of knobs 2272ah, 2272bh can be connected together. Advantageously, this can allow a user to control the plurality of knobs 2272ah, 2272bh using either a right or left hand. Each rotary wheel 2270h can be rotated about a first axis 2217h, as indicated by arrow 2216h, to cause corresponding hub and / or interventional device axial movement. In addition, the plurality of knobs 2272ah, 2272bh can be rotated about a second axis 2219h, as indicated by arrow 2220h, to cause corresponding hub and / or interventional device rotational movement. Manipulation of either the rotary wheels 2270h and / or the knobs 2272ah, 2272bh can cause corresponding hub and / or interventional device movement.

[0333] The control console 2200h, including controls 2202h, 2204h, 2206h, 2208h, can be located on or near a patient support table with a set of hubs and catheters / interventional devices. In some embodiments, the control console can be located remotely from the support table, for example behind a radiation shield or in a different room or different geographical location in a telemedicine implementation.

[0334] Each control 2202h-2208h can correspond to and drive movement of a hub and / or hub and / or interventional device. In certain embodiments, the control 2202h can be configured to move an interventional device, such as a 0.088 inch guide catheter (e.g., guide catheter 31 or guide catheter 2906), for example, axially and / or rotationally, by driving a hub (e.g., hub 30 or hub 2914) associated with the interventional device. Similarly, the control 2204h can be configured to move an interventional device, such as a 0.071 inch procedure catheter (e.g., catheter 29, catheter 120, or catheter 2904), for example, axially and / or rotationally, by driving a hub (e.g., hub 28, hub 122, or hub 2912) associated with the interventional device. The control 2206h can be configured to move an interventional device, such as a steerable access catheter (e.g., catheter 124 or catheter 2902), for example, axially and / or rotationally, by driving a hub (e.g., hub 126 or hub 2910) associated with the interventional device. The control 2208h can be configured to move an interventional device, such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example, axially and / or rotationally, by driving a hub (e.g., hub 26 or hub 2909) associated with the interventional device.

[0335] In operation, if a user rotates the rotation wheel 2270h of the first control 2202h (e.g., by a half revolution (e.g., 180°)), the corresponding hub and / or interventional device can move axially in the corresponding direction by the same or a proportional amount. For example, if a user rotates the rotation wheel 2270h counterclockwise, the corresponding hub and / or interventional device can move proximally, and if a user rotates the rotation wheel 2270h clockwise, the corresponding hub can move distally. If a user rotates either of the knobs 2272ah, 2272bh of the first control 2202h (e.g., clockwise or counterclockwise), the corresponding interventional device can be rotationally driven (e.g., by the corresponding hub) in the same direction and / or by the same or a proportional amount. If a user rotates the rotation wheel 2270h of the first control 2202h and rotates either of the knobs 2272ah, 2272bh of the first control 2202h, the corresponding connected interventional device can responsively rotate by the same or a proportional amount and move axially in the corresponding direction by the same or a proportional amount.

[0336] The controls can be configured to move the corresponding hub and / or interventional device axially on a 1 : 1 basis or on a non-1 : 1 scaled basis. For example, if a user rotates the wheel by about 5 degrees, the corresponding hub and / or interventional device can responsively move an axial distance of 5 mm.

[0337] The controls can be configured to move the corresponding interventional device rotationally on a 1 : 1 basis or on a non-1 : 1 scaled basis. For example, if a user rotates either of the knobs 2072ah, 2072bh of the first control 2202h by 5 degrees, the corresponding hub can responsively move an angular distance of 5 degrees.

[0338] The control machine 2200 can be configured to enable a clinician to adjust the proportion of linear displacement and / or rotational displacement of the corresponding hub and / or interventional device relative to movement of the controls. For example, advancement of a surgical catheter and access catheter through a guide catheter and up to the distal end of a selected ostium can desirably be accomplished in a "fast" mode. Further distal travel into a neurovascular system can desirably be accomplished in a relatively slow mode with speed-controlled actuation. For example, for a surgical phase that a clinician wishes to conduct in a "fast" mode, the clinician can adjust the controls such that a 180° rotational movement of the rotation wheel 2207h causes the corresponding connected hub and / or interventional device to move 50 mm in the same direction. For a phase of surgery that the clinician wishes to conduct in a relatively slower mode, the clinician can adjust the controls such that the same 180° rotational movement of the rotation wheel causes the corresponding connected hub and / or interventional device to move 10 mm in the same direction.

[0339] FIG. 26CThe control element 2202h' shown is FIG. 26A to FIG. 26B An alternative embodiment of one of the control elements 2202h to 2208h shown. Similar to control elements 2202h to 2208h, control element 2202h' may include a rotating wheel 2270h' and a plurality of knobs 2272ah', 2272bh'. The positions of the plurality of knobs 2272ah', 2272bh' relative to the rotating wheel 2270h' may differ from the positions of the plurality of knobs 2272ah', 2272bh' relative to the rotating wheel 2270h.

[0340] like FIG. 26B As shown, one or more rotation sensors can be used to measure the rotational movement of the rotating wheel 2270h and multiple knobs 2272ah, 2272bh. For example, one or more rotation sensors 2251h, 2253h can be configured to measure the rotational movement (e.g., 180 degrees) of the rotating wheel 2270h and / or multiple knobs 2272ah, 2272bh. For example, rotation sensor 2251h can be configured to measure the rotational movement of the rotating wheel 2270h, while rotation sensor 2253h can be configured to measure the rotational movement of the multiple knobs 2272ah, 2272bh. Among other factors, the rotational distance and / or distal travel of the corresponding hub and / or intervention device will also depend on the rotational movement measured by one or more rotation sensors 2251h, 2253h. One or more rotation sensors may include, for example, a magnet, a magnetoresistive element, an encoder, a potentiometer, a Hall effect sensor, or a combination thereof.

[0341] While exemplary operation of control element 2202h has been described above, those skilled in the art will understand that any of control elements 2204h, 2206h, and 2208h can operate in the same manner. In some embodiments, each of control elements 2202h, 2204h, 2206h, and 2208h can control both axial and rotational movement of the corresponding interventional device. In other embodiments, one or more of control elements 2202h, 2204h, 2206h, and 2208h can control only the axial movement of the corresponding interventional device or only the rotational movement of the corresponding interventional device.

[0342] FIG. 27 Another example of a control mechanism for manipulating an intervention device driven by (or otherwise associated with) a corresponding hub is shown. FIG. 27 The control unit 2200i shown is FIG. 26A to FIG. 26CAn alternative embodiment of a control console is shown. Control console 2200i can include a first control 2202i and a second control 2204i for controlling at least two corresponding hubs and / or interventional devices. More or fewer controls can be provided depending on the intended interventional device configuration. Each control can include a rotary wheel 2270i and a knob 2272i. Manipulation of the rotary wheel 2270i and / or knob 2272i can cause the corresponding hub and / or interventional device to move, for example, relative to FIG. 26A to FIG. 26C as described herein.

[0343] FIG. 28A and FIG. 28B Another exemplary control console 2200j for manipulating interventional devices driven by (or otherwise associated with) corresponding hubs is shown. FIG. 28A to FIG. 28B A control console can include any features and / or functionality described herein with respect to any other control console. In some embodiments, a control console can include controls having one or more buttons, joysticks, and / or d-pads. In some embodiments, one or more of the buttons, joysticks, and / or d-pads can be used to manipulate and / or otherwise move each hub. Each of the one or more joysticks can have a home position. The control console can be configured such that each of the one or more joysticks returns to its home position when it is not being manipulated by a user. In some embodiments, each of the buttons, joysticks, and / or d-pads can be adapted to move a unique hub and associated interventional device during an interventional procedure.

[0344] Control console 2200j can include controls 2210j having one or more buttons, joysticks, and / or d-pads. More or fewer buttons, joysticks, and / or d-pads can be provided depending on the intended interventional device configuration. For example, as shown in FIG. 22J, control console 2200j can include a first control 2212j having a first button 2214j, a first joystick 2216j, and a first d-pad 2218j. Control console 2200j can also include a second control 2220j having a second button 2222j, a second joystick 2224j, and a second d-pad 2226j. FIG. 28A and FIG. 28BAs shown, the controls 2210j can include a plurality of buttons 2221j, 2222j, 2223j, 2224j, a first joystick 2231j, a second joystick 2232j, a d-pad 2240j, a first shoulder button or bumper button 2251j, a second shoulder button or bumper button 2252j, a first trigger 2261j, and / or a second trigger 2262j. Each button, joystick, and / or d-pad can be manipulated by a user. For example, a joystick can be moved along one or more axes, and one or more of the joysticks, buttons, and d-pads can be depressed. Manipulating one or more of the buttons, joysticks, and / or d-pads can trigger a corresponding responsive movement in the hub and / or interventional device. In certain embodiments, at least some movements of the buttons, joysticks, and / or d-pads can trigger a corresponding responsive movement in a corresponding sled on the patient support table, which in turn can drive movement of a corresponding hub. The control station 2200j can be located on or near a patient support table with a set of hubs and catheters / interventional devices. In some implementations, the control station 2200j can be located remotely from the support table, such as behind a radiation shield or in a different room or different geographic location in a telemedicine implementation.

[0345] One or more of the plurality of buttons, joysticks, and / or d-pads of the controls 2210j can correspond to a hub and / or interventional device and drive movement of the hub and / or interventional device. In certain embodiments, one or more of the buttons, joysticks, and / or d-pads can be manipulated to connect or assign control of a hub (e.g., control of axial and / or rotational movement) to another one of the plurality of buttons, joysticks, and / or d-pads of the controls 2210j. For example, in certain embodiments, one of the plurality of buttons, joysticks, and / or d-pads can be selected to assign control of a particular hub to the joystick 2231j, and another one of the plurality of buttons, joysticks, and / or d-pads can be selected to assign control of a different particular hub to the joystick 2231j.

[0346] In some embodiments, button 2224j and first joystick 2231j can be configured to move an interventional device, such as a 0.088-inch guide catheter (e.g., guide catheter 31 or guide catheter 2906), for example, by driving a hub (e.g., hub 30 or hub 2914) associated with the interventional device (e.g., axially and / or rotationally). For example, a user can effect translation and / or rotation of a corresponding drive hub (e.g., hub 30 or hub 2914) or interventional device (e.g., guide catheter 31 or guide catheter 2906) by pressing button 2224j. When translation and / or rotation of the corresponding hub and / or interventional device is activated, the user can manipulate first joystick 2231j to control the corresponding drive hub and / or interventional device. Similarly, button 2222j and first joystick 2231j can be configured to move an interventional device, such as a 0.071-inch surgical catheter (e.g., catheter 29, catheter 120, or catheter 2904), for example, by driving a hub (e.g., hub 28, hub 122, or hub 2912) associated with the interventional device (e.g., axially and / or rotationally). For example, a user can effect translation and / or rotation of a corresponding hub (e.g., hub 28, hub 122, or hub 2912) and / or interventional device (e.g., catheter 29, catheter 120, or catheter 2904) by pressing button 2222j. When translation and / or rotation of the corresponding hub and / or interventional device is activated, the user can manipulate first joystick 2231j to control the corresponding hub and / or interventional device. Button 2223j and first joystick 2231j can be configured to move an interventional device, such as a steerable access catheter (e.g., catheter 124 or catheter 2902), for example, by driving a hub (e.g., hub 126 or hub 2910) associated with the interventional device (e.g., axially and / or rotationally). For example, a user can effect translation and / or rotation of a corresponding hub (e.g., hub 126 or hub 2910) and / or interventional device (e.g., catheter 124 or catheter 2902) by pressing button 2223j. When translation and / or rotation of the corresponding hub and / or interventional device is activated, the user can manipulate first joystick 2231j to control the corresponding hub and / or interventional device. Button 2221j and first joystick 2231j can be configured to drive more than one hub and / or more than one interventional device simultaneously. For example, a user can effect translation and / or rotation of multiple hubs (e.g., hubs 2910, 2912, and 2914) and / or multiple interventional devices (e.g., catheters 2902, 2904, and 2906) by pressing button 2221j. When translation and / or rotation of the multiple hubs and / or interventional devices is activated, the user can manipulate first joystick 2231j to control each of the multiple hubs and / or multiple interventional devices simultaneously.

[0347] In some cases, the second joystick 2232j can be configured to move an interventional device, such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example, by driving a hub (e.g., hub 26 or hub 2909) associated with the interventional device (e.g., axially and / or rotationally). In some embodiments, one of the plurality of buttons, joysticks, and / or d-pads can be selected to assign control of a particular hub to the joystick 2232j, and another one of the plurality of buttons, joysticks, and / or d-pads can be selected to assign control of a different particular hub to the joystick 2232j, for example, as described with respect to joystick 2231j.

[0348] The controls 2210j can be configured to enable the clinician to adjust the function of each or at least some of the plurality of buttons, joysticks, and / or d-pads. That is, the clinician can configure each of the plurality of buttons, joysticks, and / or d-pads to perform different functions and / or allow control of different hubs.

[0349] In operation, if the user implements control of the drive hub by pressing button 2222j and moves first joystick 2231j in the direction of arrow X’ (i.e., about axis 2219j), the corresponding connected hub and / or interventional device can be responsively moved in the corresponding axial direction at a predetermined linear velocity. The corresponding connected hub and / or interventional device can continue to move in the same direction at the predetermined linear velocity until the user releases (e.g., stops manipulating) first joystick 2231j or moves first joystick 2231j further. When the user stops manipulating first joystick 2231j, first joystick 2231j can return to its home position. If the user moves first joystick 2231j in the direction of arrow Y’ (i.e., about axis 2217j), the corresponding connected hub can responsively drive the corresponding interventional device rotationally in the corresponding direction at a predetermined angular velocity. When the user stops manipulating first joystick 2231j, first joystick 2231j can return to its home position. In some cases, if the user moves first joystick 2231j in a direction having both X’ and Y’ components (e.g., diagonally along arrow Z’), the corresponding connected interventional device can be responsively moved rotationally at a predetermined angular velocity and a predetermined linear velocity. The corresponding connected interventional device can continue to be moved rotationally at the predetermined angular velocity and at the predetermined linear velocity until the user releases (e.g., stops manipulating) first joystick 2231j or moves first joystick 2231j further. When the user stops manipulating first joystick 2231j, first joystick 2231j can return to its home position. The clinician can control different hubs and / or interventional devices simultaneously by pressing one of second button 2221j, third button 2223j, or fourth button 2224j, or more than one hub and / or interventional device, which can enable control of one or more of the hubs and / or interventional devices and control of the above-described hubs and / or interventional devices by operating first joystick 2231j and / or second joystick 2232j.

[0350] In some embodiments, if the user moves the second joystick 2232j in the direction of arrow Y", the corresponding connected interventional device can responsively move rotationally at a predetermined angular velocity. The corresponding connected interventional device can continue to move rotationally at the predetermined angular velocity until the user releases (e.g., stops manipulating) the second joystick 2232j or moves the second joystick 2232j further. When the user stops manipulating the second joystick 2232j, the second joystick 2232j can return to its starting position. If the user moves the second joystick 2232j in the direction of arrow X", the corresponding connected interventional device can responsively move axially at a predetermined velocity. The corresponding connected interventional device can continue to move axially at the predetermined velocity until the user releases (e.g., stops manipulating) the second joystick 2232j or moves the second joystick 2232j further. When the user stops manipulating the second joystick 2232j, the second joystick 2232j can return to its starting position.

[0351] In some embodiments, the first trigger 2261j and the second trigger 2262j can be used to articulate and / or relax an interventional device (e.g., an access catheter). For example, pressing the first trigger 2261j can cause the access catheter to relax. In some cases, the access catheter will continue to relax until the user releases the first trigger 2261j. The access catheter can remain in the relaxed position even when the first trigger 2261j is released. The user can articulate the access catheter by pressing the second trigger 2262j. In some cases, the access catheter will continue to remain articulated until the user releases the second trigger 2262j.

[0352] Other axes and degrees of freedom can be defined to enable the control 2210j to perform movements that can be translated into movements of the hub and / or the interventional device. For example, the control mechanism 2200j can be equipped with one or more deflection controls configured to initiate lateral deflection in a deflection region on the corresponding interventional device.

[0353] Movement of the first joystick 2231j and / or the second joystick 2232j in the direction of arrows X', Y', Z', Y" can be configured to move the connected hub on a 1 : 1 basis or on a non-1 : 1 scaled basis. For example, if the user rotates the first joystick 2231j about 5 degrees in the direction of arrow X' (i.e., about the axis 2219j), the corresponding hub can responsively move in the same direction at a predetermined linear velocity of 5 mm / sec.

[0354] The movement of the first joystick 2231j and / or the second joystick 2232j along arrows X', Y', Z', Y'' can be configured to rotate the connected hub on a 1:1 scale or a non-1:1 scale. For example, if the user rotates the first joystick 2231j about 5 degrees along arrow Y' (i.e., about axis 2217j), the corresponding hub can move responsively at a predetermined angular velocity of 5 degrees / second.

[0355] In some implementations, a scaling factor can be used to determine the amount of scaling described herein. The scaling factor can be applied to one or both of translational and rotational movements. In some implementations, a first scaling factor is selected for translational movements, and a second scaling factor, different from the first scaling factor, is selected for rotational movements. For a given proximal or distal operation of the control, the axial scaling factor can drive proximal catheter movement at a faster rate than distal catheter movement.

[0356] The rotational scaling factor can be 1:1, while the axial scaling factor can allow the hub to move a greater distance than the control component, such that the hub travel relative to the control component is at least about 2:1 or 5:1 or 10:1 or greater, depending on the desired axial length of the control component.

[0357] like FIG. 28C As shown, one or more rotation sensors can be used to measure the rotational movement of each joystick 2231j, 2232j about axis 2217j and / or axis 2219j relative to the starting position of each control element. For example, one or more rotation sensors can be configured to measure the rotational movement (e.g., 5 degrees) of the control element from its starting position. The linear velocity and / or predetermined angular velocity of the corresponding intervention device may depend on the measurements of one or more rotation sensors. One or more rotation sensors may include, for example, an encoder, a potentiometer, a Hall effect sensor, or a combination thereof. In some cases, control element 2200j may include one or more rotation sensors for each joystick 2231j, 2232j.

[0358] The control 2200j can be configured to enable the clinician to adjust the scale factor for different portions of the procedure. For example, advancement of the procedure catheter and access catheter through the guide catheter and up to the distal end of the selected ostium can desirably be accomplished in a "fast" mode. Further distal travel into the access neurovascular system can desirably be accomplished in a relatively slow mode with speed-controlled actuation. For example, for a stage of the procedure that the clinician wishes to proceed in a "fast" mode, the clinician can adjust the predetermined linear velocity to 10 mm / sec when the control is moved 5 degrees along arrow X' (i.e., about axis 2219j). For a stage of the procedure that the clinician wishes to proceed in a relatively slower mode, the clinician can adjust the predetermined linear velocity to 2 mm / sec when the control is moved 5 degrees along arrow X'.

[0359] Any of the control mechanisms disclosed herein, including but not limited to control mechanisms 2200, 2200a, 2200b, 2200c, 2200d, 2200e, 2200f, 2200g, 2200h, 2200i, and 2200j, can be configured to allow a user to manipulate two or more hubs and / or interventional devices simultaneously. For example, the control mechanism can be configured to fix the relative position (e.g., axial and / or rotational position) of two or more hubs and / or interventional devices relative to each other. When the relative position of two or more hubs and / or interventional devices is fixed, operation of the control as described herein can cause both or more hubs and / or interventional devices to move axially and / or rotationally together as described herein. In other embodiments, two or more hubs and / or interventional devices can be configured to move at different rates / distances when a user operates a single control. For example, moving the control 2 mm can cause a first hub and / or interventional device to move 2 mm and a second hub and / or interventional device to move 1 mm.

[0360] In some embodiments, moving a hub close to an adjacent second hub can cause the second hub to begin moving (e.g., to prevent a collision). As an example, if a first hub is within a predetermined distance of a second hub controlled by control 2204a, moving control 2202a such that the first hub moves in the direction of the second hub can cause the second hub to move (and thus the associated interventional device to move). The predetermined distance can be, for example, about 1 mm, about 2 mm, about 3 mm, about 4 mm, about 5 mm, etc. In some embodiments, moving a first hub close to an adjacent second hub can cause the first hub to stop moving. For example, if a user moves control 2202a to move a first hub within a predetermined distance of a second hub controlled by control 2204a, the user can be prevented from using control 2202a to further advance the first hub in the direction of the second hub until control 2204a is moved to move the second hub further away from the first hub.

[0361] Axially or axially and rotationally controlling the speed of the corresponding hubs can increase the overall speed of the procedure. For example, the advancement of various devices from the femoral access point to the aortic arch can desirably be accomplished at a faster rate than the distal navigation closer to the treatment site. Also, the proximal retraction of various devices, particularly the guidewire, access catheter, and procedural catheter, can desirably be accomplished at a relatively higher speed than the distal advancement.

[0362] Any of the control mechanisms disclosed herein, including but not limited to control mechanisms 2200, 2200a, 2200b, 2200c, 2200d, 2200e, 2200f, 2200g, 2200h, 2200i, and 2200j, can be configured to allow a user to control movement (e.g., axial movement) of the telescoping drive table. For example, at least one of the control mechanisms can be configured to cause axial movement of the telescoping drive table in order to cause axial movement of a hub connected to the telescoping drive table. For example, any of the control mechanisms disclosed herein, including but not limited to control mechanisms 2200, 2200a, 2200b, 2200c, 2200d, 2200e, 2200f, 2200g, 2200h, 2200i, and 2200j, can be used to control movement of embodiments of the telescoping drive table and / or one or more hubs connected thereto as described in U.S. Application No. 63 / 385,761, filed December 1, 2022, entitled “TELESCOPING DRIVE TABLE,” which is hereby incorporated by reference herein in its entirety.

[0363] Any of the control mechanisms disclosed herein, including but not limited to control mechanisms 2200, 2200a, 2200b, 2200c, 2200d, 2200e, 2200f, 2200g, 2200h, 2200i, and 2200j, can also be equipped with one or more jet control mechanisms (e.g., buttons, joysticks, and / or any other control mechanism embodiments described herein) for controlling components of the jet system, for example, to initiate and / or terminate the introduction of fluid (e.g., saline, contrast, etc.) to the catheter and / or initiate and / or terminate the aspiration of fluid from the catheter.

[0364] In some embodiments, each control mechanism and / or additional control mechanisms (not shown) can be color-coded, shape-coded, haptically coded, or otherwise coded to indicate to the user 2230 which color is configured to move which hub or interventional device. In some embodiments, the control mechanism color coding can also be applied to the hubs and / or interventional devices so that the user can visually match a particular hub / device to a particular control mechanism.

[0365] In some embodiments, other control operations besides translational and rotational movement can be performed using any of the controls described herein. For example, controls 2202-2208 can be configured to drive shape changes and / or stiffness changes of the corresponding interventional device. The controls can switch between different modes of operation. For example, the controls can switch between movement driven by acceleration and velocity and movement that mirrors actual linear displacement or rotation.

[0366] In some embodiments, the control hub can be equipped with a visual display or other indicator of the relative position of the controls, which can correspond to the relative position of the interventional device. Such a display can depict any or all of the directions of movement, instructions, percentage of movement made, and / or hub and / or catheter indicators to indicate which device is being controlled by a particular control. In some embodiments, the display can depict the applied force or resistance encountered by the catheter or other measurement detected or observed by a particular hub or interventional assembly.

[0367] In some embodiments, the control hub can include haptic components to provide haptic feedback to a user operating the controls. For example, if control 2202a triggers movement of a catheter and the catheter detects a large force at the tip, control 2202a can generate haptic feedback to indicate to the user to stop or reverse the movement made. In some embodiments, haptic feedback can be generated at the control to indicate to the user to slow down or speed up movement using the control. In some embodiments, the haptics can provide feedback for large torsional strain buildup that can precede a sudden rotation, or can provide feedback for large axial force buildup that can be a precursor to catheter buckling. Alternatively or additionally, feedback can be provided by one or more visual indicators (e.g., warning lights), audible indicators, etc.

[0368] The systems described herein can compare actual fluoroscopic image positions to input displacements from the controller. A static fluoroscopic image of a patient can be captured in which the patient's vasculature is indicated relative to bone landmarks or one or more implanted soft tissue fiducial markers. Then, a real-time fluoroscopic image can be displayed as an overlay, aligned with the static image by registration of the fiducial markers. Visual observation of the real-time movement in concert with the static image, aided by detected force data, can help confirm correct navigation of the associated catheter or guidewire. The systems described herein can also display a comparison of input proximal mechanical translation of a catheter or guidewire to resulting distal tip output movement or lack thereof. Loss of relative movement at the distal tip can indicate shaft buckling, prolapse, kinking, or similar results inside or outside the body. Such a comparison can be beneficial when the shaft buckling, prolapse, kinking, or similar results are outside of the current fluoroscopic view.

[0369] FIG. 17A side elevation schematic of a multi-catheter interventional device assembly 2900 for combined supra-aortic access and / or neurovascular site access and procedures (e.g., aspiration) is shown, as described herein. The multi-catheter assembly 2900 can be configured for manual or robotic procedures.

[0370] The interventional device assembly 2900 includes an insertion or access catheter 2902, a procedural catheter 2904, and a guide catheter 2906. Other components can include, but are not limited to, one or more guidewires (e.g., optional guidewire 2907), one or more guidewire catheters, an access sheath, and / or one or more other procedural catheters and / or associated catheter (control) hubs. In some embodiments, the assembly 2900 can also be configured with an optional deflection control 2908 for controlling deflection of one or more catheters of the assembly 2900.

[0371] In operation, the multi-catheter assembly 2900 can be used without having to change hub assemblies. For example, in the previously disclosed two-stage procedure for achieving supra-aortic access, the first stage includes installing an access catheter, a guide catheter, and a guidewire to the support table. Upon achieving supra-aortic access, the access catheter and guidewire are typically removed from the guide catheter. Then, after attaching a new guidewire hub and a procedural catheter hub to corresponding drive carriages on the support table, a second catheter assembly is introduced through the guidewire catheter.

[0372] FIG. 17 The single multi-catheter assembly 2900 is configured to operate without having to remove hubs and catheters and without adding additional assemblies and / or hubs. Thus, the multi-assembly access and procedural configuration of the assembly 2900 can utilize the guidewire 2907 manufactured to function as an access guidewire and a navigation guidewire to allow for sufficient access and support, as well as navigation to a particular distal treatment site. In a non-limiting example configured for robotic implementations, the catheter assembly can include a guidewire hub (e.g., guidewire hub 2909 or guidewire hub 26 located to the right of the catheter 2902 on the drive table), an insertion or access catheter hub 2910, a procedural catheter hub 2912, a guide catheter hub 2914, and corresponding catheters. In certain embodiments, one or more hubs can include or be connected with a hemostasis valve to accommodate introduction of an interventional device therethrough. In some embodiments, any of the control mechanisms described herein can include at least one control for opening and closing a hemostasis valve.

[0373] One or more of the interventional devices and hub combinations can also include a fluidics connection for connection to a fluid source and / or a vacuum source. For example, each of the insertion or access catheter 2902, the surgical catheter 2904, and the guide catheter 2906 can be in fluid communication with a saline source, a contrast source, and / or a vacuum source. In some embodiments, any of the control mechanisms described herein can include at least one control for initiating and / or terminating the introduction of fluid to and / or the aspiration of fluid from one or more of the catheters. For example, any of the control mechanisms described herein can include at least one control for opening and / or closing one or more valves to initiate the introduction of fluid to and / or the aspiration of fluid from one or more of the catheters. For example, any of the control mechanisms described herein can be used to control various components of a fluidics system (e.g., manifold valves, pumps, hemostasis valves, hubs, and / or catheters) as described in U.S. Patent Application No. 17 / 879,614, filed August 2, 2022, entitled “MultiCatheter System with Integrated Fluidics Management,” which is hereby incorporated by reference herein in its entirety.

[0374] In some embodiments, the control mechanisms described herein can allow a user to simultaneously control the movement (e.g., axial and / or rotational movement) of the catheters and the fluidics system (e.g., for the introduction and / or aspiration of fluid).

[0375] When access above the aortic arch is complete, the insertion or access catheter 2902 (associated with the insertion catheter hub 2910) can be parked near the carotid artery ostium, and the remainder or subset of the catheter assembly can be directed more distally to a particular site (e.g., a clot site, a surgical site, a procedure site, etc.).

[0376] In some embodiments, other smaller surgical catheters can also be added and used at the site. As used with the catheter assembly 2900 herein, in a robotic configuration of the assembly 2900, the catheter 2906 can be used as a guide catheter. The catheter 2904 can be used as a surgical (e.g., aspiration) catheter. In some embodiments, instead of or in addition to the catheter 2904, the catheter 2906 can also function to perform aspiration in addition to functioning as a guide catheter. The access catheter 2902 can have a distal deflection region and can be used to access a desired ostium. Those skilled in the art will understand from the foregoing that manual or robotic operation of a multi-catheter stack is contemplated herein. FIG. 18A to FIG. 18E

[0377] ​In some implementations, the catheter assembly 2900 (or other combined catheter assemblies described herein) can be driven to a location as an assembly. However, each catheter (or guidewire) assembly can be operated and driven to the same or different locations independently of each other.

[0378] In a non-limiting example, catheter assembly 2900 can be used for diagnostic angiography procedures. In some embodiments, assembly 2900 may include only a guidewire 2907 and an access catheter 2902 (in the form of a diagnostic angiography catheter) for performing diagnostic angiography procedures, or only the guidewire 2907 and the access catheter 2902 may be used during the procedure. Alternatively, the guiding catheter 2906 and the surgical catheter 2904 may be retracted proximally to expose the distal end of the access catheter 2902 (e.g., several centimeters of the distal end of the access catheter) for diagnostic angiography.

[0379] like FIG. 17 As shown, the guiding catheter 2906, surgical catheter 2904, access catheter 2902, and guidewire 2907 can be arranged concentrically. In some embodiments, the guiding catheter 2906 can be a "large-bore" guiding or access catheter having a diameter of at least about 0.075 inches or at least about 0.080 inches. The surgical catheter 2904 can be an aspiration catheter having a diameter of about 0.060 inches to about 0.075 inches. The access catheter 2902 can be a manipulable catheter with a deflectable distal tip having a diameter of about 0.025 inches to about 0.050 inches. The guidewire 2907 can have a diameter of about 0.014 inches to about 0.020 inches. In one example, the guiding catheter 2906 may have a diameter of about 0.088 inches, the surgical catheter 2904 may have a diameter of about 0.071 inches, the access catheter 2902 may have a diameter of about 0.035 inches, and the guidewire 2907 may have a diameter of about 0.018 inches.

[0380] FIG. 18A to FIG. 18E An exemplary sequence of steps for introducing a multi-catheter assembly is described, the multi-catheter assembly being configured to achieve direct access to the clot via manual or robotic operation. FIG. 18A to FIG. 18E It can be used FIG. 17 The interventional device components are described in this document. Other combinations of catheters may be used instead of the interventional device components, as will be understood by those skilled in the art in light of the disclosure herein.

[0381] refer to FIG. 18A, the three-catheter interventional device assembly 2900 is shown being driven through the guide sheath 3002, up through the iliac artery 3004 and into the descending aorta. Next, the access catheter 2902, the procedural catheter 2904 (e.g., 0.071 inch), and the guide catheter 2906 (e.g., 0.088 inch) are tracked to the aortic arch 3006, as shown in FIG. 18B . Here, the distal end of the guide catheter 2906 can be parked below the aortic arch 3006, and the procedural catheter 2904, the access catheter 2902 (within the procedural catheter 2904, and not visible in FIG. 18B ), and the guide wire 2907 can be driven into the ostium (e.g., simultaneously or separately). In some embodiments, the access catheter 2902 is pushed out of the procedural catheter 2904 and the guide catheter 2906 to first engage the ostium. After the distal end of the access catheter 2902 is positioned within the desired ostium, the guide wire 2907 can be advanced distally into the ostium to ensure access. After the access catheter 2902 and the guide wire 2907 are within the desired ostium, the procedural catheter 2904 and / or the guide wire 2906 can be advanced into the ostium (and, in some embodiments, beyond the ostium) while using the support of the access catheter 2902 and / or the guide wire 2907 to steer through the aorta and into the ostium. In the embodiment shown in FIG. 18B , the procedural catheter 2904 has been advanced into the ostium, while the guide catheter 2906 has remained parked below the aortic arch 3006.

[0382] Referring to FIG. 18C , the guide wire 2907 can be advanced distally, and the radiopacity of the guide wire 2907 can be used to confirm, under fluoroscopic imaging, that access through the desired ostium has been achieved. The guide wire 2907 engages the origin of the brachiocephalic artery 3014. The guide wire 2907 is then advanced up the petrous segment 3018 of the internal carotid artery 3016.

[0383] Referring to FIG. 18D , the guide catheter 2906 and the procedural catheter 2904 (within the guide catheter 2906, and not visible in FIG. 18D ) are advanced over the guide wire 2907 and the access catheter 2902 (within the procedural catheter 2904, and not visible in FIG. 18D ) while the access catheter 2902 remains at the ostium for support. The guide wire 2907 can be further advanced through the petrous segment 3018 to the site of the clot 3020, e.g., the Ml segment.

[0384] Referring to FIG. 18E , the guide catheter 2906 and the procedural catheter 2904 (within the guide catheter 2906, and not visible in FIG. 18EThe guidewire 2907 (not visible in the middle) is advanced (e.g., simultaneously or sequentially) to position the distal tip of the surgical catheter 2904 at the surgical site, such as on the surface of the clot 3020. The guidewire 2907 is removed and the inlet catheter 2902 (located within the surgical catheter 2904, and...) is inserted. FIG. 18E (Not visible in the middle), and aspiration of the clot 3020 begins through surgical catheter 2904. That is, guidewire 2907 and access catheter 2902 are retracted proximally to allow aspiration through surgical catheter 2904. After aspiration of the clot, surgical catheter 2904 and guide catheter 2906 can be removed (e.g., simultaneously or sequentially). For example, in some embodiments, surgical catheter 2904 can be removed before guide catheter 2906 is removed.

[0385] The catheter assembly 2900 can be used in neurovascular surgery, such as... FIG. 18A to FIG. 18E As shown. For example, neurovascular surgery can be neurovascular thrombosis resection. The steps of the procedure may include providing a component, which includes at least a guidewire, an access catheter, a guiding catheter, and a surgical catheter. For example, catheter assembly 2900 includes a guidewire 2907, an access (e.g., insertion) catheter 2902, a guiding catheter 2906, and at least one surgical catheter 2904. Surgical catheter 2904 may include an aspiration catheter, an embolization deployment catheter, a stent deployment catheter, a shunt deployment catheter, a diagnostic angiography catheter, a stent retrieval catheter, a clot retrieval catheter, a balloon catheter, a catheter facilitating percutaneous flap repair or replacement, an ablation catheter, and / or an RF ablation catheter or guidewire.

[0386] Neurovascular surgery may also include the following steps: connecting a component to a non-robotic or robotic drive system, and driving the component to achieve access to the aorta. The steps may also include driving a subset of the component to the neurovascular site and performing neurovascular surgery using the subset of the component. The subset of the component may include guidewires, guiding catheters, and surgical catheters.

[0387] Each of the guidewire 2907, access catheter 2902, guiding catheter 2906, and surgical catheter 2904 is configured to be adjusted by a corresponding hub. For example, guidewire 2907 may include (or be connected to) a hub mounted on one of the tray assemblies described herein. Similarly, access catheter 2902 may be connected to catheter hub 2910. Guiding catheter 2906 may be connected to guiding catheter hub 2914. Surgical catheter 2904 may be connected to surgical catheter hub 2912.

[0388] Generally, the connections of the assembly can include magnetically connecting the first hub 2909 on the guidewire 2907 to a first drive magnet, magnetically connecting the second hub 2910 on the access catheter 2902 to a second drive magnet, magnetically connecting the third hub 2912 on the surgical catheter 2904 to a third drive magnet, and magnetically connecting the fourth hub 2914 on the guide catheter 2906 to a fourth drive magnet. Generally, the first, second, third, and fourth drive magnets are each independently movably carried by a drive stage, as described by the tray assembly and controls described herein. In some embodiments, the first, second, third, and fourth drive magnets are connected (e.g., to their respective catheter hubs) through a sterile barrier (e.g., a sterile and fluid barrier) and are independently movably carried by a drive stage having a plurality of driven magnets. In some embodiments, two or more drive magnets can be pinned together or otherwise connected together to move as a combined piece in response to commands from a single controller that is pinned in or otherwise connected to one of the drive magnets.

[0389] In some implementations, the steps of performing neurovascular surgery can include driving the assembly in response to movement of each of the hub adapters along the support stage until the assembly is positioned to achieve vascular access over the aorta. The hub adapters can include, for example, connectors / trolleys that act as shuttles by being advanced proximally or distally along a track in response to operator instructions. The hub adapters described herein can each include at least one drive magnet configured to connect with a driven magnet carried by a corresponding hub. This provides a magnetic connection between the drive magnet and the driven magnet through a sterile barrier such that the corresponding hub moves into the top of the sterile barrier (as described in detail in the FIG. 4 In some implementations, the steps of performing neurovascular surgery can include driving the assembly in response to movement of each of the hub adapters along the support stage until the assembly is positioned to achieve vascular access over the aorta. The hub adapters can include, for example, connectors / trolleys that act as shuttles by being advanced proximally or distally along a track in response to operator instructions. The hub adapters described herein can each include at least one drive magnet configured to connect with a driven magnet carried by a corresponding hub. This provides a magnetic connection between the drive magnet and the driven magnet through a sterile barrier such that the corresponding hub moves into the top of the sterile barrier (as described in detail in the

[0390] The steps can also include driving a subset of the assembly in response to movement of each of the hub adapters along the support stage until the subset of the assembly is positioned to perform neurovascular surgery at the neurovascular treatment site. The subset of the assembly can include the guidewire 2907, the guide catheter 2906, and the surgical catheter 2904.

[0391] In some embodiments, the guidewire 2907, the guide catheter 2906, and the surgical catheter 2904 pass through (relative to the guidewire 2907) and over (relative to the guide catheter 2906 and the surgical catheter 2904) at least a portion of the length of the access (e.g., insertion) catheter 2902 after the aortic supra- access is achieved.

[0392] In some embodiments, the catheter assembly 2900 can be part of a robotic control system for achieving aortic supra-access and neurovascular treatment site access, as shown in FIG. 18A to FIG. 18E In some embodiments, the catheter assembly 2900 can be part of a hybrid control system (with manual and robotic components) for achieving aortic supra-access and neurovascular t...

Claims

1. A method of robotically controlling an interventional device, the method comprising: providing an interventional device assembly comprising a plurality of interventional devices; in a first mode of operation, advancing a first subset of the plurality of interventional devices into an ostium of a descending aorta in response to movement of a control of a controller, wherein the first subset of the plurality of interventional devices is connected to the control in the first mode of operation; switching from the first mode of operation to a second mode of operation in response to user input using the controller, wherein switching from the first mode of operation to the second mode of operation causes a second subset of the plurality of interventional devices to be connected to the control of the controller, the second subset of the plurality of interventional devices being different than the first subset of the plurality of interventional devices; and in the second mode of operation, advancing the second subset of the plurality of interventional devices to a treatment site in response to movement of the control of the controller.

2. The method of claim 1, wherein the first subset of the plurality of interventional devices comprises a guide catheter, a procedural catheter, and an access catheter.

3. The method of claim 2, wherein the guide catheter, the procedural catheter, and the access catheter are configured to move simultaneously in the first mode of operation in response to movement of the control.

4. The method of claim 2, wherein the second subset of the plurality of interventional devices comprises the guide catheter and the procedural catheter.

5. The method of claim 2, wherein the guide catheter and the procedural catheter are configured to move simultaneously in the second mode of operation.

6. The method of claim 2, wherein the control comprises a first control, the method further comprising advancing a guidewire into the ostium in the first mode of operation in response to movement of a second control of the controller.

7. The method of claim 6, wherein the first control comprises a first joystick and the second control comprises a second joystick.

8. The method of claim 6, further comprising connecting one of the guide catheter, the procedural catheter, and the access catheter to the second control in response to user input such that movement of the second control causes movement of the one of the guide catheter, the procedural catheter, and the access catheter.

9. The method of claim 6, wherein advancing the guidewire into the ostium in the first mode of operation in response to movement of the second control comprises advancing the guidewire in response to movement of the second control along a first axis, the method further comprising rotating the guidewire in response to movement of the second control along a second axis perpendicular to the first axis.

10. The method of claim 1, further comprising performing a neurovascular procedure at the treatment site through the procedural catheter in response to receiving user input on the controller.

11. The method of claim 10, wherein performing the neurovascular procedure comprises aspirating a clot.

12. The method of claim 1, wherein in the first mode of operation, movement of the control is configured to cause responsive movement of the first subset of the plurality of interventional devices within a first range of velocities, and wherein in the second mode of operation, movement of the control is configured to cause responsive movement of the second subset of the plurality of interventional devices within a second range of velocities different from the first range of velocities.

13. A method of robotically controlled interventional devices, the method comprising: providing a multi-catheter assembly comprising: an access catheter, a guide catheter, and a procedural catheter; in response to movement of a control of a controller, actuating the multi-catheter assembly to enable supra-aortic access; in response to movement of the control of the controller, actuating a subset of the multi-catheter assembly to a neurovascular site, wherein the subset comprises the guide catheter and the procedural catheter; and in response to user input on the controller, performing a neurovascular procedure using the procedural catheter.

14. The method of claim 13, wherein actuating the multi-catheter assembly to enable supra-aortic access comprises simultaneously advancing the access catheter, the guide catheter, and the procedural catheter in response to movement of the control of the controller.

15. The method of claim 13, wherein actuating the subset of the multi-catheter assembly to the neurovascular site comprises simultaneously advancing the guide catheter and the procedural catheter in response to movement of the control of the controller.

16. The method of claim 13, wherein the control comprises a first control, the method comprising actuating the guidewire to enable supra-aortic access in response to movement of a second control of the controller.

17. The method of claim 16, wherein the first control comprises a first joystick, and the second control comprises a second joystick.

18. The method of claim 16, further comprising, in response to user input, connecting one of the access catheter, the guide catheter, and the procedural catheter to the second control such that movement of the second control causes movement of the one of the guide catheter, the procedural catheter, and the access catheter.

19. The method of claim 13, wherein the neurovascular procedure comprises aspiration of a clot.

20. A method of robotically controlled interventional devices, the method comprising: in response to movement of a joystick of a controller, actuating a first interventional device of an interventional device assembly, wherein the first interventional device is connected to the joystick such that movement of the joystick causes responsive movement of the first interventional device; receiving user input; and in response to receiving the user input, connecting a second interventional device of the interventional device assembly to the joystick such that movement of the joystick causes responsive movement of the second interventional device.

21. The method of claim 20, further comprising, after connecting the second interventional device to the joystick, actuating the second interventional device using the joystick. ​ 22. The method of claim 20, wherein connecting the second interventional device to the joystick comprises connecting the second interventional device to the joystick such that movement of the joystick causes simultaneous responsive movement of both the first interventional device and the second interventional device.

23. The method of claim 20, wherein the first interventional device comprises a guidewire and the second interventional device comprises a guide catheter.

24. The method of claim 20, wherein the first interventional device comprises a guide catheter or a surgical catheter and the second interventional device comprises an access catheter.

25. The method of claim 20, wherein the user input comprises actuation of a button of the controller, wherein the controller is configured to connect the second interventional device to the joystick when the button is actuated.

26. The method of claim 20, wherein driving the first interventional device of the interventional device assembly in response to movement of the joystick comprises driving the first interventional device of the interventional device assembly in response to movement of the joystick along a first axis, wherein the method further comprises rotating the first interventional device of the interventional device assembly in response to movement of the joystick along a second axis different from the first axis.

27. The method of claim 26, wherein the second axis is perpendicular to the first axis.

28. The method of claim 26, wherein the first interventional device is a guidewire.

29. The method of claim 26, wherein the first interventional device is an access catheter.

30. The method of claim 20, wherein driving the first interventional device of the interventional device assembly in response to movement of the joystick of the controller comprises advancing the first interventional device to enable supra-aortic access.

31. The method of claim 20, further comprising driving the second interventional device to a treatment site to perform a neurovascular procedure in response to movement of the joystick.

32. The method of claim 31, further comprising performing the neurovascular procedure in response to user input on the controller.

33. The method of claim 32, wherein performing the neurovascular procedure comprises aspirating a clot.

34. A robotic device control system, comprising: a controller in communication with a plurality of hubs, each of the plurality of hubs connected to one of a plurality of interventional devices, the controller comprising a control and an operational mode actuator; wherein the controller is configured to transition between a first operational mode and a second operational mode in response to actuation of the operational mode actuator; wherein in the first operational mode, the control is connected to a first subset of the plurality of hubs such that movement of the control causes responsive movement of the first subset of the plurality of hubs; and and wherein in the second operating mode the control is connected to a second subset of the plurality of hubs such that movement of the control causes responsive movement of the second subset of the plurality of hubs, the second subset of the plurality of hubs being different than the first subset of the plurality of hubs.

35. The robotic device control system of claim 34, wherein, The first subset of the plurality of hubs includes a guide catheter hub, a procedural catheter hub, and an access catheter hub.

36. The robotic device control system of claim 35, wherein, When the control is connected to the first subset of the plurality of hubs, movement of the control is configured to simultaneously move each of the guide catheter hub, the procedural catheter hub, and the access catheter hub.

37. The robotic device control system of claim 35, wherein, When the control is connected to the first subset of the plurality of hubs, movement of the control is configured to move each of the guide catheter hub, the procedural catheter hub, and the access catheter hub the same distance sequentially.

38. The robotic device control system of claim 35, wherein the second subset of the plurality of hubs includes the guide catheter hub and the procedural catheter hub.

39. The robotic device control system of claim 38, wherein, When the control is connected to the second subset of the plurality of hubs, movement of the control is configured to simultaneously move each of the guide catheter hub and the procedural catheter hub.

40. The robotic device control system of claim 38, wherein, When the control is connected to the second subset of the plurality of hubs, movement of the control is configured to move each of the guide catheter hub and the procedural catheter hub the same distance sequentially.

41. The robotic device control system of claim 34, wherein the control comprises a first control, wherein the system includes a second control connected to a third subset of the plurality of hubs in the first operating mode.

42. The robotic device control system of claim 41, wherein the first subset of the plurality of hubs includes one or more of a guide catheter hub, a procedural catheter hub, and an access catheter hub, wherein the third subset of the plurality of hubs includes a guidewire hub.

43. The robotic device control system of claim 41, wherein, The first control comprises a first joystick, and the second control comprises a second joystick.

44. The robotic device control system of claim 34, wherein, The control is configured to move along a first axis and a second axis different than the first axis, wherein movement of the control along the first axis is configured to cause responsive axial movement of a hub of the plurality of hubs connected to the control, wherein movement of the control along the second axis is configured to cause rotational movement of at least some of the interventional devices connected to the hub connected to the control.

45. A robotic device control system comprising: a controller in communication with a plurality of interventional devices, the controller including a control and an operating mode actuator; wherein the controller is configured to transition between a first operating mode and a second operating mode in response to actuation of the operating mode actuator; wherein in the first operating mode the control is connected to a first subset of the plurality of interventional devices such that movement of the control causes responsive movement of the first subset of the plurality of interventional devices; and wherein in the second operating mode the control is connected to a second subset of the plurality of interventional devices such that movement of the control causes responsive movement of the second subset of the plurality of interventional devices, the second subset of the plurality of interventional devices being different than the first subset of the plurality of interventional devices. wherein in the second operating mode, the control is connected to a second subset of the plurality of interventional devices such that movement of the control causes a responsive movement of the second subset of the plurality of interventional devices, the second subset of the plurality of interventional devices being different than the first subset of the plurality of interventional devices.

46. The robotic device control system of claim 45, wherein, The first subset of the plurality of interventional devices includes a guide catheter, a procedural catheter, and an access catheter.

47. The robotic device control system of claim 46, wherein, When the control is connected to the first subset of the plurality of interventional devices, movement of the control is configured to simultaneously move each of the guide catheter, the procedural catheter, and the access catheter.

48. The robotic device control system of claim 46, wherein, When the control is connected to the first subset of the plurality of interventional devices, movement of the control is configured to move each of the guide catheter, the procedural catheter, and the access catheter the same distance sequentially.

49. The robotic device control system of claim 46, wherein the second subset of the plurality of interventional devices includes the guide catheter and the procedural catheter.

50. The robotic device control system of claim 49, wherein, When the control is connected to the second subset of the plurality of interventional devices, movement of the control is configured to simultaneously move each of the guide catheter and the procedural catheter.

51. The robotic device control system of claim 49, wherein, When the control is connected to the second subset of the plurality of interventional devices, movement of the control is configured to move each of the guide catheter and the procedural catheter the same distance sequentially.

52. The robotic device control system of claim 45, wherein the control includes a first control, wherein the system includes a second control connected to a third subset of the plurality of interventional devices in the first operating mode.

53. The robotic device control system of claim 52, wherein the first subset of the plurality of interventional devices includes one or more of a guide catheter, a procedural catheter, and an access catheter, wherein the third subset of the plurality of interventional devices includes a guidewire.

54. The robotic device control system of claim 52, wherein, The first control includes a first joystick, and the second control includes a second joystick.

55. The robotic device control system of claim 45, wherein, The control is configured to move along a first axis and a second axis different than the first axis, wherein movement of the control along the first axis is configured to cause a responsive axial movement of the plurality of interventional devices connected to the control, wherein movement of the control along the second axis is configured to cause a rotational movement of at least some of the interventional devices connected to the control.

56. A robotic device control system, comprising: a controller in communication with a plurality of hubs, each of the plurality of hubs connected to one of a plurality of interventional devices, the controller including: a joystick; and a plurality of hub actuators, wherein actuation of each of the plurality of hub actuators causes the joystick to connect with one of the plurality of hubs such that movement of the joystick causes a corresponding responsive movement of the one of the plurality of hubs.

57. The robotic device control system of claim 56, wherein actuation of a first hub actuator of the plurality of hub actuators and a second hub actuator of the plurality of hub actuators simultaneously causes the joystick and a first hub associated with the first hub actuator and a second hub associated with the second hub actuator to be connected such that movement of the joystick causes corresponding responsive movement of the first hub and the second hub.

58. The robotic device control system of claim 56, further comprising a velocity actuator, wherein actuation of the velocity actuator changes a range of axial velocities within which responsive movement of one of the plurality of hubs connected to the joystick occurs in response to movement of the joystick.

59. The robotic device control system of claim 56, wherein the system further comprises a second joystick, wherein the second joystick is connected to at least one of the plurality of hubs such that movement of the second joystick causes responsive movement of the at least one of the plurality of hubs connected to the second joystick.

60. The robotic device control system of claim 59, further comprising at least one additional hub actuator, wherein, actuation of the at least one additional hub actuator is configured to connect the second joystick with a different hub of the plurality of hubs such that movement of the second joystick causes responsive movement in the different hub of the plurality of hubs.

61. The robotic device control system of claim 56, wherein, the joystick is configured to move along a first axis and a second axis different from the first axis, wherein movement of the joystick along the first axis is configured to cause responsive axial movement of the hub connected to the joystick, wherein movement of the joystick along the second axis is configured to cause rotational movement of at least some of the interventional devices connected to the hub connected with the joystick.

62. A robotic device control system, comprising: a controller in communication with a plurality of interventional devices, the controller comprising: a joystick; and a plurality of interventional device actuators, wherein actuation of each of the plurality of interventional device actuators causes the joystick to be connected with one of the plurality of interventional devices such that movement of the joystick causes corresponding responsive movement of the one of the plurality of interventional devices.

63. The robotic device control system of claim 62, wherein actuation of a first interventional device actuator of the plurality of interventional device actuators and a second interventional device actuator of the plurality of interventional device actuators simultaneously causes the joystick and a first interventional device associated with the first interventional device actuator and a second interventional device associated with the second interventional device actuator to be connected such that movement of the joystick causes corresponding responsive movement of the first interventional device and the second interventional device.

64. The robotic device control system of claim 62, further comprising a velocity actuator, wherein actuation of the velocity actuator changes a range of axial velocities within which responsive movement of one of the plurality of interventional devices connected to the joystick occurs in response to movement of the joystick.

65. The robotic device control system of claim 62, wherein the system further comprises a second joystick, wherein the second joystick is connected to at least one of the plurality of interventional devices such that movement of the second joystick causes a responsive movement of the at least one of the plurality of interventional devices connected to the second joystick.

66. The robotic device control system of claim 65, further comprising at least one additional interventional device actuator, wherein, actuation of the at least one additional interventional device actuator is configured to connect the second joystick to a different interventional device of the plurality of interventional devices such that movement of the second joystick causes a responsive movement of the different interventional device of the plurality of interventional devices.

67. The robotic device control system of claim 62, wherein, the joystick is configured to move along a first axis and a second axis different from the first axis, wherein movement of the joystick along the first axis is configured to cause a responsive axial movement of the interventional device connected to the joystick, wherein movement of the joystick along the second axis is configured to cause a rotational movement of at least some of the interventional device connected to the joystick.

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