Telescopic drive table and method of use

Abstract

The robotic control system includes a base structure, a drive table coupled to the base structure and configured for axial movement, a first hub adapter coupled to the drive table, the first hub adapter being coupleable with a first hub coupleable with a first interventional device, and a second hub adapter coupled to the drive table, the second hub adapter being configured to axially move a second hub coupleable with a second interventional device along the drive table. The drive table further includes a main body and an extendable member configured to be at least partially received within the main body and extendable from an end of the main body. The hub adapters are coupled to the drive table and configured to couple to corresponding hubs, such that axial movement of one or more hub adapters drives the corresponding hubs.

Description

[Technical Field]

[0001] Incorporation by reference to priority applications Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet filed with this application are incorporated herein by reference under 37 C.F.R. § 1.57. This application claims priority to U.S. Provisional Patent Application No. 63 / 385,761, entitled "TELESCOPING DRIVE TABLE," filed December 1, 2022, the entire contents of which are incorporated herein by reference for all purposes and form a part hereof.

[0002] This application relates to neurovascular procedures, and more particularly to catheter assemblies and robotic control systems for neurovascular site access. [Background technology]

[0003] Various neurovascular procedures, including thrombectomy, diagnostic angiography, embolization coil deployment, and stent placement, can be accomplished via transvascular access. However, the delivery of neurovascular care is limited or delayed by a variety of challenges. For example, there are insufficient trained interventionalists and centers to meet the current demand for neurointerventions. Neurointerventions are challenging, with complex setup requirements and demands on the surgeon's dexterity. Using both hands, the surgeon must exercise precise control over three to four coaxial catheters while managing the fluoroscopy system and patient positioning. Long, tortuous anatomies require delicate and precise manipulation. Inadvertent catheter movement can occur due to the storage and release of energy caused by frictional interactions between the coaxial shaft and the patient's vasculature. Supra-aortic access, required to reach the neurovasculature, is difficult to achieve, especially in Type III arches. Once supra-aortic access is achieved, adapting the system for neurovascular treatment is time-consuming, requiring removal of the guidewire and access catheter and addition of the treatment catheter (and possibly one or more additional catheters) to the stack.

[0004] Thus, a need remains for a supra-aortic access and neurovascular site access system that addresses some or all of these challenges and improves the availability of neurovascular procedures. Preferably, the system would additionally be capable of driving devices further distally through the supra-aortic access to achieve procedures in intracranial vessels. Summary of the Invention [Means for solving the problem]

[0005] According to one aspect of the present disclosure, a supra-aortic access robotic control system is provided. The system includes a guidewire hub configured to adjust the axial and rotational positions of a guidewire; a guide catheter hub configured to adjust the axial position of a guide catheter; and an access catheter hub configured to adjust the axial and rotational positions of an access catheter. The access catheter hub is also capable of laterally deflecting a distal deflection zone of the access catheter. The guidewire hub can additionally be configured to laterally deflect a distal portion of the guidewire. The guidewire hub can be configured to rotationally adjust the guide catheter.

[0006] A treatment catheter hub configured to manipulate the treatment catheter can also be provided. Following robotic placement of the guidewire, access catheter, and guide catheter so that the guide catheter achieves supra-aortic access, the guidewire and access catheter can be withdrawn proximally, and the treatment catheter can be advanced through and over the guide catheter, with or without the support of the guidewire (which can be smaller in diameter and / or more flexible than the guidewire used to gain supra-aortic access), to reach a more distal neurovascular treatment site. The treatment catheter can be an aspiration catheter; an embolism deployment catheter; a stent deployment catheter; a flow diverter deployment catheter; an access catheter; a diagnostic angiography catheter; a guiding catheter, an imaging catheter, a physiological sensing / measuring catheter, an infusion or injection catheter, an ablation catheter, an RF ablation catheter or guidewire, a balloon catheter, or a microcatheter used to deliver a stent retriever, a balloon catheter, or a stent retriever.

[0007] The control system may further include a driven magnet on each of the guidewire hub, the access catheter hub, and the guide catheter hub, the driven magnet configured to cooperate with a corresponding drive magnet such that the driven magnet moves in response to movement of the corresponding drive magnet. The drive magnets may each be carried by the support table for independent axial movement. The drive magnet may be positioned outside the sterile field separated from the driven magnet by a barrier, and the driven magnet may be within the sterile field. The barrier may include a tray made of a thin polymer film or any film of a non-ferromagnetic material.

[0008] The control system can further include a control console, which can be connected to the support table or can be located remotely from the support table, and the position of each driven magnet and corresponding hub is movable in response to manual manipulation of a guidewire drive control, an access catheter drive control, or a treatment catheter drive control on the console or on a specific controller not associated with the console.

[0009] The control system can further include a processor for controlling the position of the drive magnet. The processor can be in wired or wireless communication with the control console. The driven magnet can be configured to remain engaged with the corresponding drive magnet until an axial breaking force of at least about 300 grams is applied. In some embodiments, the nominal drive force is at least 15 N or 1500 grams.

[0010] Also provided is a robotically driven interventional device. The device includes an elongated flexible body having a proximal end and a distal end. A hub is provided at 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 farther away from the first surface than the magnet. The hub can further be provided with at least a second roller.

[0011] Any of the guidewire hub, access catheter hub, and treatment catheter hub can be further provided with a rotational drive to rotate the corresponding interventional device relative to the hub. The hub can further be provided with an axial drive mechanism to distally advance or proximally retract a control element extending axially through the interventional device to adjust attributes such as the shape or flexibility of the interventional device. In some embodiments, at least one control element can be an axially movable tubular body or fiber, ribbon, or wire, such as a pull wire, that extends through the interventional device to, for example, the distal deflection zone. In some embodiments, any number of control elements can be similarly advanced, retracted, or otherwise moved.

[0012] Also provided is a control system for controlling movement of an interventional device. In one configuration, the control system includes a guidewire control configured to control the axial travel and rotation of the guidewire; an access catheter control configured to control the axial and rotational movement of the access catheter; and a guide catheter control configured to control the axial movement and / or rotation of the guide catheter.

[0013] The control system may further include a deflection control configured to control deflection of the access catheter or treatment catheter, and may be configured for wired or wireless communication with the robotic catheter drive system.

[0014] The control system can be configured to independently control three or more hubs in various modes. For example, two or more hubs can be selectively grouped together so that they drive each device simultaneously with the same motion. Alternatively, the control system can be configured to drive each device simultaneously but with different motions.

[0015] The control system may further include a physician interface for operating the control system. The physician interface may be carried by a support table having a robotic interventional device drive system. Alternatively, the physician interface for operating the control system may be carried on a portable handheld device or desktop computer and may be located in the same room as the patient, in the same facility as the patient, or in a remote facility.

[0016] The control system may further include a graphical user interface with at least one display for indicating the status of at least one device parameter and / or for indicating the status of at least one patient parameter.

[0017] Also provided is a sterile packaging assembly for transporting interventional devices to a robotic surgical site. The packaging assembly 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 elongated, flexible body. The hub can include at least one magnet and at least one roller configured to roll on the base.

[0018] In one implementation, the sterile barrier is removably attached to the base and defines an enclosed volume between the sterile barrier and the base. In another implementation, the sterile barrier is in the form of a tubular enclosure for enclosing the sterile volume. The tubular enclosure can surround the base and at least one interventional device, which are within the sterile volume.

[0019] The hubs can be oriented in the packaging with the rollers and magnets facing the base. Alternatively, the base can be in the form of a tray having an elongated central axis. The upper sterile field side of the tray can have an elongated support surface for supporting and allowing sliding movement of the one or more hubs. At least one, and optionally two, elongated 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 positioned in the sterile volume defined by the sterile barrier.

[0020] The base can be configured to rest on a support table adjacent to the patient. In some embodiments, the support table is a drive table. An upper surface of the base can be within the sterile field and a lower surface of the base can be outside the sterile field.

[0021] Any of the hubs disclosed herein can further include a fluid injection port and / or a wireless RF transceiver for communication and / or power transfer. The hub can include a visual indicator to indicate the presence of a clot. In some embodiments, the hub can also include wired electrical communication and power ports. The visual indicator can include a clot chamber with a transparent window. A filter can be provided in the clot chamber.

[0022] Any of the hubs disclosed herein can further include a sensor for detecting a parameter of interest, such as the presence of a blood clot. In some cases, the sensor can be positioned 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 positioning 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., an optical fiber) can locally detect strain, which can facilitate detection and / or determination of an applied force. The device can further include multiple sensors. The multiple sensors can each include one or more of any type of sensor disclosed herein. In some embodiments, multiple (e.g., three or more) sensors (e.g., fiber Bragg grating sensors) can be distributed around the perimeter to facilitate detection and / or determination of shape. The position of the device can, in some cases, be determined through the use of one or more sensors to detect and / or determine position. For example, one or more optical encoders can be positioned in or adjacent to one or more motors that drive linear motion, such that the optical encoders can determine position.

[0023] Also provided is a method for performing a neurovascular procedure, wherein a first aspect includes robotically achieving supra-aortic access and a second aspect includes manually or robotically performing a neurovascular procedure via supra-aortic access. The method includes the steps of providing an access catheter having an access catheter hub; coupling the access catheter hub to a hub adapter movably carried by a support table; and actuating the access catheter in response to movement of the hub adapter along the table until the access catheter is positioned to achieve supra-aortic access. The access catheter and access catheter hub can then be released from the hub adapter; and a treatment catheter hub with the treatment catheter can then be coupled to the hub adapter.

[0024] The method can additionally include advancing the treatment catheter hub to position a distal end of the treatment catheter at the neurovascular treatment site. Driving the access catheter can include driving the access catheter distally through the guide catheter. Driving the access catheter can include laterally deflecting a distal region of the access catheter to achieve supra-aortic access. In some embodiments, driving the access catheter can also include rotating the access catheter.

[0025] Also provided is a method for performing a neurovascular procedure, which includes providing an access assembly including a guidewire, an access catheter, and a guide catheter. The access assembly can be releasably coupled 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 supra-aortic access. The guidewire and access catheter can then be released from the access assembly, leaving the guide catheter in place. A treatment assembly can be provided including at least the guidewire and a first treatment catheter. The treatment assembly can be releasably coupled to the robotic drive system; the neurovascular procedure can be accomplished using the treatment assembly. Also provided is a second treatment catheter for extending through the first treatment catheter to a treatment site.

[0026] The step of coupling the access assembly can include magnetically coupling a hub on each of the guidewire, the access catheter, and the guide catheter to a separate corresponding coupler carrying a corresponding drive magnet independently movably carried by a drive table. The treatment assembly can include a guidewire, a first catheter, and a second catheter. The guidewire and the first catheter can be concentrically positioned within the second catheter. The treatment assembly can be advanced as a unit through at least a portion of the length of the guide catheter, and the treatment can include neurovascular thrombectomy.

[0027] Also provided is a method of performing a neurovascular procedure, comprising providing a multi-catheter assembly including an access catheter, a guide catheter, and a treatment catheter, coupling the assembly to a robotic drive system, driving the assembly to achieve supra-aortic access, driving a subset of the assembly to a neurovascular site, the subset including the guide catheter and the treatment catheter, proximally removing the access catheter, and performing the neurovascular procedure using the treatment catheter.

[0028] The neurovascular procedure can include neurovascular thrombectomy. The assembly can further include a guidewire, wherein the guidewire, access catheter, guide catheter, and treatment catheter are each configured to be adjusted by a respective hub. Coupling the assembly to the robotic drive system can include magnetically coupling a first hub of the guidewire to a first drive magnet, a second hub of the access catheter to a second drive magnet, a third hub of the guide catheter to a third drive magnet, and a fourth hub of the treatment catheter to a fourth drive magnet. 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 table. The treatment catheter can be an aspiration catheter. The treatment catheter can be an embolism deployment catheter. The treatment catheter can be a stent deployment catheter. The treatment catheter can be a flow diverter deployment catheter. The treatment catheter can be a diagnostic angiography catheter. The treatment catheter can be a stent retriever catheter. The treatment catheter can be a clot retriever. The treatment catheter can be a balloon catheter. The treatment catheter can be a catheter for facilitating percutaneous valve repair or replacement. The treatment catheter can be an ablation catheter.

[0029] Also provided is a method of performing a neurovascular procedure, the method comprising providing an assembly including a guidewire, an access catheter, a guide catheter, and a treatment catheter coaxially and movably assembled into a single multi-catheter assembly, coupling the assembly to a drive system, driving the assembly to achieve supra-aortic access, driving a subset of the assemblies to an intracranial site, the subset including the guidewire, the guide catheter, and the treatment catheter, and performing the neurovascular procedure using the subset of the assemblies.

[0030] Each of the guidewire, access catheter, guide catheter, and treatment catheter can be configured to be adjusted by a respective hub. Coupling the assembly to the drive system can include magnetically coupling a first hub of the guidewire to a first drive magnet, a second hub of the access catheter to a second drive magnet, a third hub of the guide catheter to a third drive magnet, and a fourth hub of the treatment 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 table associated with the robotic drive system. The first drive magnet, the second drive magnet, the third drive magnet, and the fourth drive magnet can each be independently movably carried by the drive table.

[0031] Also provided is a method of performing a neurovascular procedure. The method includes providing an assembly including a guidewire having a guidewire hub, an access catheter having an access catheter hub, and a guide catheter having a guide catheter hub. The method also includes coupling the guidewire hub to a first hub adapter, coupling the access catheter hub to a second hub adapter, and coupling the guide catheter hub to a third hub adapter, each of the first hub adapter, the second hub adapter, and the third hub adapter being movably carried by a support table. The method also includes actuating the assembly in response to movement of each of the first hub adapter, the second hub adapter, and the third hub adapter along the support table until the assembly is positioned to provide supra-aortic vascular access.

[0032] The method may include driving a subset of assemblies along a support table until the subset of assemblies is positioned to perform a neurovascular procedure at a neurovascular treatment site, the subset of assemblies including a guidewire, a guide catheter, and a treatment catheter. The neurovascular procedure may include a thrombectomy. Coupling the guidewire hub to the first hub adapter may include magnetically coupling the guidewire hub to a first drive magnet. Coupling the access catheter hub to the second hub adapter may include magnetically coupling the access catheter hub to a second drive magnet. Coupling the guide catheter hub to the third hub adapter may include magnetically coupling the guide catheter hub to a third drive magnet. The first drive magnet, the second drive magnet, and the third drive magnet may be independently movably carried by the support table. The first drive magnet may be coupled to the first driven magnet across a sterile field barrier. The second drive magnet can be coupled to the second driven magnet across the sterile field barrier. The third drive magnet can be coupled to the third driven magnet across the sterile field barrier. Coupling the guidewire hub to the first hub adapter can include mechanically coupling the guidewire hub to a first drive unit. Coupling the access catheter hub to the second hub adapter can include mechanically coupling the access catheter hub to a second drive unit. Coupling the guide catheter hub to the third hub adapter can include mechanically coupling the guide catheter hub to a third drive unit. The guidewire and guide catheter can be advanced as a unit along at least a portion of the length of the access catheter after supra-aortic access is achieved. The guidewire hub can be configured to adjust the axial and rotational position of the guidewire. The assembly can further include a treatment catheter having a treatment catheter hub.The treatment catheter hub can be configured to adjust the axial and rotational position of the treatment catheter. The treatment catheter hub can be further configured to laterally deflect a distal deflection zone of the treatment catheter. The guidewire hub can be configured to adjust the axial and rotational position of the guidewire. The treatment catheter hub can be configured to adjust the axial and rotational position of the treatment catheter. The guide catheter hub can be configured to adjust the axial position of the guide catheter. The access catheter hub can be configured to adjust the axial and rotational position of the access catheter. The treatment catheter hub can be further configured to laterally deflect a distal deflection zone of the treatment catheter. The access catheter hub can be further configured to laterally deflect a distal deflection zone of the access catheter. The guide catheter hub can be configured to adjust the axial position of the guide catheter. The guide catheter hub can be configured to adjust the rotational position of the guide catheter. The access catheter hub can be configured to adjust the axial and rotational position of the access catheter. The access catheter hub can be further configured to laterally deflect a distal deflection zone of the access catheter.

[0033] Also provided is a drive system for achieving supra-aortic access and neurovascular treatment site access, the system including a guidewire hub configured to adjust the axial and rotational position of a guidewire, a treatment catheter hub configured to adjust the axial and rotational position of a treatment catheter, a guide catheter hub configured to adjust the axial position of a guide catheter, and an access catheter hub configured to adjust the axial and rotational position of an access catheter, the access catheter further configured to laterally deflect a distal deflection zone of the access catheter.

[0034] The treatment catheter hub can be further configured to laterally deflect a distal deflection zone of the treatment catheter. The guidewire hub can be configured to couple to the guidewire hub adapter by magnetically coupling the guidewire hub to a first drive magnet. The access catheter hub can be configured to couple to the access catheter hub adapter by magnetically coupling the access catheter hub to a second drive magnet. The guide catheter hub can be configured to couple to the guide catheter hub adapter by magnetically coupling the guide catheter hub to a third drive magnet. The treatment catheter hub can be configured to couple to the treatment catheter hub adapter by magnetically coupling the treatment catheter hub to a fourth drive magnet. The first drive magnet, the second drive magnet, the third drive magnet, and the fourth drive magnet can be independently movably carried by a drive table. The system can further include a first driven magnet on the guidewire hub, the first driven magnet configured to cooperate with the first drive magnet such that the first driven magnet moves in response to movement of the first drive magnet. The first drive magnet can be configured to move outside the sterile field while separated from the first driven magnet by a sterile field barrier, while the first driven magnet is within the sterile field. The position of the first drive magnet can be movable in response to manipulation of a treatment drive control on a control console in electrical communication with the drive table. The system can further include a second driven magnet on the access catheter hub, the second driven magnet configured to cooperate with the second drive magnet such that the second driven magnet is configured to move in response to movement of the second drive magnet, the second drive magnet configured to move outside the sterile field while separated from the second driven magnet by a barrier, while the second driven magnet is within the sterile field.The system may further include a third driven magnet on the guide catheter hub, the third driven magnet configured to cooperate with the third drive magnet such that the third driven magnet is configured to move in response to movement of the third drive magnet, the third drive magnet configured to move outside the sterile field while separated from the third driven magnet by a barrier, while the third driven magnet is within the sterile field. The system may further include a fourth driven magnet on the treatment catheter hub, the fourth driven magnet configured to cooperate with the fourth drive magnet such that the fourth driven magnet is configured to move in response to movement of the fourth drive magnet, the fourth drive magnet configured to move outside the sterile field while separated from the fourth driven magnet by a barrier, while the fourth driven magnet is within the sterile field. The treatment catheter may be an aspiration catheter. The treatment catheter may be an embolism deployment catheter. The treatment catheter may be a stent deployment catheter. The treatment catheter can be a flow diverter deployment catheter. The treatment catheter can be a diagnostic angiography catheter. The treatment catheter can be a stent retriever catheter. The treatment catheter can be a balloon catheter. The treatment catheter can be a catheter for facilitating percutaneous valve repair or replacement. The treatment catheter can be an ablation catheter.

[0035] Also provided is a method for achieving supra-aortic access and neurovascular treatment site access. The method includes providing a drive system including a guidewire hub configured to adjust the axial and rotational position of a guidewire, a treatment catheter hub configured to adjust the axial and rotational position of a treatment catheter, a guide catheter hub configured to adjust the axial position of the guide catheter, and an access catheter hub configured to adjust the axial and rotational position of an access catheter, the access catheter further configured to laterally deflect a distal deflection zone of the access catheter, and the method includes moving at least one of the guidewire hub, treatment catheter hub, guide catheter hub, and access catheter hub to drive movement of at least one of the guidewire, treatment catheter, guide catheter, and access catheter. The method can further include controlling the treatment catheter hub to laterally deflect the distal deflection zone of the treatment catheter.

[0036] Also provided is a method of achieving supra-aortic access, the method comprising the steps of providing an assembly including a guidewire, an access catheter, and a guide catheter coaxially and movably assembled into a single multi-catheter assembly, coupling the assembly to a drive system, driving the assembly to the aortic arch, and advancing the access catheter to a branch vessel of the aortic arch to achieve supra-aortic access.

[0037] The method may further include driving a subset of the assemblies to an intracranial site and performing a neurovascular procedure using the subset of the assemblies. The subset may include a guidewire, a guide catheter, and a treatment catheter. The treatment catheter may be an aspiration catheter. The treatment catheter may be an embolism deployment catheter. The treatment catheter may be a stent deployment catheter. The treatment catheter may be a flow diverter deployment catheter. The treatment catheter may be a diagnostic angiography catheter. The treatment catheter may be a stent retriever catheter. The treatment catheter may be a clot retriever. The treatment catheter may be a balloon catheter. The treatment catheter may be a catheter for facilitating percutaneous valve repair or replacement. The treatment catheter may be an ablation catheter. The intracranial procedure may include an intracranial thrombectomy. The neurovascular procedure may include a neurovascular thrombectomy. At least one of the guidewire, access catheter, and guide catheter may include a hub configured to couple to a robotic drive system. Coupling the assembly to the drive system can include magnetically coupling the guide catheter hub to the drive system. Coupling the assembly to the drive system can include mechanically coupling the guide catheter hub to the drive system. The drive system can be a robotic drive system, wherein at least a first drive magnet, a second drive magnet, and a third drive magnet are each independently movably carried by a drive table associated with the robotic drive system.

[0038] Also provided is a robotic drive system including a base structure, a drive table coupled to the base structure and configured for axial movement, a first hub adapter coupled to the drive table, the first hub adapter being couplable with a first hub couplable with a first interventional device, and a second hub adapter coupled to the drive table, the second hub adapter being configured to axially move a second hub couplable with a second interventional device along the drive table.

[0039] The robot drive system may include an arm coupled to the base structure and the drive table, the arm configured to move the drive table axially and / or vertically relative to the base structure. The arm may be further configured to move the drive table in an orthogonal direction, the orthogonal direction may be orthogonal to the axial direction and the orthogonal direction may be orthogonal to the vertical direction. The drive table may be configured to rotate between at least a first position and at least a second position, where in the first position the drive table may be generally parallel to the ground surface and the second position may be orthogonal to the first position. The drive table may be configured to move vertically from at least a first height above the ground surface to at least a second height above the ground surface, the second height may be greater than the first height. The first hub adapter may be fixed to the drive table such that the first hub adapter cannot move relative to the drive table. The robotic drive system can be configured to move the first hub adapter in at least a first axis relative to the patient reference point by maintaining the first hub adapter in a fixed position on the drive table and by moving the drive table in the first axis relative to the patient reference point. The robotic drive system can be configured to maintain the second hub adapter in a fixed position relative to the patient reference point by moving the second hub adapter relative to the drive table in a direction opposite to the movement of the drive table relative to the patient reference point when the drive table is moved in the first axis relative to the patient reference point. The robotic drive system can be configured to maintain the second hub adapter in a fixed position relative to the patient reference point when the drive table is moved in the first axis relative to the patient reference point by moving the second hub adapter relative to the drive table in a second axial direction opposite the first axial direction when the drive table is moved in the first axial direction.The robotic drive system can be configured to move the second hub adapter independently from the first hub adapter. The robotic drive system can include a third hub adapter coupled to the drive table and a fourth hub adapter coupled to the drive table; the third hub adapter can be configured to move a third hub coupleable with a third interventional device axially along the drive table; the fourth hub adapter can be configured to move a fourth hub coupleable with a fourth interventional device axially along the drive table; the second hub adapter can be distal to the third hub adapter, and the third hub adapter can be distal to the fourth hub adapter. The second, third, and fourth hub adapters can each be independently movable axially relative to the drive table. The second hub adapter can be axially aligned with the first hub adapter such that when the first and second hubs are coupled to the first and second hub adapters, respectively, a first interventional device coupled to the first hub and a second interventional device coupled to the second hub can be coaxially aligned. The second hub adapter can be axially aligned with the first hub adapter such that when the first and second hubs are magnetically coupled to the first and second hub adapters, respectively, a first interventional device coupled to the first hub and a second interventional device coupled to the second hub can be coaxially aligned. The arm can include a first arm segment directly or indirectly coupled at its proximal end to the base structure, a second arm segment coupled at its proximal end to the distal end of the first arm segment, and a third arm segment coupled at its proximal end to the distal end of the second arm segment.The arm may include a first joint at a proximal end of the first arm segment, a second joint at a distal end of the first arm segment, and a third joint at a distal end of the second arm segment, where the first arm segment may be configured to rotate in a horizontal plane about the first joint; the second arm segment may be configured to rotate in a horizontal plane about the second joint; and the third arm segment may be configured to rotate in a horizontal plane about the third joint. The first, second, and third joints may be configured to independently exert torques on the first, second, and third arm segments in response to inputs provided by a user of the robotic drive system, causing the first, second, and third arm segments to rotate about the first, second, and third joints, respectively. The first joint, the second joint, and the third joint can be configured to be switched between a passive state and an active state, where in the passive state the joints can be freely moved manually and in the active state the joints can be configured to generate torque forces. The robot drive system can include a fourth arm segment coupled at a proximal end thereof to a distal end of the third arm segment and a fourth joint at the distal end of the third arm segment, where the fourth arm segment can be configured to rotate in a horizontal plane about the fourth joint. The fourth arm segment can be coupled at its distal end directly or indirectly to a drive table. The robot drive system can include a fifth joint at the distal end of the fourth arm segment, where the drive table can be coupled to the fifth joint and configured to rotate the drive table in a vertical plane about the fifth joint.One or more of the joints may include a selectable braking element that can be actuated to lock the joint in a fixed position, and the brake may be manually or electronically actuated. The first hub adapter and / or the second hub adapter may be configured to move axially relative to the drive table in response to input provided by a user of the robotic drive system. The first hub adapter and the second hub adapter may be configured to move independently axially relative to the drive table in response to input provided by a user of the robotic drive system. The first hub adapter and / or the second hub adapter may be configured to move axially relative to the drive table on a rack-and-pinion linear actuator in response to input provided by a user of the robotic drive system. The second hub adapter, the third hub adapter, and the fourth hub adapter may each be configured to move axially relative to the drive table via a rack-and-pinion linear actuator, and each of the second hub adapter, the third hub adapter, and the fourth hub adapter may include an independently controllable motor. The second hub adapter, the third hub adapter, and the fourth hub adapter may each include an encoder configured to provide position data that can be used by a controller of the robot drive system to determine a position of each of the second hub adapter, the third hub adapter, and the fourth hub adapter. Each of the joints may have an encoder configured to provide position data that can be used by the controller to determine a position of each joint and a position of the drive table. The first hub adapter and / or the second hub adapter may have a plurality of wheels configured to move along one or more rails of the drive table.The first hub adapter and / or the second hub adapter can be configured to move axially relative to the drive table using a belt drive system, a lead screw system, or a ball screw system. The drive table can be foldable to reduce the overall length of the drive table in a stowed configuration. The robotic drive system can include a support bracket extending axially distally away from a distal end of the drive table and an anti-buckling element coupled to the support bracket at its distal end, the anti-buckling element can be configured to stiffen a portion of the interventional device supported by the drive table that spans from the drive table to a boss clip supported by the support bracket, the boss clip can be coupled to a femoral sheath. The support bracket can be configured to couple the anti-buckling element to a flexible sheath sleeve, which can be configured to couple to the femoral sheath. The robotic drive system can include a linear actuator configured to move the drive table relative to the base structure in response to input provided by a user of the robotic drive system. The linear actuator may include a rack-and-pinion actuator, the rack-and-pinion actuator including a rack and a motor, the rack extending from a proximal end of the drive table along a majority of the length of the drive table, the motor supported by the base structure and having a pinion gear thereon, the pinion gear configured to engage the rack and move the drive table axially relative to the base structure. The rack may extend from the proximal end of the drive table along at least 70% of the length of the drive table. The rack may extend from the proximal end of the drive table along at least 80% of the length of the drive table. The rack may extend from the proximal end of the drive table along at least, or approximately, 60% to 90% or approximately 90% of the length of the drive table.The drive table can be configured to be axially movable between a proximal position and a distal position, and a distance between a distal end of the drive table at the proximal position and a distal end of the drive table at the distal position can be at least 80% of a length of the drive table from the proximal end of the drive table to the distal end of the drive table. The first hub adapter can include a drive magnet, and the drive magnet can be coupled to the first hub adapter and configured to be coupled to a driven magnet of the first hub, such that movement of the drive magnet causes movement of the driven magnet. The second hub adapter can include a drive magnet, and the drive magnet can be coupled to the second hub adapter and configured to be coupled to a driven magnet of the second hub, such that movement of the drive magnet of the second hub adapter causes movement of the driven magnet of the second hub. The robotic drive system can include a first sensor coupled to the first hub adapter or the first hub, and the first sensor. The first sensor may be configured to measure a magnitude of a magnetic field from the drive magnet of the hub adapter and / or the driven magnet of the first hub. The first sensor may be a magnetometer. The drive magnet and the driven magnet may magnetically couple the hub adapter to the hub when the hub is within a predetermined axial distance of the hub adapter. The base structure may be configured to couple with a surgical bed. The base structure may be configured to be mounted to a ground surface. The robotic drive system may include a controller or control circuit configured to control the position and movement of the drive table, the first hub adapter, and the second hub adapter. The arm may include three or more or four rotational degrees of freedom. The drive table may include a support surface positioned between the first and second hub adapters and the first and second hubs, and the support surface may be oriented at a predetermined angle with respect to a horizontal plane.

[0040] Also provided is a robotic drive system, which may include a drive table, including a main body and an extendable member configured to be at least partially received within the main body and extendable from a proximal or distal end of the main body, and which may include one or more hub adapters coupled to the drive table, each of the one or more hub adapters configured to be coupled to a corresponding hub, such that axial movement of each of the one or more hub adapters drives axial movement of the corresponding hub, including a first hub adapter configured to be coupled to the first hub, such that axial movement of the first hub adapter drives axial movement of the first hub, and which may be configured to translate from a first axial position within the main body to a second axial position within the extendable member, beyond the proximal or distal end of the main body.

[0041] The first hub adapter can be configured to drive movement of the first hub from a first axial position on the drive surface of the main body to a second axial position on the drive surface of the extendable member. The first hub can be a guide catheter hub. The one or more hub adapters can include a second hub adapter configured to couple to a procedure catheter hub; and a third hub adapter configured to couple to an access catheter hub. The one or more hub adapters can include a fourth hub adapter configured to couple to a guidewire hub. The extendable member can be extendable from a distal end of the main body. The first hub can be a guidewire hub. The extendable member can be extendable from a proximal end of the main body. The robotic drive system can further include a shuttle configured to move axially through the main body and the extendable member, and the one or more hub adapters can be configured to move axially along the shuttle. The drive table may include a first linear actuator assembly configured to control axial movement of the shuttle within the main body and the extendable member; a second linear actuator assembly configured to control axial movement of the one or more hub adapters relative to the shuttle; and a third linear actuator assembly configured to control axial movement of the extendable member. The robotic drive system may further include a cable management system configured to position one or more cables within an interior section of the shuttle. The robotic drive system may further include one or more motors configured to axially drive the one or more hub adapters along the shuttle, and the cable management system may be configured to prevent engagement of the one or more cables with the one or more motors. The extendable member may be a first extendable member, which may be extendable from a distal end of the main body, and the drive table may further include a second extendable member extendable from a proximal end of the main body.The first and second extendable members can each have a length approximately half the length of the main body. The one or more hub adapters can include a second hub adapter for translating from a first axial position within the main body to a second axial position within the second extendable member, beyond the proximal end of the main body. The robotic drive system can further include a base structure; and an arm coupled to the base structure and the drive table, the arm configured to move the drive table axially and / or vertically relative to the base structure. The drive table can include a drive surface oriented at an angle with respect to a horizontal plane.

[0042] Also provided is a method of driving an interventional device assembly that may include axially advancing an extendable member from a proximal or distal end of a main body of a drive table; and axially advancing a hub adapter from a first axial position within the main body, past the proximal or distal end of the main body, to a second axial position within the extendable member, the hub adapter configured to couple to a corresponding hub such that axial movement of the hub adapter drives axial movement of the corresponding hub.

[0043] The hub adapter can be configured to drive movement of the hub from a first axial position on the drive surface of the main body to a second axial position on the drive surface of the extendable member. The hub can be a guide catheter hub. The hub adapter can be a first hub adapter, and the method can further include axially advancing a second hub adapter configured to be coupled to an access catheter; and axially advancing a third hub adapter configured to be coupled to a treatment catheter. The method can further include axially advancing a fourth hub adapter configured to be coupled to a guidewire hub. The extendable member can be extendable from a distal end of the main body. The hub can be a guidewire hub. The extendable member can be extendable from a proximal end of the main body. The method can further include a shuttle configured to move axially through the main body and the extendable member, and the hub adapter can be configured to move axially along the shuttle. The drive table can include a first linear actuator assembly configured to control axial movement of the shuttle within the main body and the extendable member; a second linear actuator assembly configured to control axial movement of the hub adapter relative to the shuttle; and a third linear actuator assembly configured to control axial movement of the extendable member. The drive table can further include a cable management system configured to position one or more cables within an interior section of the shuttle. The drive table can further include a motor configured to drive the hub adapter axially along the shuttle, and the cable management system can be configured to prevent engagement of the one or more cables with the motor. The extendable member can be a first extendable member, which can be extendable from a distal end of the main body, and the method can further include axially advancing a second extendable member from a proximal end of the main body of the drive table.The first and second extendable members may each have a length that is approximately half the length of the main body portion. The hub adapter may include a first hub adapter, and the method may further include axially advancing the second hub adapter from a first axial position within the main body portion, over the proximal end of the main body portion, to a second axial position within the second extendable member. The method may further include moving the drive table axially and / or vertically relative to the base structure by an arm coupled to the base structure. The drive table may include a drive surface oriented at an angle with respect to a horizontal plane.

[0044] Also provided is a robotic drive system, which may include a drive table including a support surface oriented at an angle with respect to a horizontal plane; and one or more hub adapters coupled to the drive table, each of the one or more hub adapters coupleable with a corresponding hub of the one or more hubs, each hub coupleable with an interventional device of the one or more interventional devices, and the support surface positionable between the one or more hub adapters and the corresponding hub.

[0045] The support surface can be oriented between 20 and 70 degrees from the horizontal plane. The support surface can be oriented between 50 and 60 degrees from the horizontal plane. The support surface can be oriented at 55 degrees from the horizontal plane. The support surface can be oriented between 20 and 70 degrees from the vertical plane. The support surface can be oriented between 40 and 50 degrees from the vertical plane. The support surface can be oriented at 35 degrees from the vertical plane. Each of the one or more hub adapters can be magnetically coupleable with a corresponding hub. The drive table can include a main body and one or more extendable members. The one or more extendable members can be configured to transition between a folded state and an unfolded state, and the one or more hubs can be configured to move axially along the one or more extendable members. The one or more extendable members can include a distal extendable member configured to extend distally from the main body. The one or more extendable members may include a proximal extendable member configured to extend proximally from the main body portion. At least a portion of at least one of the one or more hubs may be configured to extend laterally and inferiorly relative to a lower edge of the support surface when the hub is positioned on the support surface. Each of the one or more hub adapters may be configured to move axially along the drive table to drive axial movement of the corresponding hub. At least one of the one or more interventional devices may be configured to be positioned laterally and inferiorly relative to a lower edge of the support surface when a hub to which the interventional device is coupled is positioned on the support surface. The robotic drive system may include a shuttle configured to translate axially through the drive table, and the one or more hub adapters may be coupled to the shuttle. The one or more hub adapters may be configured to move axially along the shuttle.

[0046] Also included is a robotic drive system that can include a drive table, a shuttle configured to move axially within the drive table, and one or more hub adapters coupled to the shuttle, the one or more hub adapters configured to move axially along the shuttle, each of the one or more hub adapters configured to be coupled to a corresponding hub, such that axial movement of each of the one or more hub adapters drives axial movement of the corresponding hub.

[0047] The one or more hub adapters may include a first hub adapter configured to couple to a guide catheter hub; a second hub adapter configured to couple to a procedure catheter hub; and a third hub adapter configured to couple to an access catheter hub. The one or more hub adapters may further include a fourth hub adapter configured to couple to a guidewire hub. Each of the one or more hub adapters may be configured to be magnetically coupled to a corresponding hub through a sterile barrier. The robotic drive system may further include a first linear actuator assembly configured to control axial movement of the shuttle; and a second linear actuator assembly configured to control axial movement of the one or more hub adapters relative to the shuttle. The robotic drive system may further include a cable management system configured to position one or more cables within an interior section of the shuttle. The robotic drive system may further include one or more motors configured to axially drive the one or more hub adapters along the shuttle, and the cable management system may be configured to prevent engagement of the one or more cables with the one or more motors. Movement of a proximal-most hub adapter of the one or more hub adapters can be configured to be temporarily linked to a distal-most hub adapter of the plurality of hub adapters, such that the proximal-most hub adapter and the distal-most hub adapter move in the same direction and at the same speed. The robotic drive system can further include a control system configured to control movement of the shuttle and the one or more hub adapters in response to user input. The control system can be configured to axially translate the shuttle a first distance in the first direction in response to user input to move the first hub adapter in a first direction.The control system may be configured to axially move the second hub adapter a second distance in a second direction opposite the first direction in response to a user input to move the first hub adapter in a first direction, where the second distance may be the same as the first distance. The one or more hub adapters may include a first hub adapter and a second hub adapter, and the control system may be configured to temporarily link the movement of the first hub adapter and the second hub adapter, where the first hub adapter and the second hub adapter move at the same speed and in the same direction in response to a user input to move one or both of the first hub adapter and the second hub adapter, where the axial distance between the first hub adapter and the second hub adapter is greater than an axial length of the shuttle. The drive table may include a main body and an extendable member configured to be at least partially received within the main body and may be extendable from a proximal end or a distal end of the main body. The shuttle can be configured to translate from a first axial position to a second axial position within the main body, where at least a portion of the shuttle can be positioned within the extendable member beyond the proximal or distal end of the main body. The extendable member can be a first extendable member, which can be extendable from the distal end of the main body, and the drive table can further include a second extendable member extendable from the proximal end of the main body. Each of the first and second extendable members can have a length approximately half the length of the main body. The shuttle can be configured to translate from a first axial position to a second axial position within the main body, where at least a portion of the shuttle can be positioned within the first extendable member beyond the distal end of the main body.The shuttle can be configured to translate from a first axial position to a second axial position within the main body, where at least a portion of the shuttle can be positioned within the second extendable member beyond the proximal end of the main body. The shuttle can be configured to translate from the first axial position to the second axial position, where at least a portion of the shuttle can be positioned within the first extendable member distal to the main body, and where at least a portion of the shuttle is positioned within the second extendable member proximal to the main body.

[0048] Also included is a robotic drive system that can include a base structure and a drive table coupled to the base structure and configured to rotate between at least a first position and a second position, where in the first position a longitudinal axis of the drive table can be oriented at a first angle with respect to a ground surface and where in the second position the longitudinal axis of the drive table is oriented at a second angle with respect to the ground surface, the second angle being different from the first angle.

[0049] The longitudinal axis of the drive table in the second position may be perpendicular to the longitudinal axis of the drive table in the first position. The longitudinal axis of the drive table may be parallel to the ground surface in the first position. The drive table may include a planar drive surface extending in a horizontal plane. The robot drive system may further include an arm coupled to the base structure and the drive table, the arm configured to rotate the drive table about an axis perpendicular to the longitudinal axis of the drive table. The arm may be further configured to move the drive table horizontally relative to the base structure and / or vertically relative to the ground surface. The arm may include a first arm segment directly or indirectly coupled at its proximal end to the base structure, a second arm segment coupled at its proximal end to a distal end of the first arm segment, and a third arm segment coupled at its proximal end to a distal end of the second arm segment. The arm may be configured to rotate the drive table in a vertical plane. The arm can include a joint configured to rotate the drive table in a vertical plane, and the joint can include a selectable brake that can be actuated to lock the joint in a fixed position. The selectable brake can be actuated manually or electronically. The drive table can include a main body and an extendable member configured to be at least partially received within the main body and can be extendable from a proximal end or a distal end of the main body.The robotic drive system may further include one or more hub adapters coupled to the drive table, each of the one or more hub adapters configured to be coupled to a corresponding hub, such that axial movement of each of the one or more hub adapters drives axial movement of the corresponding hub, and the one or more hub adapters may include a first hub adapter configured to be coupled to the first hub, such that axial movement of the first hub adapter drives axial movement of the first hub, and the first hub adapter may be configured to translate from a first axial position within the main body to a second axial position within the extendable member, beyond the proximal or distal end of the main body. The first hub adapter may be configured to drive movement of the first hub from a first axial position on the drive surface of the main body to a second axial position on the drive surface of the extendable member. The robotic drive system may further include a shuttle configured to move axially through the main body and the extendable member, and the one or more hub adapters may be configured to move axially along the shuttle. The extendable member may be a first extendable member, which may be extendable from a distal end of the main body, and the drive table may further include a second extendable member extendable from a proximal end of the main body. Each of the first and second extendable members may have a length approximately half the length of the main body. The one or more hub adapters may include a second hub adapter for translating from a first axial position within the main body to a second axial position within the second extendable member, beyond the proximal end of the main body.The robotic drive system may further include a shuttle configured to move axially within the drive table; and one or more hub adapters coupled to the shuttle, wherein the one or more hub adapters may be configured to move axially along the shuttle, and each of the one or more hub adapters may be configured to be coupled to a corresponding hub, such that axial movement of each of the one or more hub adapters drives axial movement of the corresponding hub. [Brief explanation of the drawings]

[0050] [Figure 1] FIG. 1 is a schematic perspective view of an interventional setup having an imaging system, a patient support table, and a robotic drive system according to the present disclosure. [Figure 2] FIG. 1 is a longitudinal cross-sectional view showing the concentric relationship between a guidewire with two degrees of freedom, an access catheter with three degrees of freedom, and a guide catheter with one degree of freedom. [Figure 3A] FIG. 1 is an exploded schematic view of an interventional device hub separated from a support table by a sterile barrier. [Figure 3B] FIG. 10 shows an alternative sterility barrier in the form of a shipping tray having one or more storage channels for carrying interventional devices. [Figure 3C] FIG. 10 shows an alternative sterility barrier in the form of a shipping tray having one or more storage channels for carrying interventional devices. [Figure 3D] FIG. 10 shows an alternative sterility barrier in the form of a shipping tray having one or more storage channels for carrying interventional devices. [Figure 3E] FIG. 10 shows an alternative sterility barrier in the form of a shipping tray having one or more storage channels for carrying interventional devices. [Figure 3F] FIG. 10 shows an alternative sterility barrier in the form of a shipping tray having one or more storage channels for carrying interventional devices. [Figure 3G]10A-10C show alternative sterility barrier embodiments having convex drive surfaces. [Figure 3H] 10A-10C show alternative sterility barrier embodiments having convex drive surfaces. [Figure 3I] 10A-10C show alternative sterility barrier embodiments having convex drive surfaces. [Figure 3J] 10A-10C show alternative sterility barrier embodiments having convex drive surfaces. [Figure 3K] 10A-10C show alternative sterility barrier embodiments having convex drive surfaces. [Figure 3L] 3A-3K depict examples of hubs that may be used with the sterility barriers of FIGS. 3G-3K. [Figure 3M] 3A-3K depict examples of hubs that may be used with the sterility barriers of FIGS. 3G-3K. [Figure 4] FIG. 1 is a schematic elevational cross-section through a hub adapter having a drive magnet separated from an interventional device hub and driven magnet by a sterile barrier. [Figure 5A] FIG. 10 is a diagram illustrating a schematic of an interventional device assembly having three interventional devices. [Figure 5B] FIG. 10 is a diagram illustrating a schematic diagram of an interventional device assembly having four interventional devices. [Figure 6] FIG. [Figure 7] FIG. 10 is a close-up view of the motor-driven end of the support table. [Figure 8] 1 is an elevational section through the motor and belt drive assembly. [Figure 9] FIG. 10 is a close-up view of the pulley end of the support table. [Figure 10] This is an elevational section through a belt pulley. [Figure 11] FIG. 5C is a side cross-sectional view through a distal portion of a catheter such as either of the catheters shown in FIGS. 5A and 5B. [Figure 12A] FIG. 10 is a diagram illustrating a schematic of a force sensor integrated into the sidewall of a catheter. [Figure 12B] FIG. 10 is a diagram illustrating a schematic of a force sensor integrated into the sidewall of a catheter. [Figure 13A] 10A and 10B are diagrams illustrating schematically a sensor for measuring the elastic force in the magnetic coupling between a hub and a corresponding carriage. [Figure 13B] 10A and 10B are diagrams illustrating schematically a sensor for measuring the elastic force in the magnetic coupling between a hub and a corresponding carriage. [Figure 14] FIG. 10 schematically illustrates a dual-encoder torque sensor for use with a catheter of the present disclosure. [Figure 15] 10A-10C illustrate a clot capture and visualization device that may be integrated into the hub and / or connected to a suction line. [Figure 16A] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 16B] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 16C] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 17] FIG. 1 is a side schematic view of an interventional device assembly for supra-aortic access and neurointerventional procedures. [Figure 18A] 1A-1C depict an exemplary sequence of steps for introducing a catheter assembly configured to provide supra-aortic access and neurovascular site access. [Figure 18B] 1A-1C depict an exemplary sequence of steps for introducing a catheter assembly configured to provide supra-aortic access and neurovascular site access. [Figure 18C] 1A-1C depict an exemplary sequence of steps for introducing a catheter assembly configured to provide supra-aortic access and neurovascular site access. [Figure 18D]1A-1C depict an exemplary sequence of steps for introducing a catheter assembly configured to provide supra-aortic access and neurovascular site access. [Figure 18E] 1A-1C depict an exemplary sequence of steps for introducing a catheter assembly configured to provide supra-aortic access and neurovascular site access. [Figure 19A] FIG. 1 illustrates another embodiment of a robotic control system. [Figure 19B] FIG. 1 illustrates another embodiment of a robotic control system. [Figure 19C] FIG. 1 illustrates another embodiment of a robotic control system. [Figure 19D] FIG. 1 illustrates another embodiment of a robotic control system. [Figure 19E] FIG. 1 illustrates another embodiment of a robotic control system. [Figure 19F] FIG. 1 illustrates another embodiment of a robotic control system. [Figure 19G] FIG. 1 illustrates another embodiment of a robotic control system. [Figure 19H] FIG. 1 illustrates another embodiment of a robotic control system. [Figure 19I] FIG. 1 illustrates another embodiment of a robotic control system. [Figure 19J] FIG. 1 illustrates another embodiment of a robotic control system. [Figure 20] FIG. 1 illustrates another embodiment of a robotic control system. [Figure 21] FIG. 1 illustrates a portion of another embodiment of a robotic control system. [Figure 22A] FIG. 1 illustrates a portion of another embodiment of a robotic control system. [Figure 22B] FIG. 1 illustrates a portion of another embodiment of a robotic control system. [Figure 22C] FIG. 1 illustrates a portion of another embodiment of a robotic control system. [Figure 22D]FIG. 1 illustrates a portion of another embodiment of a robotic control system. [Figure 23] 1A-1C are diagrams illustrating schematically embodiments of mechanical couplings between a driving mechanism and a driven mechanism. [Figure 24A] FIG. 2 is a front perspective view of the telescopic drive table. [Figure 24B] FIG. 2 is a front perspective view of the telescopic drive table. [Figure 24C] FIG. 24C is a front perspective view of the internal components of the telescoping drive table of FIG. 24B. [Figure 24D] FIG. 24D is a cross-sectional view of the internal components of the telescoping drive table of FIG. 24C. [Figure 24E] FIG. 24C is a side view of the internal components of the telescoping drive table of FIG. 24B. [Figure 24F] FIG. 10 is a front perspective view of the telescoping drive table in the deployed position. [Figure 24G] FIG. 10 is a front perspective view of the telescoping drive table in the deployed position. [Figure 24H] FIG. 12 is a front perspective view of a telescoping drive table with a deployable sterility barrier. [Figure 25] FIG. 1 illustrates an angled drive table in an operating room. [Figure 26] FIG. 10 is a front perspective view of the angled drive table. [Figure 27] FIG. 27 is a side view of the angled drive table of FIG. 26. [Figure 28] FIG. 27 is a front view of the angled drive table of FIG. 26. [Figure 29] FIG. 10 is a front perspective view of the angled telescoping drive table. [Figure 30] 1 is a schematic diagram of a control system. DETAILED DESCRIPTION OF THE INVENTION

[0051] In certain embodiments, a system is provided for advancing a guide catheter from femoral or radial artery access into the ostium of one of the great vessels above the aortic arch, thereby achieving supra-aortic access. The surgeon can then take over and advance an interventional device into the cerebral vasculature via the robotically placed guide catheter.

[0052] In some implementations, the system can additionally be configured to robotically obtain intracranial vascular access and to perform aspiration thrombectomy or other neurovascular procedures.

[0053] The drive table is positioned on or near the patient and is configured to axially advance, retract, and in some cases rotate and / or laterally deflect two, three, or more different (e.g., concentrically or side-by-side oriented) intravascular devices. The hubs are movable along paths along the surface of the drive table to advance or retract the interventional devices as desired. Each hub can also contain mechanisms for rotating or deflecting the device as desired and is connected to fluid delivery tubing (not shown) of the type conventionally attached to catheter hubs. Each hub can be in electrical communication with an electronic control system via either a hardwired connection, an RF wireless connection, or a combination of both.

[0054] Each hub is independently movable across a surface of a sterile field barrier membrane carried by a drive table. Each hub is releasably magnetically coupled to a unique drive carriage on the table side of the sterile field barrier. The drive system independently moves each hub proximally or distally across the surface of the barrier to move a corresponding interventional device proximally or distally within the patient's vasculature.

[0055] The carriage on the drive table, which magnetically couples with the hub to provide linear motion actuation, is universal. Catheter / guidewire functionality is provided based on what is contained in the hub and shaft design. This allows for the flexibility to configure the system to perform a wide range of procedures using a wide variety of interventional devices on the same drive table. Additionally, the interventional devices and methods disclosed herein can be easily adapted for use with any of a wide variety of other drive systems (e.g., any of a wide variety of robotic surgical drive systems).

[0056] 1 is a schematic perspective view of an interventional setup 10 having a patient support table 12 for supporting a patient 14. An imaging system 16 can be provided along with a robotic interventional device drive system 18 according to the present disclosure.

[0057] Drive system 18 can include, for example, a support table 20 for supporting a guidewire hub 26, an access catheter hub 28, and a guide catheter hub 30. In this context, the term "access" catheter can be any catheter having a lumen with at least one distally or laterally facing distal opening that can be utilized to aspirate thrombus, to provide access for additional devices to be advanced therethrough, or to inject saline, contrast media, or therapeutic agents.

[0058] Depending on the desired clinical procedure, more or fewer interventional device hubs may be provided. For example, in certain embodiments, a diagnostic angiography procedure may be performed using only a guidewire hub 26 and an access catheter hub 28 for driving a guidewire and an access catheter (in the form of a diagnostic angiography catheter), respectively. Multiple interventional devices 22 extend between the support table 20 and (in the illustrated example) a femoral access point 24 on the patient 14. Depending on the desired procedure, access may be achieved by percutaneous or cut-down access to any of various arteries or veins, such as the femoral or radial arteries. Although disclosed herein primarily in the context of neurovascular access and procedures, the robotic drive systems and associated interventional devices can be readily adapted for use in a wide variety of additional medical interventions, such as in the peripheral and coronary arterial and venous vasculature, the gastrointestinal system, the lymphatic system, cerebrospinal fluid lumens or spaces (e.g., the spinal canal, ventricles, and subarachnoid space), the pulmonary airways, treatment sites reached via transurethral or urethral or tubal navigation, or in other hollow organs or structures within the body (e.g., in intracardiac or structural cardiac applications such as valve repair or replacement, or in any endoluminal procedure).

[0059] For example, a display 23 for viewing fluoroscopic images, catheter data (e.g., fiber Bragg grating optical fiber sensor data or other force or shape sensing data), or other patient data, etc. may be carried by support table 20 and / or patient support 12. Alternatively, the physician input / output interface including display 23 may be remote from the patient, e.g., behind radiation shielding, in a different room than the patient, or in a different facility than the patient.

[0060] In the illustrated example, a guidewire hub 26 is carried by the support table 20 and is movable along the table to advance a guidewire into and out of the patient 14. An access catheter hub 28 is also carried by the support table 20 and is movable along the table to advance an 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 to laterally deflect a deflectable portion of the access catheter in response to operation of a deflection control.

[0061] FIG. 2 is a longitudinal cross-sectional view that schematically illustrates the motion relationships between a guidewire 27 having two degrees of freedom (axial and rotational), an access catheter 29 having three degrees of freedom (axial, rotational, and lateral deflection), and a guide catheter 31 having one degree of freedom (axial).

[0062] 3A, support table 20 includes a drive mechanism, described in more detail below, for independently driving guidewire hub 26, access catheter hub 28, and guide catheter hub 30. Anti-buckling features 34 can be provided in the proximal anti-buckling zone to resist buckling of the portion of the interventional device spanning the distance between support table 20 and femoral artery access point 24. Anti-buckling features 34 can include a plurality of concentric, telescoping, axially extendable and collapsible tubes through which the interventional device extends.

[0063] Alternatively, one or more proximal segments of the device shaft can be configured with enhanced stiffness to reduce buckling under compression. For example, a proximal reinforced segment can extend distally from the hub for a distance of at least about 5 or 10 centimeters, but typically no more than about 120 or 100 centimeters, to support the device between the hub and the access point 24 on the patient. Reinforcement can be achieved by using metal or polymer tubing or by embedding at least one, two, or more axially extending elements, such as elongated wires or ribbons, into the wall of the device shaft. In some implementations, the extending elements are hollow, flexible coatings attached to the hub to protect against abrasion, buckling, or damage at the inputs and outputs of the hub. For example, a hollow, flexible coating can cover a portion of the device shaft when threaded through the hub. Such a coating can be attached to a portion of the hub, such that threading a catheter device through the hub 26, 28, or 30 also threads the catheter device through the coating. In some implementations, an anti-buckling device can be placed on or around or surrounding the device shaft to avoid misalignment or insertion angle errors between the hubs or between the hub and the insertion point. The anti-buckling device can be a laser-cut hypotube, a spring, an expandable tube, or tensioned split tubing, etc.

[0064] In some implementations, multiple deflection sensors can be placed along the catheter length to identify buckling. Identifying buckling can be performed by detecting distal advancement of the hub while the distal tip of the catheter or interventional device is not being moved. In some implementations, buckling can be detected by detecting an energy load (e.g., due to friction) between the catheter shaft.

[0065] Alternatively, a thin tubular stiffening structure can be embedded within or carried on the exterior of the device wall, such as a tubular polymer extrusion or length of hypotube. Alternatively, a removable stiffening mandrel can be placed within the lumen in the proximal segment of the device and removed proximally following distal advancement of the hub toward the patient access site to prevent buckling of the proximal shaft during distal advancement of the hub. Alternatively, one or more proximal segments of the device shaft can be constructed as a tubular hypotube, which can be machined (e.g., by laser) so that its mechanical properties vary along its length. This proximal segment can be formed from stainless steel, nitinol, and / or cobalt-chromium alloy, optionally in combination with a polymer component that can provide lubricity and hydraulic sealing. In some embodiments, the proximal segment can be formed from a polymer such as polyetheretherketone (PEEK), polyetherketoneketone (PEKK), polyethyleneimine (PEI), or polyimide (PI), etc. Alternatively, the wall thickness or diameter of the interventional device can be increased in the anti-buckling zone.

[0066] In certain embodiments, a device shaft with high stiffness (e.g., axially and torsionally) can provide improved motion 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 motion applied at the proximal end. Such embodiments can be advantageous for robotic actuation in the absence of tactile feedback to the user.

[0067] In some embodiments, a flexible coating 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 it.

[0068] 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 reside on the non-sterile side (below) of the sterile barrier 32. The guidewire hub 26, access catheter hub 28, guide catheter hub 30, and associated interventional devices are all on the sterile side (above) of the sterile barrier 32. The sterile barrier is preferably waterproof and can also serve as a tray used in packaging the interventional devices (discussed further below). The interventional devices can be provided individually or as a coaxially pre-assembled kit, which is shipped and stored in a tray and enclosed in sterile packaging.

[0069] 3B-3F schematically illustrate an alternative sterile barrier in the form of a dual-function sterile barrier for placement on a support table during an interventional procedure and a shipping tray with one or more storage channels for carrying sterile interventional devices. The sterile barrier can also act as a sterile work surface for preparing catheters or other devices during the procedure.

[0070] 3B and 3C, a sterility barrier 32 is shown in the form of a pre-shaped tray to fit over the elongated support table 20. In use, the elongated support table 20 is positioned below the sterility barrier 32. The sterility barrier 32 extends between a proximal end 100 and a distal end 102 and includes an upper support surface 104 for supporting an interventional device hub. In one implementation, the support surface 104 has an axial length greater than the length of the intended interventional device in a linear drive configuration.

[0071] The length of the support surface 104 will typically be at least about 100 centimeters and will be in the range of about 100 centimeters to about 2.7 meters. Shorter lengths can be utilized in systems configured to advance the drive coupler 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 between 100 centimeters and about 2.7 meters. The width of the linear drive table is preferably no more than about 30 centimeters to about 80 centimeters.

[0072] At least a first channel 106 may be provided, extending axially for at least a portion of the length of the support table 20. In the illustrated implementation, the first channel 106 extends the entire length of the support table 20. Preferably, the first channel 106 has a length sufficient to hold an interventional device and a width and depth sufficient to hold a corresponding hub (e.g., by providing lateral support to prevent dislodgement of the hub when force is applied to the hub). The first channel 106 is defined in the floor 108, the outer sidewall 110, and the inner sidewall 111 and forms an upwardly facing concave surface. Optionally, a second channel 112 may be provided. The second channel 112 may be located on the same or opposite side of the upper support surface 104 from the first channel 106. Two, three or more additional recesses, such as additional channels or wells, can be provided to hold additional medical devices or supplies that may be useful during the interventional procedure, as well as to collect fluids and act as washing reservoirs for the catheter and related devices.

[0073] 3D, guide catheter hub 30 is shown positioned on upper support surface 104 and magnetically coupled to a corresponding coupler holding a drive magnet positioned below sterile barrier 32. Access catheter hub 28 and access catheter 29, as well as guidewire hub 26 and guidewire 27, are shown to reside within first channel 106, e.g., prior to introduction through guide catheter 31 or following removal from guide catheter 31.

[0074] An interventional device can be positioned in the channel 106 and enclosed within a sterile barrier for shipping. At the clinical site, the upper panel of the sterile barrier can be removed, or the tubular sterile barrier packaging can be opened and axially removed from the support table 20 and sterile barrier 32 assembly, exposing the sterile top side of the sterile barrier tray and any contained interventional device. The interventional device can be carried separately in the channel or pre-assembled into an access or treatment assembly, which are discussed in additional detail below.

[0075] Figures 3D-3F illustrate the support table with the sterile barrier in place, and Figure 3E illustrates the interventional device configured into the access assembly for aortic access following coupling of the access assembly to a corresponding carriage below the sterile barrier. The access assembly can be pre-assembled with the guidewire fully advanced through the access catheter and the access catheter fully advanced through the guide catheter. In embodiments where the access catheter or other catheters are pre-shaped (i.e., not pre-curved or straight), the guidewire and / or outer catheter can be positioned so that the relatively stiff sections do not overlap the curved, stiffer sections of the pre-shaped catheter, e.g., to avoid creep or straightening of the pre-shaped catheter and / or to avoid introducing a curve into an otherwise straight catheter. The access assembly can be lifted from the channel 106 and positioned on the support surface 104 for coupling to the respective drive magnets and introduction into the patient. The guide catheter hub 30 is the distal-most hub. The access catheter hub 28 is positioned proximally to the guide catheter hub to allow the access catheter 29 to extend distally through the guide catheter. The guidewire hub 26 is positioned proximally most to allow the guidewire 27 to be advanced through the access catheter 29 and the guide catheter 31.

[0076] The treatment assembly is shown in FIG. 3F following its introduction through the guide catheter 31 used to achieve supra-aortic access. In this implementation, the guide catheter 31 remains the most distal of the interventional devices. A first treatment catheter 120 and corresponding hub 122 are shown extending through the guide catheter 31. An optional second treatment catheter 124 and corresponding hub 126 are shown extending through the first treatment catheter 120. A guidewire 27 extends through at least a portion of the second treatment catheter 124 in a rapid exchange version of the second treatment catheter 124, or through the entire length of the second treatment catheter 124 in an over-the-wire implementation.

[0077] As discussed in more detail in connection with FIG. 17 , a multi-catheter stack can be utilized to achieve both access and endovascular procedures without the need for catheter exchange. This can be accomplished with either manually or robotically driven procedures. In one example, the guide catheter 31 can include a catheter having an inner diameter of at least about 0.08 inches, and in one implementation, an inner diameter of about 0.088 inches. The first treatment catheter 120 can include a catheter having an inner diameter in the range of about 0.065 inches to about 0.075 inches, and in one implementation, the catheter 120 has an inner diameter of about 0.071 inches. The second treatment catheter 124 can be an access catheter with an OD sized to allow advancement through the first treatment catheter 120. The second treatment catheter can be steerable and include a deflection control 2908 configured to laterally deflect the distal end of the catheter. The second treatment (access) catheter can also have an inner lumen that is sized to allow an appropriately sized guidewire to remain inside the second treatment catheter while contrast injection is performed through the second treatment catheter.

[0078] In certain embodiments, catheter 31 can be a "large bore" access or guide catheter having an inner diameter of at least about 0.075 or at least about 0.080 inches in diameter. Catheter 120 can be an aspiration catheter having an inner diameter in the range of about 0.060 inches to about 0.075 inches. Catheter 124 can be a steerable catheter with a deflectable distal tip having an inner diameter in the range of about 0.025 inches to about 0.050 inches. Guidewire 27 can have an outer diameter in the range of about 0.014 inches to about 0.020 inches. In one example, catheter 31 can have an outer diameter of about 0.088 inches, catheter 120 can have an outer diameter of about 0.071 inches, catheter 124 can have an outer diameter of about 0.035 inches, and guidewire 27 can have a diameter of about 0.018 inches.

[0079] In one commercial implementation, a pre-assembled access assembly (guide catheter, access catheter, and guidewire) can be carried in a first channel on the sterile barrier tray, and a pre-assembled treatment assembly (one or two treatment catheters and guidewire) can be carried in the same or a different second channel on the sterile barrier tray. One, two, or more additional catheters or interventional tools can also be provided, depending on potential needs during the interventional procedure.

[0080] 3G-3K illustrate an alternative sterility barrier embodiment having a convex drive surface (e.g., a convex crowned road drive surface). FIG. 3G is a cross-sectional view of sterility barrier 232. Sterility barrier 232 includes a convex upper support surface 204. Fluid channels 205 and 207 are positioned laterally and below support surface 204 for self-clearing or draining fluid from support surface 204 (e.g., during an interventional procedure). Fluid channels 205 and 207 can extend axially for at least a portion of the length of the sterility barrier.

[0081] 3I, 3J, and 3K illustrate a cross-sectional perspective view, a cross-sectional view, and a top cross-sectional view, respectively, of the proximal end of sterility barrier 232. As shown in FIGS. 3I-3K, sterility barrier 232 can include a trough 240 in communication with fluid channels 205 and 207. Trough 240 can receive fluid from channels 205 and 207 (e.g., during an interventional procedure). Trough 240 can be positioned at least partially below fluid channels 205 and 207 such that fluid in channels 205 and 207 flows into trough 240. In certain embodiments, fluid channels 205 and 207 can be angled relative to a horizontal plane (e.g., can descend from the end of the channel farthest from trough 240 into trough 240) such that fluid in channels 205 and 207 is directed toward trough 240. For example, channels 205 and 207 can increase in depth from the ends of the channels farthest from trough 240 to trough 240. Alternatively, sterility barrier 232 and / or support table can be positioned at an angle relative to a horizontal plane during part or all of the interventional procedure, such that the ends of channels 205 and 207 farthest from trough 240 are positioned higher than trough 240. For example, sterility barrier 232 and / or support table can be constructed or positioned in an angled arrangement such that the ends of sterility barrier 232 and / or support table opposite trough 240 are positioned higher than trough 240. Alternatively or additionally, the drive mechanism may be capable of temporarily tilting the sterile barrier 232 and / or support table (e.g., by lifting the end of the sterile barrier and / or support table opposite the trough 240 or by lowering the end of the sterile barrier 232 and / or support table on which the trough 240 is positioned) so that the end of the sterile barrier 232 and / or support table opposite the trough 240 is positioned higher than the trough 240, allowing the fluid in the channels 205 and 207 to flow into the trough 240.

[0082] The trough 240 can include a drain hole 242. The trough 240 can be shaped, sized, and / or otherwise configured to allow fluid in the trough 240 to empty into the drain hole 242. The drain hole 242 can include tubing, a barb fitting, and / or an on-off valve for removal of fluid from the trough 240. As shown in FIGS. 3I-3K, the trough 240 can be positioned at the proximal end of the sterility barrier 232. In an alternative embodiment, the trough 240 can be positioned at the distal end of the sterility barrier 232. In some embodiments, the sterility barrier 232 can include a first trough 240 at the proximal end and a second trough 240 at the distal end. In some embodiments, the trough 240 can also be used as a washing reservoir.

[0083] The first channel 206 can extend axially for at least a portion of the length of the sterility barrier 232. The channel 206 can have a length sufficient to hold an interventional device and a width and depth sufficient to hold a corresponding hub (e.g., by providing support to prevent the hub from dislodging when force is applied to the hub). Optionally, a second channel 212 can be provided. The second channel 212 can be positioned on the same or opposite side of the upper support surface 204 from the first channel 206. FIG. 3G illustrates the channel 212 positioned on the opposite side of the support surface 204 from the channel 206. FIG. 3H is a cross-sectional view illustrating an alternative embodiment of the sterility barrier 232 in which the channel 212 is on the same side of the support surface 204 as the channel 206.

[0084] 3G and 3H, channels 206 and 212 can have a generally triangular, wedge-shaped, or otherwise angled cross-section to hold the hub at an angle relative to the horizontal plane. Holding the hub at an angle relative to the horizontal plane can allow for a smaller width of sterility barrier 232.

[0085] Two, three, or more additional recesses, such as additional channels or wells, can be provided to hold additional medical devices or supplies that may be useful during the interventional procedure, as well as to collect fluids and act as washing reservoirs for the catheter and related devices. In some embodiments, any of the channels or wells described herein may not be part of the sterile barrier, but instead may be part of a drive table that is positioned below the sterile barrier.

[0086] In some embodiments, the sterility barrier 232 can include one or more structural ribs 236. The sterility barrier 232 can further include one or more frame support bosses 228 and 238.

[0087] In the embodiment of the sterility barrier 232 shown in FIG. 3G, the width x1 can be 14 inches wide, approximately 14 inches wide, between 12 inches and 16 inches wide, between 10 inches and 18 inches wide, or any other suitable width. In the embodiment of the sterility barrier 232 shown in FIG. 3H, the width x1 can be 15 inches wide, approximately 15 inches wide, between 13 inches and 17 inches wide, between 11 inches and 19 inches wide, or any other suitable width. The height y1 of the support surface 204 can be 0.125 inches high, approximately 0.125 inches high, between 0.1 inches and 0.15 inches high, or any other suitable height. In some embodiments, the support surface 204 can be recessed from the top surface 233 of the sterility barrier 232. The height y2 between the bottom and top surface 233 of support surface 204 can be 0.5 inches high, approximately 0.5 inches high, between 0.25 inches and 0.75 inches high, or any other suitable height. The width x2 from the lateral edge of channel 205 to the lateral edge of channel 207 can be 5 inches wide, approximately 5 inches wide, between 4 inches and 6 inches wide, or any other suitable width. The width x3 of support surface 204 can be 4 inches wide, approximately 4 inches wide, between 3 inches and 5 inches wide, or any other suitable width. The height y3 of channel 206 and / or channel 212 can be 1.5 inches high, approximately 1.5 inches high, between 1 inch and 2 inches high, or any other suitable height. The width x4 of channel 206 and / or channel 212 can be 3 inches wide, approximately 3 inches wide, between 2 inches and 4 inches wide, or any other suitable width. Channel 206 and / or channel 212 can be defined by an arc angle α of 90°, an arc angle α of approximately 90°, an arc angle α of between 80° and 100°, or any other suitable angle, and by a radius of curvature of 0.125 inches, a radius of curvature of approximately 0.125 inches, a radius of curvature between 0.1 inches and 0.15 inches, or any other suitable radius of curvature.In certain embodiments, an arc angle α of 90° or approximately 90° can be used to hold a hub having a rectangular or generally rectangular cross-section. Support surface 204 can be defined by a radius of curvature of 13 inches, approximately 13 inches, between 11 and 15 inches, or any other suitable radius of curvature. Channel 205 and / or channel 207 can be defined by a radius of curvature of 0.25 inches, approximately 0.25 inches, between 0.15 and 0.35 inches, or any other suitable radius of curvature.

[0088] 3L and 3M depict exemplary dimensions of a hub 250 that may be used with the sterility barrier 232 shown in FIGS. 3G-3K. The hub 250 can be any of the hubs described herein. In certain embodiments, the hub 250 can have a width w1 of 3.75 inches, a width w1 of approximately 3.75 inches, a width w1 of between 3.25 inches and 4.25 inches, or any other suitable width. The hub 250 can have a height h1 of 1.5 inches, a height h1 of approximately 1.5 inches, a height h1 of between 1.25 inches and 1.75 inches, or any other suitable height. Alternatively, the hub 250 can have a height h2 of 2 inches, a height h2 of approximately 2 inches, a height h2 of between 1.75 inches and 2.25 inches, or any other suitable height. In some embodiments, the hub 250 can have a length L1 of 2.5 inches, a length L1 of approximately 2.5 inches, a length L1 of between 2 and 3 inches, or any other suitable length. Alternatively, the hub 250 can have a length L2 of 4 inches, a length L2 of approximately 4 inches, a length L2 of between 3.25 and 4.75 inches, or any other suitable length.

[0089] In some embodiments, the upper surface of the support table can include surface features that generally correspond to those of the sterility barrier 232. For example, the support table can include a convex surface configured to correspond to the shape, size, and location of the support surface 204 and / or one or more recesses configured to correspond to the shape, size, and location of the channels 205 and 207.

[0090] In alternative embodiments, the planar support surface (e.g., support surface 104 of sterility barrier 32) can be positioned at an angle relative to the horizontal plane to facilitate drainage of fluids. In some embodiments, the sterility barrier and / or support table can be positioned at an angle relative to the horizontal plane to facilitate drainage of fluids during part or all of an interventional procedure. For example, the sterility barrier and / or support table can be constructed or positioned in an angled arrangement to facilitate drainage of fluids (e.g., one lateral side of the planar support surface is positioned higher than the other 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). Alternatively or additionally, the drive mechanism may temporarily tilt the sterile barrier and / or support table (e.g., so that one lateral side of the planar support surface is positioned higher than the other lateral side of the planar support surface, so that the proximal end is higher than the distal end, or so that the distal end is higher than the proximal end) to facilitate fluid drainage. For example, the drive mechanism may 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.

[0091] In certain embodiments, the support surface (e.g., support surface 104 of sterile barrier 32) can be positioned in a vertical configuration rather than the horizontal configuration shown in, for example, FIGS. 3A-3F. For example, support surface 104 can be positioned approximately 90 degrees (or any other suitable angle) from the horizontal plane (e.g., rotated 90 degrees about the long axis of support surface 104 relative to the embodiment shown in FIGS. 3A-3F). The vertical configuration can provide easier interaction with drive system 18 by the physician. The vertical configuration can also provide a lower axis of catheter travel closer to the patient without adding standoff height to drive system 18.

[0092] In some embodiments, drive system 18 can be positioned at an angle relative to a horizontal plane to facilitate fluid drainage during part or all of an interventional procedure. For example, drive system 18 can be constructed or positioned in an angled arrangement (e.g., one lateral side of the planar support surface is positioned higher than the other 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) to facilitate fluid drainage. Alternatively or additionally, the drive mechanism can temporarily tilt drive system 18 to facilitate fluid drainage (e.g., one lateral side of drive system 18 is positioned higher than the other lateral side of drive system 18, the proximal end is higher than the distal end, or the distal end is higher than the proximal end). 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 so that it extends at an angle away from the access point 24 (e.g., so that the proximal end is higher than the distal end), for example, to allow clearance for the patient's feet.

[0093] Referring to FIG. 4 , the hub 36 can represent any of the hubs previously described. 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 of the interventional devices disclosed herein) extends distally from the hub 36 into the patient 14 (not shown). The hub adapter 48, or carriage, acts as a shuttle by advancing proximally or distally along a track in response to operator commands or controller manipulation. The hub adapter 48 includes at least one drive magnet 67 configured to couple with a driven magnet 69 carried by the hub 36. This provides a magnetic coupling between the drive magnet 67 and the driven magnet 69 through the sterile barrier such that the hub 36 is moved across the 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 is described in additional detail below.

[0094] To reduce friction within the system, the hub 36 can be provided with at least a first roller 53 and a second roller 55, which can be in the form of a wheel, a rotatable ball, or a drum. The rollers space the sterility barrier from the surface of the driven magnet 69 by at least about 0.008 inches, and typically about 0.03 inches or less. In some implementations, the space is within a range of about 0.010 inches to about 0.016 inches. The space between the drive magnet 67 and the driven magnet 69 is typically about 0.15 inches or less, and in some implementations, about 0.10 inches or less, such as within a range of about 0.085 inches to about 0.090 inches. The hub adapter 48 may likewise be provided with at least a first hub adapter roller 59 and a second hub adapter roller 63, which may be positioned opposite the respective first roller 53 and second roller 55, as shown in FIG. 4.

[0095] 6, one example of a low-profile linear drive support table 20 is illustrated 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 table support 56 is provided for stabilizing the support table 20 relative to a patient (not shown). The support 56 may include one or more legs, or preferably, articulating arms, that are configured to allow movement and positioning of the frame 51 on or adjacent to the patient.

[0096] One example of the linear drive table 20 shown in FIG. 7 includes three individual 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 carriage bracket 61 is fixed to the first drive belt 60 such that rotation of the first drive pulley 58 causes rotation of the first drive belt 60 through an elongated closed-loop path. The first carriage bracket 61 can be advanced proximally or distally along the longitudinal axis of the support table 20 depending on the direction of rotation of the drive pulley 58. In the illustrated implementation, the drive pulley 58 is provided with surface structure, such as a plurality of drive pulley teeth 62, for engaging complementary teeth on the first drive belt 60.

[0097] The second drive pulley 64 can be engaged with a second drive belt 66, which is configured to axially move a second carriage bracket 68 along an axial path over the support table 20. The third drive pulley 70 can be configured to drive a third drive belt 72 to axially advance a third carriage bracket 73 along the support table 20. Each of the carriage brackets can be provided with a drive magnet assembly, not shown in FIG. 7 but previously discussed, to form a coupler for magnetically coupling to a corresponding driven magnet in the hub of an interventional device as discussed.

[0098] A detailed view of the drive system is shown schematically in FIG. 8 . A drive support 74 can be carried by the frame 51 for supporting the drive assembly. The second drive pulley 64 is shown in elevational section as being rotationally driven by a motor 75 via a rotatable shaft 76. The rotatable shaft 76 can be rotatably carried by the support 74 via a first bearing 78, a shaft coupling 80, and a second bearing 79. The motor 75 can be stabilized by a motor bracket 82 connected to the drive support 74 and / or the frame 51. The belt drive assemblies for the first drive belt 60 and the third drive belt 72 can be similarly constructed and will not be further detailed herein. In some embodiments, the drive system described herein can be a foldable rack-and-pinion drive table system. In such embodiments, the motor 75 can be attached to the carriage and move with the carriage.

[0099] 9 and 10, each of the first, second, and third drive belts extends around a corresponding first idler pulley 84, a second idler pulley 86, and a third idler pulley 88. Each idler pulley may be provided with a corresponding tensioning bracket 90 configured to adjust the idler pulley proximally or distally to adjust the tension of the respective belt. Accordingly, each tensioning bracket 90 is provided with a tensioning adjustment portion 92, such as a rotatable screw or the like.

[0100] As seen in FIG. 10, the second idler pulley 86 may be carried, for example, by a rotatable shaft 94 that is rotatably fixed relative to the mounting bracket by a first bearing 96 and a second bearing 98.

[0101] For example, any of the catheters illustrated in Figures 5A, 5B, or 11 generally include an elongated tubular body extending between a proximal end and a distal working end. The length and diameter of the tubular body depend on the desired application. For example, lengths in the area of ​​about 90 centimeters to about 195 centimeters or more are typical for use in percutaneous transluminal coronary applications with femoral access. Intracranial or other applications may require different catheter shaft lengths depending on the vascular access site.

[0102] Any of the catheters disclosed herein can be provided with a beveled distal tip. Referring to Figure 11, a distal catheter tip 1150 includes a tubular body 1152, which includes an advancement segment 1154, a marker band 1156, and a proximal segment 1158. An inner tubular liner 1160 can extend throughout the length of the distal catheter tip 1150 and can include dip-coated or extruded PTFE or other lubricious material.

[0103] A reinforcing element 1162, such as a braid and / or spring coils, is embedded within an outer jacket 1164, which may extend the entire length of the catheter.

[0104] The advancing segment 1154 terminates distally in an angled surface 1166 and provides a leading sidewall portion 1168 having a length measured between the distal end 130 of the marker band 1156 and a distal tip 1172. In some embodiments, the entire distal tip can be shaped to avoid snagging of the tip in the area of ​​an arterial bifurcation. The trailing sidewall portion 1174 of the advancing segment 1154 has an axial length that, in the illustrated embodiment, is approximately equal to the axial length of the leading sidewall portion 1168 as measured approximately 180 degrees around the catheter from the leading sidewall portion 1168. The leading sidewall portion 1168 can have an axial length in the range of about 0.1 millimeter to about 5 millimeters, and typically in the range of about 1 millimeter to 3 millimeters. The trailing sidewall portion 1174 can be equal to or at least about 0.1 millimeter, 0.5 millimeter, 1 millimeter, 2 millimeters, or more shorter than the axial length of the leading sidewall portion 1168, depending on the desired performance.

[0105] The angled surface 1166 is inclined at an angle A ranging from about 45 degrees to about 80 degrees from the longitudinal axis of the catheter. For certain implementations, the angle is ranging from about 55 degrees to about 65 degrees from the longitudinal axis of the catheter. In one implementation, angle A is about 60 degrees. One result of an angle A less than 90 degrees is that the major axis of the distal port area is lengthened, which can increase the surface area of ​​the port and enhance clot aspiration or retention. Compared to the surface area of ​​a circular port (where angle A is 90 degrees), the area of ​​the angled port is generally at least about 105 percent and not more than about 130 percent, and in some implementations, is in the range of about 110 percent to about 125 percent, and in one example, is about 115 percent of the area of ​​the corresponding circular port (where angle A is 90 degrees).

[0106] In the illustrated embodiment, the axial length of the advancement segment is substantially constant around the circumference of the catheter, such that the angled surface 1166 is approximately parallel to the distal surface 1176 of the marker band 1156. The marker band 1156 has a proximal surface that is approximately transverse to the longitudinal axis of the catheter, creating a right-angled trapezoidal configuration for the marker band 1156 in side view. The short sidewall portion 1178 is rotationally aligned with the trailing sidewall portion 1174 and has an axial length in the range of about 0.2 millimeters to about 4 millimeters, with an axial length of about 0.5 millimeters to about 2 millimeters being typical. The opposing long sidewall portion 1180 is rotationally aligned with the leading sidewall portion 1168. The long sidewall 1180 of the marker band 1156 is generally at least about 10 or 20 percent longer than the short sidewall 1178, and depending on the desired performance, can be at least about 50, 70, or 90 percent or more longer than the short sidewall 1178. Generally, the long sidewall 1180 will have a length of at least about 0.5 millimeters or 1 millimeter and less than about 5 millimeters or less than 4 millimeters.

[0107] 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 length. The slits can be located on or between the short sidewall 1178 or the long sidewall 1180 depending on the desired bending characteristics. The marker band can comprise any of a variety of radiopaque materials, such as a platinum / iridium alloy, and the wall thickness is preferably about 0.003 inches or less, and in one implementation, about 0.001 inches.

[0108] The fluoroscopic appearance of the marker bands can be unique or individual for each catheter size or type when multiple catheters are utilized, such that the marker bands can be distinguishable from one another by a software algorithm. Distinguishing the marker bands of multiple catheters can be advantageous when multiple catheters are used together, for example, in a multi-catheter assembly or stack as described herein. In some embodiments, the marker bands of the catheters can be configured to allow a software algorithm to detect catheter tip movement.

[0109] The marker band zone of the assembled catheter can have a relatively high bending stiffness and high crush strength (e.g., at least about 50 percent or at least about 100 percent less than the proximal segment 1158, but not more than about 200 percent less than the proximal segment 1158). The high crush strength can provide radial support to the adjacent advancement segment 1154, particularly the leading sidewall portion 1168, and promote the distal tip 1172 to function as an atraumatic bumper during transluminal advancement and resist collapse under vacuum. The proximal segment 1158 preferably has a lower bending stiffness than the marker band zone, and the advancement segment 1154 preferably has an even lower bending stiffness and crush strength than the proximal segment 1158.

[0110] The advancement segment 1154 can include a distal extension of an outer tubular jacket 1164 and optionally an inner liner 1160 without any other internal support structure distal to the marker band 1156. The outer jacket 1164 can include an extruded polyurethane such as Tecothane®. The advancement segment 1154 can have a bending stiffness and radial crush stiffness that are about 50 percent or less, and in some implementations about 25 percent or less, 15 percent or less, or 5 percent or less, than the corresponding values ​​of the proximal segment 1158.

[0111] The catheter can further include an axial tension element or support, such as a ribbon or one or more filaments or fibers, to increase tension resistance and / or affect bending characteristics in the distal zone. The tension support can include one or more axially extending monostrand or multistrand filaments. One or more tension elements 1182 can be axially positioned inside the catheter wall near the distal end of the catheter. The one or more tension elements 1182 can function as tension supports and resist tip dislodgement or stretching of the catheter wall under tension (e.g., when the catheter is retracted proximally through a kinked outer catheter or tortuous or narrowed vasculature).

[0112] At least one of the one or more tension elements 1182 can extend proximally along the length of the catheter wall from within about 1.0 centimeter of the distal end of the catheter, to less than about 10 centimeters from the distal end of the catheter, to less than about 20 centimeters from the distal end of the catheter, to less than about 30 centimeters from the distal end of the catheter, to less than about 40 centimeters from the distal end of the catheter, or to less than about 50 centimeters from the distal end of the catheter.

[0113] 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.

[0114] At least one of the one or more tension elements 1182 can extend over at least about the most distal 50 centimeters of the length of the catheter, at least about the most distal 40 centimeters of the length of the catheter, at least about the most distal 30 centimeters, or 20 centimeters, or 10 centimeters of the length of the catheter.

[0115] In some implementations, the tension element extends proximally from the distal end of the catheter along the length of the coil 24, terminating proximally within about 5 centimeters or 2 centimeters or less on either side of the transition between the distal coil and the proximal braid. The tension element can terminate at the transition without overlapping the braid.

[0116] One or more tension elements 1182 can be located near or radially outside the inner liner 1160. One or more tension elements 1182 can be located 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 surface of the inner liner or other underlying layer by adhesive before the addition of the next outer adjacent layer, such as a coil. Preferably, the tension elements 1182 are secured to the marker band 1156 by adhesive or mechanical interference. In one implementation, the tension elements 1182 extend distally over and 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, extend along a second (e.g., outer) surface in either or both a proximal angled direction or a circumferential direction, and completely wrap around the marker band.

[0117] When two or more tension elements 1182 or filament bundles are circumferentially spaced apart within the catheter wall, the tension elements 1182 can be positioned in a radially symmetric manner. For example, the angle between two tension elements 1182 relative to the radial center of the catheter can be approximately 180 degrees. Alternatively, depending on the desired clinical performance (e.g., flexibility, trackability), the tension elements 1182 can be positioned in a radially asymmetric manner. The angle between any two tension elements 1182 relative to the radial center of the catheter can be less than or equal to approximately 180 degrees, less than or equal to approximately 165 degrees, less than or equal to approximately 135 degrees, less than or equal to approximately 120 degrees, less than or equal to approximately 90 degrees, less than or equal to approximately 45 degrees, or less than or equal to approximately 15 degrees.

[0118] The one or more tension elements 1182 can comprise materials such as 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 round or rectangular (e.g., ribbon) cross-section. The terms fiber or filament do not convey composition; they can comprise any of a variety of high tensile strength polymers, metals, or alloys, depending on design considerations such as the desired tensile fracture limit and wall thickness. The cross-sectional dimension of the one or more tension elements 1182, as measured radially, can be approximately 2 percent or less, 5 percent or less, 8 percent or less, 15 percent or less, or 20 percent or less of that of the catheter 10.

[0119] The cross-sectional dimension of one or more tension elements 1182, as measured radially, can be about 0.03 millimeters (about 0.001 inches) or less, about 0.0508 millimeters (about 0.002 inches) or less, about 0.1 millimeters (about 0.004 inches) or less, about 0.15 millimeters (about 0.006 inches) or less, about 0.2 millimeters (about 0.008 inches) or less, or about 0.38 millimeters (about 0.015 inches) or less.

[0120] The one or more tensioning elements 1182 can increase the tensile strength of the distal zone of the catheter before failure under tension (e.g., marker band detachment) to at least about 1 lb, at least about 2 lb, at least about 3 lb, at least about 4 lb, at least about 5 lb, at least about 6 lb, at least about 7 lb, at least about 8 lb, or at least about 10 lb or more.

[0121] Depending on the desired data, any of a variety of sensors can be provided on either the catheter, hub, carriage, or table. For example, in some implementations, it may be desirable to measure axial tension or compression applied to the catheter, such as along a force-sensing zone. The distal end of the catheter would be made of a similar construction as shown in FIG. 11 with a helical coil distal section. However, instead of using a single helical coil of nitinol wire, first conductor 140 and second conductor 142 are wound into intertwined helical coils and are electrically isolated 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 trace or a proximal extension of the wire.

[0122] This construction of dual, electrically isolated helical coils creates a capacitor, roughly equivalent to two plates of Nitinol with a plastic layer between them, as shown in FIG. 12B. Capacitance is inversely proportional to the distance between the wires. The only variable that will vary is d (the distance between the plates). When an axial compressive force is applied to the catheter, the wires (e.g., conductors 140 and 142) will move closer together, thus increasing the capacitance. When 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, providing a measure of the force on the helical capacitor. Although called a capacitor, the sensor is measuring the electrical interaction between the two coils of wire. There can be a measurable change in inductance or other resulting change due to the applied axial force.

[0123] At least a first helical capacitor can have at least one, five, ten, or more complete turns of the respective wire. The capacitor can be positioned within the distal-most 5, 10, or 20 centimeters of the catheter body to sense forces experienced at the distal end. At least a second capacitor can be provided within the proximal-most 5, 10, or 20 centimeters of the catheter body to sense forces experienced at the proximal end of the catheter.

[0124] It may also be desirable to measure the elastic force across the magnetic linkage between the hub and the corresponding carriage, using the natural springiness (compliance) of the magnetic linkage to measure the force applied to the hub. The magnetic linkage between the hub and carriage creates a spring. When a force is applied to the hub, the hub will move a small amount relative to the carriage. See FIG. 13A. In robotics, this is called a series elastic actuator. This property can be used to measure the force applied to the hub from the carriage. To measure the force, the relative distance between the hub and carriage (dx shown in FIG. 13A) is determined to characterize some effective spring constant k between the two components. See FIG. 13B.

[0125] Relative distance can be measured in several different ways. One method for measuring the relative distance between the hub and carriage is with a magnetic sensor (e.g., a Hall effect sensor between the hub and carriage). A magnet is mounted on either the hub or the carriage, and a corresponding magnetic sensor is mounted on the other device (carriage or hub). The magnetic sensor can be a Hall effect sensor, a magnetoresistive sensor, or another type of magnetic field sensor. Generally, multiple sensors can be used to increase the reliability of the measurement. This reduces noise and reduces interference from external magnetic fields.

[0126] Other non-contact distance sensors can also be used. These include optical, inductive, and capacitive sensors. Optical sensors would preferably be configured in a manner that avoids the accumulation of blood or other fluids at the interface between the hub and the carriage. In some implementations, for example, wireless (i.e., inductive) power can be used to transduce movement and / or transfer information across the sterile barrier between the drive carriage and the hub.

[0127] The magnetic coupling between the hub and carriage has a shear or axial break threshold, which can be approximately 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 that, if applied to the catheter, is perceived to create a risk to the patient. If the trigger force is reached, the processor can be configured to generate a response, such as visual, auditory, or tactile feedback to the physician, and / or to slow and stop further advancement of the catheter until a reset is achieved. An override feature can be provided so that the physician can choose to continue advancing the catheter at a force higher than the trigger force in situations where the physician believes incremental force is justified.

[0128] Force and / or torque sensing optical fibers (e.g., fiber Bragg grating (FBG) sensors) can be incorporated into the catheter sidewall or, alternatively, integrated into the guidewire to measure force and / or torque at various locations along the catheter shaft. The fiber measures axial strain, which (when helically wound) can be converted to axial force or torque. At least a first FBG sensor can be integrated into a distal, proximal, and / or intermediate sensing zone on the catheter or guidewire to measure force and / or torque in the vicinity of the sensor.

[0129] It may also be desirable to understand the three-dimensional configuration of a catheter or guidewire during and / or following transvascular placement. Shape-sensing optical fibers, such as arrays of FBG fibers, are used to sense the shape of catheters and guidewires. By using multiple force-sensing fibers at known distances from each other, the shape along the length of the catheter / guidewire can be determined.

[0130] Resistive strain gauges can be integrated into the body of the catheter or guidewire to measure force or torque, such as at the distal tip and / or proximal end of the device.

[0131] Measurements of the 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. A warning can be provided to the user when the applied force and / or torque exceeds the safety threshold. Measurements of the applied force and / or torque can also be used to provide feedback related to better catheter manipulation and control. Measurements of the applied force and / or torque can also be used in conjunction with processed fluoroscopic imaging information to determine or characterize distal tip motion.

[0132] The absolute position of the hub (and corresponding catheter) along the length of the table can be determined in a variety of ways. For example, a non-contact magnetic sensor can be configured to measure the position of the hub directly through the sterile barrier. The same type of sensor can also be configured to measure the position of the carriage. Each hub can have at least one magnet attached to it. The robotic table will have a corresponding linear array of magnetic sensors spanning the length of the table. A processor can be configured to determine the location of the magnet along the length of the linear sensor array and display the axial position information to the physician.

[0133] Alternatively, the foregoing can be accomplished using non-contact inductive sensors to directly measure the position of the hub through the sterile barrier. Each hub or carriage can be provided with an inductive "target" therein. The robot table can be provided with an inductive sensing array throughout the working length of the table. As a further alternative, an absolute linear encoder can be used to directly measure the linear position of the hub or carriage. The encoder can use any of a variety of different technologies, including optical, magnetic, inductive, and capacitive methods.

[0134] In one implementation, 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 table (e.g., at least about 1.5 meters to about 1.9 meters) configured to ping an interrogator signal that stimulates a return signal from the passive coil. The PCB is configured to identify the return signal and its location.

[0135] The axial position of the carriage can be determined using a multi-turn rotary encoder to measure the rotational position of the pulley, which directly correlates to the linear position of the carriage. Direct measurement of the carriage location can alternatively be achieved by recording the number of steps commanded to a stepper motor to measure the rotational position of the pulley, which directly correlates to the linear position of the carriage.

[0136] The location of the catheter and guidewire within the anatomy can also be determined by processing fluoroscopic images with machine vision to, for example, 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 motion, which can indicate device shaft buckling, prolapse, kinking, or similar consequences (e.g., along the device shaft length inside the body (e.g., in the aorta) or outside the body between the hubs). Processing can be done in real time to provide position / orientation data at up to 30 Hz, although this technique will only provide data while fluoroscopic imaging is turned on. In some embodiments, machine vision algorithms can be used to generate and suggest optimal catheter maneuvers to access or reach anatomical landmarks, similar to driver assistance. Machine vision algorithms can utilize the data to automatically navigate the catheter according to the anatomy presented by fluoroscopy.

[0137] The 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 spaced axially along a shaft 148 to measure the difference in angle over the length of a flexible catheter / tube. The difference in angle is interpolated as torque because the catheter / tube has a known torsional stiffness. 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 (dθ) gives the torque: T=k*dθ, where k is the torsional stiffness.

[0138] Ensuring the absence of bubbles in the fluid line can also be achieved using a bubble sensor, especially when the physician is remote from the patient. This can be achieved using a non-contact ultrasonic sensor that measures the intensity and Doppler shift of reflected ultrasound through the sidewall of the fluid tubing to detect bubbles and measure fluid flow rate or level. An ultrasonic or optical sensor can be positioned adjacent to the inflow fluid flow path in the hub or in the supply line leading to the hub. To detect the presence of air bubbles in an infusion line (which is formed from an 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 measure transmission through the liquid passing through the tubing to detect bubbles. Alternatively, the reflected ultrasound signal can be detected from the same side of the flow path as the source due to the relatively high echogenicity of bubbles.

[0139] Preferably, the bubble removal system is automatically activated upon detection of an in-line bubble. The processor can be configured to activate a valve positioned in the flow path downstream of the bubble detector upon detection of a bubble. The valve diverts the column of fluid from the flow path to the patient into the reservoir. Once bubbles are no longer detected in the flow path, and after a 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 source of fluid to the patient through the flow path. In other embodiments, the bubble removal system can include a pump and control system upstream of the bubble detector for removal of in-line bubbles. The processor can be configured to activate the pump upon detection of a bubble to reverse fluid flow and remove the bubble into the waste reservoir before reestablishing forward, bubble-free flow.

[0140] Additionally, it may be desirable for the physician to be able to view the aspirated clot at a predetermined location within the sterile field, and preferably as close to the patient as practical for fluid management purposes. This can be accomplished by providing a clot retrieval device mounted on the hub or mounted in the aspiration line leading away from the hub toward the pump. Referring to FIG. 15 , one example of a clot retrieval device 370 can include a body portion 380 enclosing a chamber 381 that communicates with a first port 310 and a second port 320.

[0141] In some embodiments, body 380 includes a housing having a top portion 382 and a bottom portion 384. Body 380 can include filter 330, which is positioned within chamber 381 between top portion 382 and bottom portion 384. In some examples, first port 310 is configured to connect to a first end of first tubing 340, which is fluidly connected to the proximal end of the suction catheter.

[0142] In embodiments configured to be connected downstream from a hub, first tube 340 includes connector 342 positioned at a second end of first tube 340 that is configured to engage or mate with a corresponding connector on or in communication with the hub. First port 310 is in direct communication with the chamber upstream (e.g., top side) of the filter, and second port 320 is in direct communication with the chamber downstream (e.g., bottom side) of the filter, facilitating direct visualization of captured material on the upstream side of the filter.

[0143] In implementations configured for remote operation, any of a variety of sensors may be provided to detect clots passing through the aspiration line and / or trapped in the filter, such as, for example, optical sensors, pressure sensors, flow sensors, ultrasonic sensors, or others known in the art.

[0144] In some embodiments, the second port 320 is configured to connect to a first end of a second tube 350 that is fluidly connected to a suction source (e.g., a pump). In some embodiments, the second tube 350 includes a connector 352 positioned at the second end of the second tube 350 that is configured to engage or mate with a corresponding connector on the pump.

[0145] In some examples, system 300 can include an on-off valve 360, such as a clamp. The clamp can be positioned between filter 330 and the patient (e.g., on first tube 340) to allow a user to engage the clamp and to provide flow control by isolating the patient from clot retrieval device 370. Closing valve 360 ​​and operating a remote vacuum pump (not shown) causes the vacuum pump and the canister associated with chamber 381 to reach the same low pressure. Due to the short lumen distance and small line volume between chamber 381 and the distal end of the catheter, a sharp negative pressure spike is experienced at the distal end of the catheter immediately following the opening of valve 360. Additional details are disclosed in U.S. Patent No. 11,259,821, entitled "Aspiration System with Accelerated Response," issued March 1, 2022 to Buck et al., the entire contents of which are expressly incorporated herein by reference. In some embodiments, a vacuum can be circulated over the clot to retrieve it. The vacuum can be automatically and robotically controlled to remove the clot.

[0146] The body portion 380 can have a top surface spaced apart from a bottom surface by a tubular sidewall. In the illustrated implementation, the top and bottom surfaces are substantially circular and spaced apart by a cylindrical sidewall. The top surface can have a diameter at least about three or five or more times the axial length (transverse to the top and bottom surfaces) of the sidewall to create a generally disk-shaped housing. Preferably, at least a portion of the top wall is optically transparent to improve clot visualization once the clot is trapped within the clot retrieval device 370. Additional details can be found in U.S. Patent Application No. 63 / 256,743, the entire contents of which are incorporated herein by reference.

[0147] In some examples, the main body portion 380 can include a flush port (not shown) configured to allow injection of an optically transparent medium (e.g., air, saline, or other fluid) into the chamber 381 to clear the optical path between the window and the filter for improved clot visualization once the clot is trapped in the filter 330.

[0148] The foregoing represents certain specific implementations of drive tables and associated components and catheters. As those skilled in the art will recognize in light of the disclosure herein, a wide variety of different drive table configurations can be made to support and axially advance and retract two, three, four, or more drive magnet assemblies for robotically driving interventional devices, fluidic elements, and electrical umbilical elements for transmitting electrical signals and fluids to the catheter hub. Additional details can be found in U.S. Patent Application Serial No. 17 / 527,393, the entirety of which is incorporated herein by reference.

[0149] Although the foregoing describes robotically driven and manually driven interventional devices, the devices can be manually driven, robotically driven, or a combination of both manually and robotically driven interventional devices, as will be recognized by those skilled in the art in light of the disclosure herein.

[0150] 16A-16C illustrate an exemplary control mechanism 2200 for manipulating an interventional device driven by (or otherwise associated with) a respective hub. For example, each hub can be manipulated and / or otherwise moved using at least one controller located within the control mechanism 2200. Each controller can be adapted to move its own hub and associated interventional device during an interventional procedure.

[0151] 16A, the control mechanism 2200 includes a first control unit 2202, a second control unit 2204, a third control unit 2206, and a fourth control unit 2208. More or fewer controls may be provided depending on the intended interventional device configuration. Each control unit 2202-2208 is movably carried on a shaft 2210, which is coupled to a distal bracket 2212 and a proximal bracket 2214. The control units 2202-2208 may be advanced distally or retracted proximally on the shaft 2210, as indicated by arrow 2218 and arrow 2216. Additionally, each control unit 2202-2208 may also be rotated about the shaft 2210, as indicated by arrow 2220. Movement of each control can trigger a responsive movement in a corresponding carriage on the support table, which can drive movement of a corresponding hub, as discussed above.

[0152] The control mechanism 2200 can be positioned on or near a patient support table with a set of hubs and catheter / interventional devices. In some implementations, the control mechanism 2200 can be positioned remotely from the support table, such as behind a radiation shield in a telemedicine implementation, or in a different room or geographic location.

[0153] Each controller 2202-2208 can correspond to and drive the movement of a hub and / or a hub and interventional device combination. For example, controller 2202 can be configured to drive hub 30 (FIG. 3F) to move an interventional device, such as a 0.088-inch guide catheter, corresponding to hub 30. Similarly, controller 2204 can be configured to drive hub 28 (122) to move an interventional device, such as a 0.071-inch treatment catheter. Controller 2206 can be configured to drive hub 126 to move an interventional device, such as a steerable access catheter. Controller 2208 can be configured to drive hub 26 to move an interventional device, such as a guidewire, axially and rotationally.

[0154] 16B illustrates an example of manually manipulating the control 2202 on the control mechanism 2200. In operation, when the user 2230 moves the control 2202 axially and distally along the shaft 2210, as indicated by arrow 2232, the corresponding coupled hub and / or interventional device can responsively move in the same direction by the same or scaled amount. When the user 2230 rotates the control 2202 about the shaft 2210 and advances the control proximally, as indicated by arrow 2234, the corresponding coupled interventional device will responsively move rotationally and proximally by the same or scaled amount. When the user 2230 moves the control 2202 rotationally about the shaft 2210, as indicated by arrow 2236 or arrow 2238, the corresponding coupled hub will rotationally drive the corresponding interventional device in the same direction and / or by the same or scaled amount.

[0155] Other axes and degrees of freedom can be defined to enable the control unit 2202 to perform movements that can be translated into movements of the hub and / or interventional device. For example, the control mechanism can be provided with one or more deflection controls configured to initiate lateral deflection within a deflection zone on a corresponding interventional device.

[0156] Axial movement of the control can be configured to move the coupled hub on a 1:1 basis or on a non-1:1 scaled basis. For example, if the user 2230 advances the control 2022 distally along the shaft 2210 approximately 5 millimeters, the corresponding hub can move distally 5 millimeters in response.

[0157] If the user 2230 rotates the control 2022 by 5 degrees about its axis of rotation, the coupled hub will rotate the corresponding interventional device on a 1:1 basis or on a non-1:1 scaled basis. The scaled amount can be selected to reduce or increase the distance and amount of rotation that the hub and / or interventional device travels in accordance with the control movement.

[0158] In some implementations, the scaled amounts described herein can be determined using a scale factor. The scale factor can be applied to one or both of the translational and rotational movements. In some implementations, a first scale factor is selected for the translational movement, and a second scale factor, different from the first scale factor, is selected for the rotational movement. The axial scaling factor can drive proximal catheter movement at a faster rate than distal catheter movement for a given proximal or distal manipulation of the control.

[0159] The rotational scale factor can be 1:1, while the axial scale factor can move the hub a greater distance than the control travel, such that the hub travel to control travel ratio is at least about 2:1, or 5:1, or 10:1, or more, depending on the desired axial length of the control assembly.

[0160] The control mechanism 2200 can be configured to allow the clinician to adjust the scale factor for different parts of the procedure. For example, distal advancement of the treatment catheter and access catheter through the guide catheter and to the selected ostium can preferably be achieved in a "fast" mode, while more distal travel into the neurovasculature can preferably be achieved in a slower mode by actuation of the speed control.

[0161] In another implementation, one or more controls can be configured to incrementally drive the advancement or retraction rate of a corresponding hub and associated catheter. For example, the distal control 2202 can drive a guide catheter. Small distal movements of the control 2202 can advance the guide catheter distally at a slow rate, while advancing the control 2202 distally a greater distance increases the rate of distal travel of the guide catheter.

[0162] Controlling the speed of the corresponding hubs, either axially or both axially and rotationally, can enhance the overall speed of the procedure. For example, advancement of various devices from the femoral access point to the aortic arch can desirably be achieved at a faster rate than distal navigation closer to the treatment site. Also, proximal retraction of various devices (guidewires, access catheters, and treatment catheters, among others) can desirably be achieved at a relatively higher rate than distal advancement.

[0163] FIG. 16C illustrates another example of manually manipulating controls on the control mechanism 2200 to move a hub and / or other interventional devices. 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, the user 2230 moves the control unit 2204 and the control unit 2206 in combination (e.g., sequentially, simultaneously), such as to simultaneously move a 0.088 guide catheter and a 0.071 suction catheter as a unit. Exemplary movement of the control unit 2204 can include axial proximal movement in the direction indicated by arrow 2250. Sequentially or simultaneously, the user 2230 can move the control unit 2206 axially in either of the directions indicated by arrows 2254 and 2256 and simultaneously move the control unit 2206 rotationally in either of the directions indicated by arrows 2258 and 2260.

[0164] In some implementations, each control mechanism and / or additional controls (not shown) can be color-coded, shape-coded, tactilely coded, or otherwise coded to indicate to the user 2230 which color is configured to move which hub or interventional device. In some implementations, the color coding of the controls can also be applied to the hub and / or interventional device, allowing the user to visually match a particular hub / device with a particular control.

[0165] In some implementations, control operations other than translational and rotational movements can be performed using the controllers 2202-2208. For example, the controllers 2202-2208 can be configured to drive shape and / or stiffness changes of the corresponding interventional device. The controllers 2202-2208 can be switched between different operating modes. For example, the controllers 2202-2208 can be switched between movements driven by acceleration and velocity and movements reflecting actual linear displacement or rotation.

[0166] In some implementations, the control mechanism 2200 can be provided 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 movement directions, commands, movement percentages performed, and / or hub and / or catheter indicators to show which devices are controlled by a particular control. In some implementations, the display can depict the applied force or resistance encountered by the catheter, or other measurements being detected or observed by a particular hub or interventional component.

[0167] In some implementations, the control mechanism 2200 can include a haptic component to provide haptic feedback to a user operating the controller. For example, if the controller 2202a is triggering catheter movement and the catheter detects a large force at the tip, the controller 2202a can generate haptic feedback to indicate to the user to stop or reverse the movement that was performed. In some implementations, haptic feedback can be generated in the controller to indicate to the user to use the controller to slow or speed up the movement. In some implementations, haptics can provide feedback regarding the accumulation of large torsional strains that may precede a sharp rotation or the accumulation of large axial forces that may be a precursor to catheter buckling.

[0168] The systems described herein can compare actual fluoroscopic image positions with input displacements from a controller. A static fluoroscopic image of the patient can be captured, in which the patient's vasculature is indexed relative to bony landmarks or one or more implanted soft tissue fiducial markers. A real-time fluoroscopic image can then be displayed as an overlay, aligned with the static image by fiducial marker registration. Visual observation of the compatibility of real-time movement with the static image, aided by detected force data, can help confirm proper navigation of the associated catheter or guidewire. The systems described herein can also display a comparison of the input proximal mechanical translation of the catheter or guidewire and the resulting distal tip output motion, or lack thereof. Loss of relative motion at the distal tip can indicate shaft buckling, prolapse, kinking, or similar consequences, either inside or outside the body. Such a comparison can be beneficial when shaft buckling, prolapse, kinking, or similar consequences occur outside the current fluoroscopic field of view.

[0169] 17 illustrates a side schematic view of a multi-catheter interventional device assembly 2900 for combined supra-aortic and / or neurovascular site access and treatment (e.g., aspiration) as described herein. The multi-catheter assembly 2900 can be configured for either manual or robotic procedures.

[0170] Interventional device assembly 2900 includes an insertion or access catheter 2902, a treatment catheter 2904, and a guide catheter 2906. Other components are possible, including, but not limited to, one or more guidewires (e.g., optional guidewire 2907), one or more guide catheters, an access sheath, and / or one or more other treatment catheters, and / or associated catheter (control) hubs. In some embodiments, assembly 2900 can also be configured with an optional deflection control 2908 for controlling the deflection of one or more catheters of assembly 2900.

[0171] In operation, the multi-catheter assembly 2900 can be used without the need to exchange hub components. For example, in the previously disclosed two-stage procedure, the first stage to achieve supra-aortic access involves loading the access catheter, guide catheter, and guidewire onto a support table. Once supra-aortic access is obtained, the access catheter and guidewire are typically removed from the guide catheter. A second catheter assembly is then introduced through the guide catheter after attaching a new guidewire hub and procedure catheter hub to corresponding drive carriages on the support table.

[0172] The single multi-catheter assembly 2900 of FIG. 17 is configured to be operated without the need to remove hubs and catheters and without the addition of additional assemblies and / or hubs. Thus, the multi-component access and treatment configuration of assembly 2900 can utilize guidewire 2907, which is manufactured to function as both an access guidewire and a navigation guidewire, allowing for sufficient access and support to, and navigation of, a particular distal treatment site. In a non-limiting example configured for robotic implementation, the catheter assembly can include a guidewire hub (e.g., guidewire hub 2909 or guidewire hub 26 positioned on the drive table and to the right of catheter 2902), an insertion or access catheter hub 2910, a treatment catheter hub 2912, a guide catheter hub 2914, and corresponding catheters. In certain embodiments, one or more of the hubs can include or be coupled to a hemostasis valve (e.g., a rotary hemostasis valve) to accommodate the introduction of an interventional device therethrough. Additional details regarding hemostasis valves are contained in U.S. Patent Application No. 17 / 879,614, entitled "Multi Catheter System With Integrated Fluidics Management," filed August 2, 2022, which is expressly incorporated by reference in its entirety into this specification.

[0173] Once access is achieved above the aortic arch, the insertion or access catheter 2902 (associated with the insertion catheter hub 2910) can be placed near the carotid ostium, and the remainder or subset of the catheter assembly can be guided more distally toward a particular site (e.g., clot site, surgical site, treatment site, etc.).

[0174] In some embodiments, additional smaller treatment catheters may be used at the site. As used herein with respect to catheter assembly 2900, in a robotic configuration of assembly 2900, catheter 2906 may function as a guide catheter. Catheter 2904 may function as a treatment (e.g., suction) catheter. In some embodiments, catheter 2906 may function to perform suction in addition to functioning as a guide catheter, instead of or in addition to catheter 2904. Access catheter 2902 may have a distal deflection zone and may function to access a desired ostium. Those skilled in the art will recognize from FIGS. 18A-18E that either manual or robotic manipulation of a multi-catheter stack is contemplated herein.

[0175] In some embodiments, catheter assembly 2900 (or other combined catheter assemblies described herein) can be driven to a predetermined location as a unit, but each catheter (or guidewire) component can instead be actuated and driven to the same or different locations independently of each other.

[0176] In a non-limiting example, catheter assembly 2900 can be used for a diagnostic angiography procedure. In some embodiments, assembly 2900 can include only guidewire 2907 and access catheter 2902 (in the form of a diagnostic angiography catheter) for performing a diagnostic angiography procedure, or only guidewire 2907 and access catheter 2902 can be utilized during the procedure. Alternatively, guide catheter 2906 and treatment catheter 2904 can be retracted proximally to expose the distal end of access catheter 2902 (e.g., several centimeters of the distal end of the access catheter) to perform a diagnostic angiography procedure.

[0177] 17, guide catheter 2906, treatment catheter 2904, access catheter 2902, and guidewire 2907 can be arranged concentrically. In certain embodiments, guide catheter 2906 can be a "large bore" guide or access catheter having a diameter of at least about 0.075 or at least about 0.080 inches. Treatment catheter 2904 can be an aspiration catheter having a diameter in the range of about 0.060 inches to about 0.075 inches. Access catheter 2902 can be a steerable catheter with a deflectable distal tip having a diameter in the range of about 0.025 inches to about 0.050 inches. Guidewire 2907 can have a diameter in the range of about 0.014 inches to about 0.020 inches. In one example, the guide catheter 2906 can have a diameter of approximately 0.088 inches, the treatment catheter 2904 can have a diameter of approximately 0.071 inches, the access catheter 2902 can have a diameter of approximately 0.035 inches, and the guidewire 2907 can have a diameter of approximately 0.018 inches.

[0178] 18A-18E depict an exemplary sequence of steps for introducing, either manually or robotically, a multi-catheter assembly configured to provide access to a blood clot. 18A-18E can be described using the interventional device assembly of FIG. 17. Other combinations of catheters can be substituted for the interventional device assembly, as one of ordinary skill in the art would recognize in light of the disclosure herein.

[0179] Referring to FIG. 18A, a three catheter interventional device assembly 2900 is shown being driven through an introducer sheath 3002, through an iliac artery 3004, and into the descending aorta. Next, the access catheter 2902, the treatment catheter 2904 (e.g., 0.071 inches), and the guide catheter 2906 (e.g., 0.088 inches) are tracked to the aortic arch 3006, as shown in FIG. 18B. Here, the distal end of the guide catheter 2906 can be placed below the aortic arch 3006, and the treatment catheter 2904, the access catheter 2902 (positioned within the treatment catheter 2904 and not visible in FIG. 18B), and the guidewire 2907 can be driven (e.g., simultaneously or separately) into the ostium. In some embodiments, the access catheter 2902 is advanced out of the treatment catheter 2904 and the guide catheter 2906, engaging the ostium first. After the distal end of the access catheter 2902 is positioned within the desired ostium, the guidewire 2907 can be advanced distally into the ostium to secure access. After the access catheter 2902 and guidewire 2907 are positioned within the desired ostium, the treatment catheter 2904 and / or guide catheter 2906 can be advanced into (and, in some embodiments, beyond) the ostium, using the support of the access catheter 2902 and / or guidewire 2907 to navigate through the aorta and into the ostium. In the embodiment shown in FIG. 18B , the treatment catheter 2904 has been advanced into the ostium, while the guide catheter 2906 remains indwelling below the aortic arch 3006.

[0180] 18C, the guidewire 2907 can be advanced distally, and the radiopacity of the guidewire 2907 can be used to confirm under fluoroscopic imaging that access through the desired ostium has been achieved. The guidewire 2907 engages the origin of the brachiocephalic trunk 3014. The guidewire 2907 is then advanced to the petrous segment 3018 of the internal carotid artery 3016.

[0181] 18D, guide catheter 2906 and treatment catheter 2904 (positioned within guide catheter 2906 and not visible in FIG. 18D) are both advanced (e.g., simultaneously or sequentially) over guidewire 2907 and over insertion or access catheter 2902 (positioned within treatment catheter 2904 and not visible in FIG. 18D), while access catheter 2902 remains at the ostium for support. Guidewire 2907 can be advanced further beyond cone segment 3018 to the site of clot 3020, such as the M1 segment.

[0182] 18E , guide catheter 2906 and treatment catheter 2904 (positioned within guide catheter 2906 and not visible in FIG. 18E ) are advanced (e.g., simultaneously or sequentially) to position the distal tip of treatment catheter 2904 at the treatment site (e.g., at the face of clot 3020). Guidewire 2907 and access catheter 2902 (positioned within treatment catheter 2904 and not visible in FIG. 18E ) are removed, and aspiration of clot 3020 begins through treatment catheter 2904. That is, guidewire 2907 and access catheter 2902 are retracted proximally to allow aspiration through treatment catheter 2904. After aspiration of the clot, treatment catheter 2904 and guide catheter 2906 can be removed (e.g., simultaneously or sequentially). For example, in some embodiments, treatment catheter 2904 can be removed before removing guide catheter 2906.

[0183] The catheter assembly 2900 can be used to perform a neurovascular procedure, as illustrated in FIGS. 18A-18E. For example, the neurovascular procedure can be a neurovascular thrombectomy. The steps of the procedure can include providing an assembly including at least a guidewire, an access catheter, a guide catheter, and a treatment catheter. For example, the catheter assembly 2900 includes a guidewire 2907, an access (e.g., insertion) catheter 2902, a guide catheter 2906, and at least one treatment catheter 2904. The treatment catheter 2904 can include an aspiration catheter, an embolism deployment catheter, a stent deployment catheter, a flow diverter deployment catheter, a diagnostic angiography catheter, a stent retriever catheter, a clot retrieval catheter, a balloon catheter, a catheter for facilitating percutaneous valve repair or replacement, an ablation catheter, and / or an RF ablation catheter or guidewire.

[0184] The neurovascular procedure may further include coupling the assemblies to a non-robotic or robotic drive system and driving the assemblies to achieve supra-aortic access. The steps may further include driving a subset of the assemblies to a neurovascular site and performing the neurovascular procedure using the subset of the assemblies. The subset of assemblies may include a guidewire, a guide catheter, and a treatment catheter.

[0185] Each of the guidewire 2907, access catheter 2902, guide catheter 2906, and treatment catheter 2904 is configured to be regulated by a respective hub. For example, the guidewire 2907 can include (or be coupled to) a hub mounted on one of the tray assemblies described herein. Similarly, the access catheter 2902 can be coupled to a catheter hub 2910. The guide catheter 2906 can be coupled to a guide catheter hub 2914. The treatment catheter 2904 can be coupled to a treatment catheter hub 2912.

[0186] Generally, coupling of the assemblies can include magnetically coupling a first hub 2909 on the guidewire 2907 to a first drive magnet, a second hub 2910 on the access catheter 2902 to a second drive magnet, a third hub 2912 on the treatment catheter 2904 to a third drive magnet, and a 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 table, as described with respect to the tray assemblies and controls described herein. In some embodiments, the first, second, third, and fourth drive magnets are coupled (e.g., to their respective catheter hubs) through a sterile barrier (e.g., a sterile barrier and a fluid barrier) and independently movably carried by a drive table having a plurality of driven magnets. In some embodiments, two or more drive magnets can be tethered or otherwise coupled together so that they move as a unit in response to commands from a single controller that is tethered or otherwise coupled to one of the drive magnets.

[0187] In some implementations, performing a neurovascular procedure can include driving the hub adapters in response to movement of each of the hub adapters along the support table until the assemblies are positioned to provide supra-aortic vascular access. The hub adapters can include, for example, a coupler / carriage that acts as a shuttle by advancing proximally or distally along a track in response to an operator command. The hub adapters described herein can each include at least one drive magnet configured to couple with a driven magnet carried by the respective hub. This provides a magnetic coupling between the drive magnet and the driven magnet through the sterile barrier such that the respective hubs are moved across the top of the sterile barrier in response to movement of the hub adapter outside the sterile field (as described in detail in FIG. 4 ). Movement of the hub adapters is driven by a drive system carried by the support table on which the guidewire hub 2909, guide catheter hub 2914, procedure catheter hub 2912, and access catheter hub 2910 are mounted.

[0188] The steps can further include actuating the subset of assemblies in response to respective movement of the hub adapters along the support table until the subset of assemblies is positioned to perform a neurovascular procedure at the neurovascular treatment site. The subset of assemblies can include a guidewire 2907, a guide catheter 2906, and a treatment catheter 2904.

[0189] In some embodiments, the guidewire 2907, guide catheter 2906, and treatment catheter 2904 are advanced as a unit through (with respect to the guidewire 2907) and over (with respect to the guide catheter 2906 and treatment catheter 2904) at least a portion of the length of the access (e.g., insertion) catheter 2902 after supra-aortic access has been achieved.

[0190] In some embodiments, the catheter assembly 2900 can be part of a robotic control system for achieving supra-aortic access and neurovascular treatment site access, as illustrated in FIGS. 18A-18E . In some embodiments, the catheter assembly 2900 can be part of a manually controlled system for achieving supra-aortic access and neurovascular treatment site access. In some embodiments, the catheter assembly 2900 can be part of a hybrid control system (comprising manual and robotic components) for achieving supra-aortic access and neurovascular treatment site access. For example, in such a hybrid system, the supra-aortic access can be robotically driven, while the neurovascular site access and embolectomy or other procedure can be manual. Alternatively, in such a hybrid system, the supra-aortic access can be manual, while the neurovascular site access can be robotically achieved. Furthermore, in such a hybrid system, any one or more of the guidewire, access catheter, guide catheter, or treatment catheter can be robotically driven or manually operated.

[0191] The exemplary robotic control system can include at least a guidewire hub (e.g., guidewire hub 2909) configured to adjust the axial and rotational positions of guidewire 2907. The robotic control system can also include an access catheter hub 2910 configured to adjust the axial and rotational movement of access catheter 2902. The robotic control system can also include a guide catheter hub 2914 configured to control the axial movement of guide catheter 2906. The robotic control system can also include a treatment catheter hub 2912 configured to adjust the axial and rotational position of treatment catheter 2904.

[0192] In some embodiments, the treatment catheter hub 2912 is further configured to laterally deflect a distal deflection zone of the treatment catheter 2904 .

[0193] In some embodiments, guidewire hub 2909 is configured to couple to the guidewire hub adapter by magnetically coupling the guidewire hub to a first drive magnet. Access catheter hub 2910 is configured to couple to the access catheter hub adapter by magnetically coupling the access catheter hub 2910 to a second drive magnet. Treatment catheter hub 2912 is configured to couple to the treatment catheter hub adapter by magnetically coupling the treatment catheter hub 2912 to a third drive magnet. Guide catheter hub 2914 is configured to couple to the guide catheter hub adapter by magnetically coupling the guide catheter hub 2914 to a fourth drive magnet. In some embodiments, the first drive magnet, the second drive magnet, the third drive magnet, and the fourth drive magnet are independently movably carried by a drive table.

[0194] In some embodiments, the robotic control system includes a first driven magnet on the guidewire hub 2909. The first driven magnet can be configured to cooperate with the first drive magnet such that the first driven magnet is configured to move in response to movement of the first drive magnet. In some embodiments, the first drive magnet is configured to move outside the sterile field separated from the first driven magnet by a barrier, while the first driven magnet is within the sterile field. In some embodiments, the position of the first driven magnet is movable in response to manipulation of a treatment drive control on a control console associated with the drive table. The interaction of the drive magnet and driven magnet is described in detail with respect to FIG. 4 above.

[0195] In some embodiments, the robotic control system includes a second driven magnet on the access catheter hub 2910. The second driven magnet can be configured to cooperate with the second drive magnet such that the second driven magnet is configured to move in response to movement of the second drive magnet. In some embodiments, the second drive magnet is configured to move outside the sterile field separated from the second driven magnet by a barrier, while the second driven magnet is within the sterile field.

[0196] In some embodiments, the robotic control system includes a third driven magnet on the treatment catheter hub 2912. The third driven magnet can be configured to cooperate with the third drive magnet such that the third driven magnet is configured to move in response to movement of the third drive magnet. In some embodiments, the third drive magnet is configured to move outside the sterile field separated from the third driven magnet by a barrier, while the third driven magnet is within the sterile field.

[0197] In some embodiments, the robotic control system includes a fourth driven magnet on the guide catheter hub 2914. The fourth driven magnet can be configured to cooperate with the fourth drive magnet such that the fourth driven magnet is configured to move in response to movement of the fourth drive magnet. In some embodiments, the fourth drive magnet is configured to move outside the sterile field separated from the fourth driven magnet by a barrier, while the fourth driven magnet is within the sterile field. In some embodiments, there can be more than four driven magnets and corresponding catheter hubs for control of additional catheters.

[0198] In some embodiments, the devices described herein (e.g., hubs, hub adapters, interventional devices, and / or trays) can be used during robotically driven procedures. For example, in a robotically driven procedure, one or more of the interventional devices can be driven through the vasculature to a treatment site. Robotically driving such devices can include engaging electromechanical components controlled by user input. In some implementations, a user can provide input at a control system that interfaces with one or more hubs and hub adapters.

[0199] In some embodiments, the hubs, hub adapters, interventional devices, and trays described herein can be used during non-robotic (e.g., manually driven) procedures. Manually driving such devices can include manually engaging the hub to affect movement of the interventional device.

[0200] In some embodiments, the devices described herein can be used to perform a method of performing an intracranial procedure at an intracranial site. The method of performing an intracranial procedure can include any of the same steps described herein for performing a neurovascular procedure. The procedure can be performed robotically, manually, or a hybrid combination of both.

[0201] While the above describes magnetically coupling the hub to the drive magnet, in other embodiments, either the interventional device and / or the hub can be mechanically coupled to the drive system. Any of the methods described herein can include mechanically coupling one or more interventional devices (e.g., guidewire 2907, access catheter 2902, treatment catheter 2904, and / or guide catheter 2906) and / or one or more hubs (e.g., guidewire hub 2909, access catheter hub 2910, treatment catheter hub 2912, and / or guide catheter hub 2914) to one or more drive mechanisms.

[0202] 23 illustrates a mechanical linkage 1654 between the drive mechanism 1650 and the driven mechanism 1652. The drive mechanism 1650 and the driven mechanism 1652 can have any of the same or similar features or functions as the drive magnet 67 and the driven magnet 69, respectively, unless otherwise described herein. The drive mechanism 1650 can be part of or coupled to a hub adapter (e.g., hub adapter 48). The driven mechanism 1652 can be part of or coupled to a hub (e.g., hub 36, guidewire hub 2909, access catheter hub 2910, procedure catheter hub 2912, or guide catheter hub 2914). In some cases, the mechanical linkage 1654 can include structural support (e.g., a support rod or support strut) extending transversely through a seal in the sterile barrier 1632. The seal can allow the structural support to be advanced along the length of the sterile barrier 1632 while still maintaining a seal with the structural support to maintain a sterile field when the drive mechanism 1650 and driven mechanism 1652 are advanced and / or retracted, as described herein. For example, the seal can include a tongue and groove closure mechanism along the sterile barrier 1632 that is configured to close on either side of the structural support while allowing passage of the structural support through the sterile barrier 1632 and maintaining a seal against the structural support as the structural support is advanced along the length of the sterile barrier 1632.

[0203] In some embodiments, the structural support can extend through an elongated self-closing seal between two adjacent joining edges (e.g., similar in shape to duckbill valves) of flexible material extending along an axis. As the structural support advances along the axis between the joining edges, the joining edges can allow the structural support to advance and then be biased back into sealing engagement with one another as the structural support passes any given point along the axis.

[0204] In some embodiments, the drive mechanism can be a splined drive shaft (e.g., a non-sterile splined drive shaft). The mechanical linkage 1654 can include a pulley in the plate that serves as the sterile barrier 1632 and a sterile splined shaft configured to couple to the driven mechanism 1652. The driven mechanism 1652 can be a sterile pulley that receives the sterile splined shaft from the sterile barrier. In some embodiments, one or more splined drive shafts can engage and turn a corresponding pulley in the plate that serves as the sterile barrier. Each hub can have a sterile pulley configured to receive the sterile splined shaft from the sterile barrier plate. Rotation of the splined drive shaft can turn a pulley in the sterile barrier plate, which can turn a sterile pulley in the hub via the sterile splined shaft.

[0205] Those skilled in the art will appreciate that any of the embodiments as described herein may be modified to incorporate a mechanical linkage, for example, as shown in FIG. 23.

[0206] Telescoping hub drive: Any embodiment of the robotic control system disclosed herein can have a telescoping or extendable drive table coupled thereto. An exemplary embodiment of a robotic control system 4000 having a telescoping drive table 4002 coupled to a base structure 4004 is shown in FIG. 19A. In some embodiments, the drive table 4002 can have any of the components, features, and / or details of any other embodiment of the drive table disclosed herein, including, but not limited to, one, two, three, four, or five or more hub adapters 4012 (e.g., hub adapters 4012a-d in FIG. 19A) that can be used to axially and / or vertically move one, two, three, four, or five or more hubs (not shown in FIG. 19A), as will be described. As described, the hubs can each be coupled to or configured to receive an interventional device. More or fewer hub adapters and interventional device hubs can be supported by the drive table 4002 depending on the desired clinical procedure.

[0207] FIG. 19A depicts a top perspective view of control system 4000. FIG. 19B depicts another top perspective view of control system 4000. FIG. 19C depicts a bottom perspective view of control system 4000. FIG. 19D depicts a top view of control system 4000. FIG. 19E depicts a partial top perspective view of control system 4000. FIG. 19F depicts another bottom perspective view of control system 4000. FIG. 19G depicts a partial bottom perspective view of control system 4000. FIG. 19H depicts a partial top perspective view of control system 4000. FIG. 191 depicts a top perspective view of hub adapter 4012 of control system 4000. FIG. 19J depicts a side schematic view of control system 4000.

[0208] In some embodiments, the drive table 4002 can be rotated, translated axially (e.g., proximally and distally), and / or translated vertically (e.g., up and down). Other embodiments of the robotic control system 4000 can be configured to translate and / or rotate. An axial direction is a direction collinear with the axial centerline of an interventional device supported by or coupled to the drive table. A vertical direction is a direction perpendicular to the axial direction and perpendicular to the ground surface. As will be described in more detail, axial movement of the drive table 4002 can result in axial (proximal and distal) movement of the hub adapter (and any of the hubs and interventional devices coupled thereto).

[0209] In certain embodiments, the telescoping drive table 4002 can be translated axially to axially translate one or more interventional devices coupled to the drive table 4002 during a neurovascular (or other) procedure. The axial translation of the drive table 4002 to axially translate an interventional device can allow the drive table 4002 to have a shorter length (e.g., between the distal end 4002a and the proximal end 4002b) compared to a drive table that does not translate axially. For example, at least some of the axial movement of an interventional device coupled to the drive table 4002 relative to a patient reference point (e.g., the femoral access point 24) can be achieved by moving the drive table 4002 while the interventional device is coupled to the drive table 4002, instead of moving the interventional device relative to the drive table 4002.

[0210] In embodiments having a drive table that does not translate axially, each interventional device of an interventional device assembly (e.g., interventional device assembly 2900) can move along and relative to the drive table during a neurovascular procedure. In such embodiments, the drive table can have a length sufficient to accommodate the desired range of motion of each interventional device.

[0211] In embodiments having an axially translatable telescoping drive table 4002, at least some of the desired range of axial motion for one or more interventional devices can be provided by axial movement of the drive table 4002.

[0212] In some embodiments, the position of one of the interventional devices coupled to the drive table 4002 can be fixed relative to the drive table (e.g., by a hub adapter secured to the drive table 4002), such that the axial range of motion desired for that interventional device is accommodated by axial movement of the drive table 4002. Thus, such a telescoping drive table 4002, compared to a drive table that does not translate axially, can reduce the overall length of the drive table 4002 by at least a portion (e.g., by 90%, 80%, 70%, 60%, 50%, or any other suitable percentage) of the desired range of motion of the interventional device having a fixed position of the drive table 4002. Reducing the length of the telescoping drive table 4002 can be beneficial for storage of the drive table 4002.

[0213] In some embodiments, the telescoping drive table 4002 can have a length of between 100 cm and 160 cm, between 110 cm and 150 cm, between 120 cm and 140 cm, about 100 cm, about 110 cm, about 120 cm, about 130 cm, about 140 cm, about 150 cm, about 160 cm, or any other suitable length.

[0214] Embodiments of the robotic control system 4000 disclosed herein can include at least a guidewire hub (e.g., guidewire hub 2909) configured to adjust the axial and rotational positions of a guidewire (e.g., guidewire 2907). Any embodiment of the robotic control system 4000 can also include an access catheter hub (e.g., access catheter hub 2910) configured to adjust the axial and rotational movement of an access catheter (e.g., access catheter 2902). The robotic control system 4000 can also include a treatment catheter hub (e.g., treatment catheter hub 2912) configured to adjust the axial and rotational position of a treatment catheter (e.g., treatment catheter 2904). The robotic control system 4000 can also include a guide catheter hub (e.g., guide catheter hub 2914) configured to control the axial movement of a guide catheter (e.g., guide catheter 2906). In some embodiments, the access catheter hub can be further configured to laterally deflect a distal deflection zone of the access catheter. In some embodiments, the treatment catheter hub can be further configured to laterally deflect a distal deflection zone of the treatment catheter. Each of the aforementioned interventional devices and hubs can be coupled with a hub adapter of the drive table 4002. Any other component, feature, or other detail of the robotic control system embodiments or interventional devices disclosed above can be combined with any of the features of any of the robotic control system 4000 embodiments or interventional devices disclosed below.

[0215] 19A-19H, in any embodiment disclosed herein, the robotic control system 4000 can include a drive table 4002, a base structure 4004, and an arm 4006 coupled to the base structure 4004 and the drive table 4002. As described in further detail herein, in certain embodiments, the drive table 4002 can be configured to move axially (e.g., along a desired axis of catheter insertion and / or along a longitudinal axis of the drive table 4002). In certain embodiments, the drive table 4002 can be configured to move (e.g., axially) relative to the base structure 4004. The axial direction is represented by arrow A1 in FIG. 19D, which points in both directions along the longitudinal axis of the drive table 4002.

[0216] In some embodiments, the arm 4006 can be configured to move the drive table 4002 (and any interventional device coupled thereto) at least axially along a desired axis of catheter insertion. In some embodiments, moving the drive table 4002 axially along the desired axis of catheter insertion includes moving the drive table 4002 relative to the base structure 4004.

[0217] Additionally, some embodiments of the robotic control system 4000 can be configured to move the drive table 4002 in a vertical direction (e.g., relative to the base structure 4004) in response to inputs provided by a user of the robotic control system. The vertical direction is represented in FIG. 19A by arrow A2, which points both toward the ground surface or along an axis perpendicular to the bottom surface 4004a of the base structure 4004. In some embodiments, the drive table 4002 can be configured to move vertically from at least a first height above the ground surface to at least a second height above the ground surface, where the second height can be greater than the first height.

[0218] In some embodiments, the arm 4006 can also be configured to move the drive table 4002 (and any interventional device coupled thereto) in an orthogonal direction (e.g., relative to the base structure 4004) in response to inputs provided by a user of the robotic control system, the orthogonal direction being orthogonal to the axial direction and orthogonal to the vertical direction. The orthogonal direction is represented in FIG. 19D by arrow A3, which points both horizontally and orthogonally to the axial direction of the drive table 4002.

[0219] In some embodiments, the drive table 4002 (and any interventional device coupled thereto) can be configured to rotate at any desired angle relative to the ground surface (e.g., relative to the base structure 4004), such as, but not limited to, such that the drive table 4002 moves along an axis angled relative to a horizontal plane. For example, but not limited to, some embodiments of the robotic control system 4000 can include a rotatable joint 4022 configured to rotate about an axis parallel to the ground surface or parallel to the bottom surface of some embodiments of the base structure 4004 (such as, for example, the illustrated embodiment). In some embodiments, the drive table 4002 can be configured to rotate at an angle or orientation orthogonal to the ground surface (e.g., to an upright stored position). In other words, in some embodiments, the drive table 4002 can be configured to rotate between at least a first position and at least a second position, where in the first position the drive table 4002 is generally parallel to the ground surface and where in the second position the drive table 4002 is orthogonal to the first position or within or approximately 10 degrees of orthogonal to the ground surface. This can be useful for moving the drive table 4002 to a stored position to make the robotic control system 4000 more compact when not in use and for moving or transporting the robotic control system 4000.

[0220] In some embodiments, the drive table 4002 can be configured to rotate to an angle or orientation appropriate for advancing an interventional device coupled to the drive table into an access point while positioning the drive table 4002 over the patient's anatomy. For example, the drive table 4002 can be rotated so that the proximal end 4002b of the drive table 4002 is vertically above the distal end 4002a of the drive table 4002 to position the proximal section of the drive table 4002 vertically above the patient's foot.

[0221] In some embodiments, the drive table 4002 is foldable, which can reduce the overall length of the drive table 4002 in a stowed configuration, thus providing a more compact robotic surgical system that can offer space savings compared to conventional surgical robots.

[0222] In some embodiments, the base structure 4004 can be configured to be coupled to a surgical bed. In some embodiments, the base structure 4004 can be configured to be mounted to a ground surface.

[0223] In some embodiments, the robotic control system 4000 can include a first hub adapter 4012a coupled to the drive table 4002, which can be configured to couple to and / or move a first hub coupled to a first interventional device (which can be any of the interventional devices disclosed herein and / or which is suitable for use in any interventional procedure) at least axially (e.g., relative to the base structure 4004) in response to input provided by a user of the robotic control system. In some embodiments, the first hub adapter 4012a can be configured to couple to and / or move a guide catheter hub (e.g., guide catheter hub 2914) coupled to a guide catheter (e.g., guide catheter 2906).

[0224] In some embodiments, the robotic control system 4000 can include a second hub adapter 4012b coupled to the drive table 4002. The second hub adapter 4012b can be configured to couple to and / or move a second hub coupled to a second interventional device (which can be any of the interventional devices disclosed herein and / or which is suitable for use in any interventional procedure) at least axially (e.g., relative to the base structure 4004) in response to input provided by a user of the robotic control system. In some embodiments, the second hub adapter 4012b can be configured to couple to and / or move a treatment catheter hub (e.g., treatment catheter hub 2912) coupled to a treatment catheter (e.g., treatment catheter 2904).

[0225] In some embodiments, the robotic control system 4000 can include a third hub adapter 4012c coupled to the drive table 4002. The third hub adapter 4012c can be configured to couple to and / or move a third hub coupled to a third interventional device (which can be any of the interventional devices disclosed herein and / or which is suitable for use in any interventional procedure) at least axially (e.g., relative to the base structure 4004) in response to input provided by a user of the robotic control system. In some embodiments, the third hub adapter 4012c can be configured to couple to and / or move an access catheter hub (e.g., access catheter hub 2910) coupled to an access catheter (e.g., access catheter 2902).

[0226] In some embodiments, the robotic control system 4000 can include a fourth hub adapter 4012d coupled to the drive table 4002. The fourth hub adapter 4012d can be configured to couple to and / or move a fourth hub coupled to a fourth interventional device (which can be any of the interventional devices disclosed herein and / or which is suitable for use in any interventional procedure) at least axially (e.g., relative to the base structure 4004) in response to input provided by a user of the robotic control system. In some embodiments, the fourth hub adapter 4012d can be configured to couple to and / or move a guidewire hub (e.g., guidewire hub 2909) coupled to a guidewire (e.g., guidewire 2907).

[0227] In some embodiments, the first hub adapter 4012a can be coupled to the drive table 4002 in a fixed position such that the position of the first hub adapter 4012a relative to the drive table 4002 does not change (e.g., the first hub adapter 4012a does not move relative to the drive table). In this configuration, the robotic control system 4000 can be configured to move the first hub adapter 4012a (and any hubs and interventional devices coupled thereto) axially (e.g., proximally or distally) relative to a patient reference point (e.g., a femoral access point) by maintaining the first hub adapter 4012a in a fixed position on the drive table 4002 and by moving the drive table 4002 axially (e.g., proximally or distally) relative to the patient reference point, thereby effectively moving the first hub adapter 4012a relative to the patient reference point. In this manner, the drive table 4002 can be moved axially to move an interventional device coupled to the drive table 4002 at a fixed location (e.g., via a hub coupled to the hub adapter 4012a). The interventional device can be the distal-most interventional device (e.g., guide catheter 2906). In other embodiments, the interventional device coupled to the drive table 4002 at a fixed location can be the proximal-most interventional device (e.g., guidewire 2907).

[0228] In some embodiments, any of the second hub adapter 4012b, the third hub adapter 4012c, and the fourth hub adapter 4012d (and any interventional devices / hubs coupled thereto) can be configured to move axially relative to the drive table 4002 (e.g., by moving proximally or distally along the drive table 4002). In some embodiments, any of the second hub adapter 4012b, the third hub adapter 4012c, and the fourth hub adapter 4012d (and any interventional devices / hubs coupled thereto) can be configured to move axially relative to the first hub adapter 4012a (and any interventional devices / hubs coupled thereto) (e.g., by moving proximally or distally along the drive table 4002).

[0229] For example, with reference to interventional device assembly 2900, one or more of treatment catheter 2904 (e.g., coupled to hub adapter 4012b via hub 2912), access catheter 2902 (e.g., coupled to hub adapter 4012c via hub 2910), and guidewire 2907 (e.g., coupled to hub adapter 4012d via hub 2909) may be movable axially along drive table 4002 relative to guide catheter 2906 (e.g., coupled to hub adapter 4012a via hub 2914), which may be coupled to drive table 4002 at a fixed position. In such an embodiment, guide catheter 2906 may be movable axially via axial movement of drive table 4002.

[0230] In certain embodiments, the robotic control system 4000 can include a control mechanism having one or more user controls for controlling the movement of the hub adapters 4012a-d, and thereby the movement of the interventional devices coupled to the hub adapters 4012a-d. For example, a user can operate a first control to control the axial movement of the drive table and, consequently, the first hub adapter 4012a and the interventional device coupled thereto. A user can operate a second control to control the axial movement of the second hub adapter 4012b and the interventional device coupled thereto along the drive table 4002, a third control to control the axial movement of the third hub adapter 4012c and the interventional device coupled thereto along the drive table 4002, and a fourth control to control the axial movement of the hub adapter 4012d and the interventional device coupled thereto along the drive table 4002.

[0231] In some embodiments, in response to movement of the drive table 4002 and / or user control actions to control movement of the drive table 4002, the robotic control system 4000 can be configured to adjust the positions of the movable hub adapters relative to the patient reference point (e.g., access point 24) along with the drive table 4002 (e.g., hub adapters 4012b-d) and the interventional devices coupled thereto to correspond to the positions they would be in the absence of movement of the drive table 4002. For example, the robotic control system 4000 can be configured to adjust the positions of the movable hub adapters relative to the patient reference point (e.g., access point 24) along with the drive table 4002 (e.g., hub adapters 4012b-d) and the interventional devices coupled thereto to correspond to the positions they would be in if each of the hub adapters 4012a-d were independently movable relative to the drive table (e.g., as discussed herein with respect to drive table 20).

[0232] For example, in any embodiment disclosed herein, in the absence of a user control action to move the second hub adapter 4012b (e.g., a user operating a control to axially move an interventional device coupled to the second hub adapter 4012b), the robotic control system 4000 can be configured to maintain the second hub adapter 4012b in a fixed position relative to a patient reference point (e.g., access point 24) as the drive table 4002 is moved relative to the patient reference point. For example, in certain embodiments, the robotic control system 4000 can move the second hub adapter 4012b relative to the drive table 4002 in a direction opposite to the movement of the drive table 4002 relative to the patient reference point. In other words, when the drive table 4002 is moved, such as to move the first hub adapter 4012a (and corresponding interventional device), the position of the second hub adapter 4012b relative to the patient reference point can be maintained or fixed by moving the second hub adapter 4012b on the drive table 4002 by an equal magnitude or speed compared to the movement of the drive table 4002 in the opposite direction. As another example, the robotic control system 4000 can be configured to maintain the second hub adapter 4012b in a fixed position relative to the patient reference point when the drive table 4002 is moved in a first axial direction by moving the second hub adapter 4012b relative to the drive table 4002 in a second axial direction that is opposite the first axial direction when the drive table 4002 is moved in a first axial direction relative to the patient reference point. Similarly, the robot control system 4000 can be configured to maintain the third hub adapter 4012c and / or the fourth hub adapter 4012d (and / or any other additional hub adapters) in a fixed position relative to the patient reference point when the drive table 4002 is moved relative to the patient reference point.

[0233] In some embodiments, in response to user actuation of a controller to move the hub adapters 4012a-d, the control system 4000 can cause the hub adapters 4012a-d to adjust their positions relative to one another to correspond to the positions that each of the hub adapters 4012a-d would be in if they were independently movable relative to the drive table (e.g., as discussed herein with respect to drive table 20). For example, in response to a user actuation of a control (e.g., manipulation of a first controller) to distally move an interventional device coupled to hub adapter 4012a by distally moving drive table 4002, the control system 4000 can adjust the positions of hub adapters 4012b-d so that they move proximally along the drive table with equal magnitude or speed.

[0234] In response to a control action to axially move hub adapter 4012a (via movement of drive table 4002) and also to axially move one or more of the other hub adapters 4012b-d, the control system 4000 can move hub adapters 4012b-d to the same positions relative to the patient reference point or relative to hub adapter 4012a that they would be moved to in the absence of movement of drive table 4002. For example, if a user performs a control action to move hub adapter 4012a and hub adapter 4012b distally by 5 mm, the control system can move drive table 4002 distally by 5 mm without moving hub adapter 4012b relative to drive table 4002. If the user performs a control action to move hub adapter 4012a distally by 5 mm and hub adapter 4012b distally by 6 mm, the control system 4000 can move drive table 4002 distally by 5 mm and move hub adapter 4012b distally by 1 mm along the drive table, such that hub adapter 4012b has moved distally a total of 6 mm relative to the patient reference point (e.g., access point 24).

[0235] During some procedures, a user may perform control actions intended to move a distal-most interventional device (e.g., guide catheter 2906) coupled to the hub adapter 4012a distally relative to a proximal-most interventional device (e.g., guidewire 2907) (e.g., coupled to the hub adapter 4012d) a distance greater than the total length of the drive table 4002. As described above, when a user performs control actions to move the table 4002 and hub adapter 4012a distally, the control system 4000 may adjust the position of the hub adapter 4012d by moving the hub adapter 4012d proximally (preferably by an equal magnitude or speed). In some procedures, the table 4002 may be able to move distally a greater amount than the hub adapter 4012d can move proximally. In other words, while adjusting in response to movement of the table 4002, the hub adapter 4012d may reach a proximal-most position along the table 4002 and be prevented from further movement while the table 4002 continues to move distally. In response, the control system 4000 may compensate by temporarily linking the movement of the hub adapter 4012d with the movement of the hub adapter 4012a so that the hub adapter 4012d moves synchronously with the hub adapter 4012a.

[0236] For example, when linked, if the hub adapter 4012a is moved distally (meaning the table 4002 is moved distally), the hub adapter 4012d can move distally by the same amount and / or at the same speed. In this situation, the hub adapter 4012d can move distally by the same amount and / or at the same speed as the hub adapter 4012a by maintaining its position on the table while the table 4002 moves distally. Similarly, if the hub adapter 4012a is moved proximally (meaning the table 4002 is moved proximally), the hub adapter 4012d can move proximally by the same amount and / or at the same speed. In this situation, the hub adapter 4012d can move proximally by the same amount and / or at the same speed as the hub adapter 4012a by maintaining its position on the table while the table 4002 moves proximally.

[0237] In some embodiments, the hub adapter 4012d can be unlinked from the hub adapter 4012a in response to user manipulation of the controls for the hub adapter 4012d, which causes the hub adapter 4012d to move independently (e.g., so that it adjusts in response to movement of the hub adapter 4012a). In certain embodiments, while the hub adapter 4012a and the hub adapter 4012d are linked, the control system 4000 can track the desired relative position of the hub adapter 4012d with respect to the hub adapter 4012a and / or with respect to a patient reference point, and can adjust the hub adapter 4012d to the desired position once sufficient space becomes available along the drive table 4002.

[0238] Linking the distal-most hub adapter (e.g., hub adapter 4012a) and the proximal-most hub adapter (e.g., hub adapter 4012d) can allow for a shorter drive table. By way of example, in certain embodiments, the length of the drive table 4002 can be approximately 130 cm long. The distal-most interventional device (e.g., guide catheter 2906) can have a length of approximately 127 cm. The length of the section of the distal-most interventional device that overlaps the drive table 4002 (e.g., when coupled to a hub coupled to the distal-most hub adapter (e.g., hub adapter 4012a)) can be approximately 3 cm. The proximal-most interventional device (e.g., guidewire 2907) can have a length of approximately 265 cm. The section of the proximal-most interventional device can, in some embodiments, extend proximally from the proximal end of the proximal-most hub coupled to the proximal-most hub adapter (e.g., hub adapter 4012d). For example, in certain embodiments, the section of the most proximal interventional device can extend between about 2 cm and about 20 cm, between about 5 cm and about 15 cm, or about 10 cm from the proximal end of the most proximal hub. In some embodiments, the most proximal hub can extend proximally from the proximal end of the drive table 4002 by about 2.5 cm at its most proximal position. In certain embodiments, the most proximal end of the most proximal interventional device can be positioned proximally from the proximal end of the drive table 4002 by a distance between about 4.5 cm and about 22.5 cm, between about 7.5 cm and about 17.5 cm, or about 12.5 cm when the most proximal hub adapter is in its most proximal position. In the initial configuration, the most distal end of the most proximal interventional device can be proximal to the most distal end of the most distal interventional device.

[0239] Although discussed with respect to drive table 4002, the linkages of the hub adapters and / or hubs of the drive table (e.g., the linkages of the proximal and distal hub adapters and / or the linkages of the proximal and distal hubs) can be implemented by any of the drive table embodiments described herein.

[0240] In any embodiment disclosed herein, the robotic control system can be configured to move the second hub adapter 4012b independently from the first hub adapter 4012a. Furthermore, in any embodiment having two, three, four, five, or more hub adapters disposed on the drive table 4002, the robotic control system 4000 can be configured such that each of the hub adapters is independently controllable and movable relative to the other hub adapters. For example, without limitation, each of the hub adapters 4012a-d on the drive table 4002 (including, or in some embodiments excluding, the first hub adapter 4012a) can have an independently controllable motor 4030 or other actuator configured to independently move the hub adapter 4012a-d relative to the drive table 4002.

[0241] In an embodiment having a first hub adapter 4012a, a second hub adapter 4012b, a third hub adapter 4012c, and a fourth hub adapter 4012d, the first hub adapter 4012a may be fixed to the drive table 4002, and the second hub adapter 4012b, the third hub adapter 4012c, and the fourth hub adapter 4012d may each have an independently controllable motor 4030 or actuator configured to independently move the second hub adapter 4012b, the third hub adapter 4012c, and the fourth hub adapter 4012d relative to the drive table 4002 and the first hub adapter 4012a.

[0242] In another embodiment having a first hub adapter 4012a, a second hub adapter 4012b, a third hub adapter 4012c, and a fourth hub adapter 4012d, the first hub adapter 4012a, the second hub adapter 4012b, the third hub adapter 4012c, and the fourth hub adapter 4012d may each have an independently controllable motor or actuator configured to independently move the first hub adapter 4012a, the second hub adapter 4012b, the third hub adapter 4012c, and the fourth hub adapter 4012d relative to the drive table 4002. Additionally, any of the embodiments disclosed herein may have a fifth hub adapter 4012 (not shown).

[0243] As described above, in some embodiments, the second hub adapter 4012b, the third hub adapter 4012c, and the fourth hub adapter 4012d can each be configured to move axially relative to the drive table 4002 in response to inputs provided by a user of the robotic control system.

[0244] In some embodiments, one or more of the second hub adapter 4012b, the third hub adapter 4012c, and the fourth hub adapter 4012d can be configured to move axially relative to the drive table 4002 via a linear actuator (e.g., a rack-and-pinion linear actuator) in response to input provided by a user of the robotic control system. Referring to FIG. 19H, the rack-and-pinion arrangement can include a rack (or straight gear) 4032 and a pinion gear 4038 coupled to the shaft of the motor 4030. For example, without limitation, the second hub adapter 4012b can include the motor 4030 and a pinion gear 4038b that can engage with the rack 4032. The third hub adapter 4012c can include the motor 4030 and a pinion gear 4038c that can also engage with the rack 4032. Similarly, the fourth hub adapter 4012d may have a motor and pinion gear that may also engage with rack 4032. Each hub adapter 4012b-d may have its own unique motor and pinion gear to allow independent movement of each hub adapter 4012b-d.

[0245] 19E, in some embodiments, hub adapters 4012b-d are coupled to and capable of axial movement along rails or linear guides 4014a and / or rails or linear guides 4014b. Linear guides 4014a and / or linear guides 4014b can guide and / or constrain hub adapters 4012b-d to move axially (e.g., proximally and distally) along a linear path when moved by a linear actuator.

[0246] In any embodiment, the second hub adapter 4012b, the third hub adapter 4012c, and / or the fourth hub adapter 4012d (and / or any other hub adapters) can be configured to move axially relative to the drive table 4002 using a belt drive system, a lead screw system, a ball screw system, or any other suitable drive system.

[0247] 21 , the hub adapter 4012 (which may be any of the hub adapters described herein) may have a plurality of wheels 4120 (e.g., low friction wheels) configured to move along one or more rails 4124 of the drive table 4102. In some embodiments, one side of the hub adapter 4012 may be spring loaded to facilitate coupling with the rails 4124.

[0248] 21, the hub adapter 4012 can be configured to move axially relative to the drive table 4002 via a linear actuator (e.g., a rack and pinion linear actuator). For example, the second hub adapter 4012 can have a motor and a pinion gear 4026 that can engage with a rack 4028.

[0249] Although only one hub adapter 4012 is shown in Figure 21, one skilled in the art will understand that multiple hub adapters can be used with the embodiment of Figure 21. For example, hub adapters 4012a-d can all be coupled to and move along rails 4124, or hub adapter 4012a can be maintained in a fixed position while hub adapters 4012b-d move along rails 4124 (e.g., if drive table 4102 is a telescoping table). In some embodiments, drive table 4102 does not telescope.

[0250] In some embodiments, the drive table 4102 can be a foldable drive table having two segments connected at a hinge or joint that can be folded together. The connection between the hub adapter 4012 and the rails 4124 described with respect to FIG. 21 can be beneficial to a foldable drive table by allowing for less precise alignment of the rail sections of the rails 4124 that are split at the hinge or joint when folding and unfolding compared to other drive systems.

[0251] In some embodiments, before folding a foldable drive table (such as, for example, drive table 4102), each of the hub adapters 4012 (e.g., hub adapters 4012a-d) coupled to the drive table can be moved to one side (e.g., the proximal side) of the hinge or joint. After the drive table is unfolded, each of the hub adapters 4012 can be moved along the drive table to a desired position.

[0252] 19A, the first hub adapter 4012a can be distal to the second hub adapter 4012b, which can be distal to the third hub adapter 4012c, which can be distal to the fourth hub adapter 4012d. In any embodiment, the second hub adapter 4012b can be axially aligned with the first hub adapter 4012a such that a first interventional device coupled with the first hub and a second interventional device coupled with the second hub are coaxially aligned when the first and second hubs are coupled with the first and second hub adapters 4012a, 4012b, respectively. Additionally, in some embodiments, the third hub adapter 4012c and the fourth hub adapter 4012d can be axially aligned with the first hub adapter 4012a such that the first interventional device coupled with the first hub, the second interventional device coupled with the second hub, the third interventional device coupled with the third hub, and the fourth interventional device coupled with the fourth hub are coaxially aligned with the first interventional device coupled with the first hub when the first, second, third, and fourth hubs are coupled (e.g., magnetically coupled) with the first, second, third, and fourth hub adapters 4012, respectively. As described herein, the first interventional device, the second interventional device, the third interventional device, and the fourth interventional device can be arranged in a concentric stack.

[0253] In some embodiments, the robotic control system 4000 may include a linear actuator 4050 configured to move the drive table 4002 (e.g., relative to the base structure 4004) in response to input provided by a user of the robotic control system. For example, but not limited to, the linear actuator 4050 may include a rack and pinion actuator having a rack (or straight gear) 4052 and a motor 4054, the rack 4052 extending from the proximal end 4002b of the drive table 4002 along most of the length of the drive table 4002, the motor 4054 being supported by the arm 4006 (directly or indirectly, for example, by one or more brackets (e.g., support bracket 4008)), and having a pinion gear 4056 coupled to the shaft of the motor 4054, as shown in FIG. 19G, which may be configured to engage the rack 4052 and move the drive table 4002 axially (e.g., relative to the base structure 4004) in response to input provided by a user of the robotic control system.

[0254] In some embodiments, the rack can extend from the proximal end 4002b of the drive table 4002 along at least or approximately 70% of the length of the drive table 4002, or along at least or approximately 80% of the length of the drive table 4002, or along at least or approximately 60% to 90% or approximately 90% of the length of the drive table 4002. In some embodiments, the drive table 4002 may be configured to be axially movable between a proximal position and a distal position, and the distance between the distal end 4002a of the drive table 4002 at the proximal position and the distal end 4002a of the drive table 4002 at the distal position may be at least 80% or approximately 80%, or at least 70% or approximately 70%, or at least 60% or approximately 60% to 90% or approximately 90% of the length of the drive table 4002 from the proximal end of the drive table 4002 to the distal end of the drive table 4002.

[0255] 19C , the table 4002 can include or be coupled to a rail or linear guide 4058 that can move within a carriage 4060 in response to movement of the table 4002 by the linear actuator 4050. The linear guide 4058 and carriage 4060 can constrain axial (proximal and distal) movement of the table 4002. The carriage 4060 can be part of or coupled to a support bracket 4008. The support bracket 4008 can be coupled to the base structure 4004.

[0256] In some embodiments, as shown in FIGS. 19A-19H , the drive table 4002 is configured to move (e.g., axially) relative to the arm 4006 (e.g., via a linear actuator 4050). In some embodiments, the arm 4006 can be configured to provide additional or alternative axial movement to the drive table 4002. In alternative embodiments, the drive table 4002 can be axially fixed (e.g., does not move axially) relative to a fixed attachment point with the base structure 4004. For example, the drive table 4002 can be coupled at a fixed attachment point with the end of the arm 4006 (e.g., at the fifth joint 4022 in some embodiments), and the arm 4006 can be configured to move the drive table 4002 axially. In such embodiments, the drive table 4002 can be axially fixed relative to the fixed attachment point. In such embodiments, a joint in the robot arm 4006 can be used to provide the desired axial movement. Such an embodiment may be beneficial in allowing easier application of a sterile barrier between the robotic control system 4000 and the patient (e.g., by allowing axial movement without shifting seams that may be covered and uncovered during movement) compared to embodiments in which the drive table 4002 moves axially relative to its attachment point with the arm 4006 and / or base structure 4004.

[0257] In some embodiments, the support bracket 4008 can extend axially distally, away from the distal end 4002a of the drive table 4002, when the drive table 4002 is in the proximal position. As shown in FIG. 19J , the support bracket 4008 can extend to and be coupled to a boss clip 4070 configured to couple to a femoral sheath 4072. The robotic control system can also include an anti-buckling feature 4074 (which can be the same as or similar to any of the anti-buckling features described herein) coupled to the support bracket 4008 at its distal end. The anti-buckling feature 4074 can be configured to stiffen a portion of the interventional device supported by the drive table 4002 that spans from the drive table 4002 to the boss clip 4070 supported by the support bracket 4008. In some embodiments, the support bracket 4008 can be configured to couple the anti-buckling feature to a flexible sheath sleeve, which can be configured to couple to the femoral sheath 4072.

[0258] 20, the support bracket 4008 does not extend to or connect to the boss clip or anti-buckling system. Instead, a separate arm 4076 can be provided to support the boss clip 4070 and / or anti-buckling feature 4074 for the femoral sheath 4072. The arm 4076 can be connected to a surgical bed or ground surface.

[0259] In some embodiments, the control system 4000 can include one or more sensors configured to detect the orientation of the boss clip 4070 and / or sheath 4072 relative to the table 4002 and / or an interventional device coupled thereto. The control system 4000 can be configured to adjust the position of the table 4002 (e.g., the angle, height, lateral position of the table 4002, etc.) to align the interventional device with the boss clip 4070 and / or femoral sheath 4072.

[0260] In some embodiments, any one of the first hub adapter 4012a, the second hub adapter 4012b, the third hub adapter 4012c, and / or the fourth hub adapter 4012d (i.e., in any combination) can include an encoder 4062 configured to provide position data that can be used by a controller of the robotic control system 4000 to determine the position of each of the first hub adapter 4012a, the second hub adapter 4012b, the third hub adapter 4012c, and the fourth hub adapter 4012d. As shown in FIG. 191, the encoder 4062 can be a linear encoder positioned on a surface of the hub adapter 4012. The position data from the encoder 4062 can be used to determine the position of a hub and / or interventional device coupled to the hub adapters 4012a-d relative to the table 4002. Additionally or alternatively, in some embodiments, one of the motors of the hub adapter (e.g., motor 4030) may include an encoder 4062 (e.g., a rotary to linear encoder) that can determine the position of the hub adapter based on detected motor movement.

[0261] In some embodiments, any of the hub adapters 4012a-d may include both a linear encoder positioned on the hub adapter and an encoder in the motor to provide redundancy and to detect errors. For example, if the hub adapter 4012 becomes dislodged from the table 4002, the motor 4030 may still operate without causing movement of the hub adapter 4012 relative to the table. In such an embodiment, the motor encoder may determine that the hub adapter 4012 is moving, while the linear encoder may determine that the hub adapter 4012 is not moving, which may be used for error detection and handling.

[0262] Similarly, one or more encoders can be used to determine the position of the drive table 4002. For example, one or more linear encoders can be positioned along the support bracket 4008. Additionally or alternatively, the motor 4054 can include one or more encoders to determine the position of the table 4002 based on detected motor movement.

[0263] The detected positions of the table 4002 and the detected positions of the hub adapters along the table 4002 can be used to determine the position of each hub adapter relative to a patient reference point.

[0264] As described herein, in any embodiment, the first hub adapter 4012a can include a drive magnet that is coupled to the first hub adapter 4012a and configured to couple with the driven magnet of the first hub (e.g., through a sterile barrier) such that the driven magnet moves in response to movement of the drive magnet, and the second hub adapter 4012b can include a drive magnet that is coupled to the second hub adapter 4012b and configured to couple with the driven magnet of the second hub such that the driven magnet of the second hub moves in response to movement of the drive magnet of the second hub adapter 4012b. The third hub adapter 4012c can include a drive magnet, the drive magnet coupled to the third hub adapter 4012c and configured to couple with the driven magnet of the third hub, such that movement of the drive magnet of the third hub adapter 4012c causes movement of the driven magnet of the third hub, and the fourth hub adapter 4012d can include a drive magnet, the drive magnet coupled to the fourth hub adapter 4012d and configured to couple with the driven magnet of the fourth hub, such that movement of the drive magnet of the fourth hub adapter 4012d causes movement of the driven magnet of the fourth hub.

[0265] In any embodiment, the robotic control system 4000 can include a sensor 4064 coupled to one or more of the hub adapter or the hub and configured to measure the magnitude of a magnetic field above the sensor from the drive magnet of the hub adapter and / or the driven magnet of the hub. For example, without limitation, the sensor 4064 can be a magnetometer. In some embodiments, the drive magnet and driven magnet can be configured to magnetically couple the hub adapter to the hub when the hub is within a predetermined axial distance of the hub adapter.

[0266] In any embodiment disclosed herein, the robot control system 4000 may include a controller or control circuit configured to control the position and movement of the drive table 4002, as well as the second hub adapter 4012b, the third hub adapter 4012c, and the fourth hub adapter 4012d.

[0267] In some embodiments, the arm 4006 can include a first arm segment 4016a coupled directly or indirectly at its proximal end to the base structure 4004, a second arm segment 4016b coupled at its proximal end to the distal end of the first arm segment 4016a, and a third arm segment 4016c coupled at its proximal end to the distal end of the second arm segment 4016b. In some embodiments, the first arm segment 4016a can be coupled to a fixed arm segment 4017 that is rigidly coupled to the base structure 4004.

[0268] In some embodiments, the arm 4006 can include a first joint 4020a at a proximal end of the first arm segment 4016a, a second joint 4020b at a distal end of the first arm segment 4016a, which is also at the proximal end of the second arm segment 4016b, and a third joint 4020c at a distal end of the second arm segment 4016b, where the first arm segment 4016a can be configured to rotate in a horizontal plane about the first joint 4020a, the second arm segment 4016b can be configured to rotate in a horizontal plane about the second joint 4020b, and the third arm segment 4016c can be configured to rotate in a horizontal plane about the third joint 4020c.

[0269] In some embodiments, the robotic control system may include a fourth arm segment 4016d coupled at its proximal end to the distal end of the third arm segment 4016c and may include a fourth joint 4020d at the distal end of the third arm segment 4016c. In some embodiments, the arm 4006 may have three or more or four rotational degrees of freedom. The fourth arm segment 4016d may be configured to rotate in a horizontal plane about the fourth joint 4020d. In some embodiments, the fourth arm segment 4016d may be coupled directly or indirectly at its distal end to the drive table 4002.

[0270] In some embodiments, the first joint 4020a, the second joint 4020b, the third joint 4020c, and / or the fourth joint 4020d (i.e., any combination of joints) can be configured to independently exert torques on the first arm segment 4016a, the second arm segment 4016b, and the third arm segment 4016c, respectively, in response to inputs provided by a user of the robot control system, causing the first arm segment 4016a, the second arm segment 4016b, and the third arm segment 4016c to rotate about the first, second, and third joints 4020, respectively. In some embodiments, the first joint 4020a, the second joint 4020b, and the third joint 4020c can be switched between a passive state and an active state, in which the joints can be freely moved manually by a user, and in which the joints can be controlled by a controller of the robot control system 4000 and are configured to generate torque forces in response to input from a user of the robot control system 4000.

[0271] In any embodiment, the robotic control system 4000 can include a fifth joint 4022 at the distal end of the fourth arm segment 4016d, and the drive table 4002 can be coupled to the fifth joint 4022, which can be configured to rotate the drive table 4002 in a vertical plane about the fifth joint 4022, as described above. In any embodiment, one or more of the joints can have selectable braking elements (not shown) that can be actuated to lock the joint in a fixed position, and the brakes can be manually or electronically actuated.

[0272] In some embodiments, each of the joints 4020 may have an encoder configured to provide position data that may be used by the controller to determine the position of each joint 4020 and the position of the drive table 4002.

[0273] While the hub adapter 4012a is described with respect to various previous embodiments as being maintained in a fixed position relative to the table 4002 (e.g., by being fixedly coupled thereto), in some embodiments, the hub adapter 4012a can be configured to move independently along the table (e.g., using a linear actuator system). In such embodiments, the hub adapter 4012a can be moved along the table 4002 for specific procedural steps. For example, the hub adapter 4012a can be moved proximally along with the hub adapters 4012b-d during an initial setup step so that interventional devices coupled to the hub adapters 4012a-d are maintained in a sterile field during setup. In such embodiments, the control system 4000 can maintain the hub adapter 4012a in a fixed position relative to the table 4002 (e.g., at a distal-most position along the table 4002) during other procedural steps so that the hub adapter 4012a moves with the table 4002.

[0274] An alternative embodiment of a portion of a robotic control system 5000 having a telescoping drive table 5002 is shown in FIGS. 22A-22D. As shown, the telescoping drive table 5002 can include a first table segment 5002a and a second table segment 5002b configured to telescope relative to one another. The second table segment 5002b can be moved axially (e.g., distally and proximally) relative to the first table segment 5002a (e.g., via a linear actuator (e.g., a rack-and-pinion linear actuator, etc.)). For example, the second table segment 5002b can be moved distally from a fully nested configuration shown in FIG. 22A to an extended configuration shown in FIGS. 22C-22D. In some embodiments, the second table segment 5002b can be referred to as an arm, extension, extension member, telescoping member, or actuation beam.

[0275] One or more hub adapters 5012 (which may be any of the hub adapters described herein) may be configured to move along both the first table segment 5002a and the second table segment 5002b. For example, a first linear actuator 5026a (e.g., a rack-and-pinion linear actuator) may be configured to linearly move the hub adapter 5012 along the first table segment 5002a. The hub adapter 5012 may include or be coupled to a first set of wheels 5024a configured to move within channels 5020a of the first table segment 5002a as the hub adapter 5012 moves along the first table segment 5002a. The channels 5020a and wheels 5024a may guide or constrain the movement of the hub adapter 5012 in an axial direction (e.g., distal and proximal movement).

[0276] The second linear actuator 5026b (e.g., a rack and pinion linear actuator) can be configured to linearly move the hub adapter 5012 along the second table segment 5002b. The hub adapter 5012 can include or be coupled to a second set of wheels 5024b, which are configured to move within the channels 5020b of the second table segment 5002b as the hub adapter 5012 moves along the second table segment 5002b. The channels 5020b and wheels 5024b can guide or constrain the movement of the hub adapter 5012 in an axial direction (e.g., distal and proximal).

[0277] In use, when the second table segment 5002b is in the extended position shown in FIGS. 22C-22D relative to the first table segment 5002a, the hub adapter 5012 can be moved distally along the first table segment 5002a via the first linear actuator 5026a with the first set of wheels 5024a engaged in the first channel 5020a. When the hub adapter 5012 reaches the proximal end of the second table segment 5002b, the second linear actuator 5026b can engage the hub adapter 5012 and move the hub adapter 5012 further distally along the second table segment 5002b. In some embodiments, when the second linear actuator 5026b engages the hub adapter 5012, the first linear actuator 5026a can be disengaged from the hub adapter 5012. In some embodiments, when the hub adapter 5012 reaches the proximal end of the second table segment 5002b, the second set of wheels 5024b can engage with the channels 5020b. When the hub adapter 5012 is moved distally beyond the distal end of the first table segment 5002a, the wheels 5024a can disengage from the channels 5020a (e.g., by extending distally beyond the distal end of the channels 5020a).

[0278] Similarly, when the hub adapter 5012 is moved proximally from the second table segment 5002b and reaches the proximal end of the first table segment 5002a, the hub adapter 5012 can disengage from the second table segment 5002b and engage with the first table segment 5002a.

[0279] 22B, one skilled in the art will appreciate that the table can include multiple hub adapters 5012 coupled to various hubs and / or interventional devices (e.g., hubs and interventional devices of the interventional device assembly 2900) that can move along the drive table 5002. In other embodiments, multiple drive tables 5002 can be provided, each capable of facilitating the movement of a different interventional device.

[0280] In certain embodiments, a robotic control system (such as robotic control system 4000) can be used to move the drive table to and from the appropriate position before and after a treatment procedure. For example, robotic control system 4000 can use arm 4006 to move the drive table to and from the appropriate position. The drive table can be a telescoping drive table (e.g., drive table 4002, drive table 5002) that moves axially during a treatment procedure, or a drive table (e.g., drive table 20) that remains stationary during a treatment procedure. A drive table that remains stationary during a treatment procedure can have a greater length. For example, such a drive table can have a length between about 200 cm and about 260 cm, between about 210 cm and about 250 cm, between about 220 cm and about 240 cm, about 200 cm, about 210 cm, about 220 cm, about 230 cm, about 240 cm, about 250 cm, about 260 cm, or any other suitable length.

[0281] 24A-24G illustrate an embodiment of a telescoping drive table 6000. FIG.

[0282] FIG. 24A illustrates a front perspective view of the telescoping drive table 6000. As shown in FIG. 24A, the telescoping drive table 6000 can include a main body portion 6004 and one or more telescoping members 6008A, 6008B. The telescoping members 6008A, 6008B can also be referred to as arms, extensions, extension members, extendable members, table segments, or actuation beams. The main body portion 6004 can further include a support surface 6006 and one or more openings 6007A, 6007B. In some embodiments, the support surface 6006 can be, or form at least a portion of, a sterility barrier. In some embodiments, the telescoping drive table 6000 can further include a separate sterility barrier.

[0283] The telescoping drive table 6000 can be the same as or similar to any of the drive tables described herein. For example, the telescoping drive table 6000 can have any of the same or similar features and / or functionality as the support table 20 or drive table 4002 described above. The telescoping drive table 6000 can transition between two or more lengths. In some embodiments, one or more telescoping members 6008A, 6008B can extend (e.g., proximally and / or distally) from the main body portion 6004. The extension of the one or more telescoping members 6008A, 6008B from the main body portion 6004 can increase the longitudinal length of the telescoping drive table 6000 from a first length to a second length. The second length can include the length of the main body portion 6004 and at least a portion of the one or more telescoping members 6008A, 6008B. In some embodiments, the second length can include the sum of the length of the main body portion 6004 and the length of the one or more telescoping members 6008A, 6008B.

[0284] In some embodiments, the telescoping members 6008A, 6008B can extend from a fully retracted position within the main body portion 6004 to a fully extended position in less than 5 seconds, less than 4 seconds, less than 3 seconds, or less than 2 seconds. This can reduce the time required to perform a procedure or to set up the drive table 6000 to perform a procedure.

[0285] The main body 6004 can form an outer shell or housing of the telescoping drive table 6000 for accommodating internal components. For example, the main body 6004 can include one or more actuators (e.g., linear actuator assemblies, etc.). The main body 6004 can be defined by one or more exterior walls that define an interior cavity. The main body 6004 can have a longitudinal length. The longitudinal length of the main body 6004 can be fixed. The longitudinal length of the main body 6004 can be between 3 feet and 5 feet. For example, in some embodiments, the main body 6004 can have a longitudinal length of 4 feet. The main body 6004 can have a first end and a second end. In some embodiments, the first end can be positioned at a first longitudinal end of the main body portion 6004, and the second end can be positioned at a second longitudinal end of the main body portion 6004 opposite the first end.

[0286] The support surface 6006 can be a surface configured to support one or more hubs and / or interventional devices. In some embodiments, the support surface 6006 can be a superior or upper surface of the main body portion 6004.

[0287] The one or more openings 6007A, 6007B can provide access to an interior cavity of the main body portion 6004. The interior cavity can be defined by the main body portion 6004. In some embodiments, the one or more openings 6007A, 6007B can be sized to accept one or more telescoping members 6008A, 6008B. For example, in certain embodiments, the main body portion 6004 can include a single opening 6007A or 6007B configured to accept a single telescoping member 6008A or 6008B. In other embodiments, the main body portion can include a first opening 6007A configured to accept a first telescoping member 6008A and a second opening 6007B configured to accept a second telescoping member 6008B. In some embodiments, the one or more openings 6007A, 6007B can be positioned at lateral ends of the main body portion 6004. In some embodiments, the one or more openings 6007A, 6007B can be shaped to correspond to the profile of the one or more telescoping members 6008A, 6008B.

[0288] The one or more telescoping members 6008A, 6008B can transition between a folded state and an unfolded state. Transitioning the one or more telescoping members 6008A, 6008B between the folded state and the unfolded state can adjust the overall length of the telescoping drive table 6000. Each of the one or more telescoping members 6008A, 6008B can be sized relative to the main body portion 6004. In some embodiments, each of the one or more telescoping members 6008A, 6008B can be sized to fit within the main body portion 6004. In some embodiments, the one or more telescoping members 6008A, 6008B can have the same structure or share one or more of the same dimensions. For example, each of the one or more telescoping members 6008A, 6008B can have the same longitudinal length. In some embodiments, the one or more telescoping members 6008A, 6008B can have a longitudinal length that is up to half the length of the main body portion 6004. In some embodiments, the telescoping drive table 6000 can include two telescoping members 6008A, 6008B. In some embodiments, the one or more telescoping members 6008A, 6008B can include a first telescoping member 6008A and a second telescoping member 6008B. In some embodiments, the first telescoping member 6008A can extend from a first end of the main body portion 6004 and the second telescoping member 6008B can extend from a second end of the main body portion 6004.

[0289] The main body portion 6004 can slidably receive one or more telescoping members 6008A, 6008B through one or more openings 6007A, 6007B, respectively. Each of the one or more telescoping members 6008A, 6008B can be coupled to a corresponding linear actuator assembly housed within the main body portion 6004, as described in more detail below. The one or more telescoping members 6008A, 6008B can be configured to extend linearly along an axis between a folded state and an unfolded state. In the folded state, the one or more telescoping members 6008A, 6008B can be completely contained within the main body portion 6004, such that the overall length of the telescoping drive table 6000 can be the length of the main body portion 6004. In other embodiments, the one or more telescoping members 6008A, 6008B can be partially contained within the main body portion in the folded state. 24A , the one or more telescoping members 6008A, 6008B can be substantially contained within the main body portion 6004. In the deployed state, the one or more telescoping members 6008A, 6008B can extend linearly away from the main body portion 6004. In some embodiments, the one or more telescoping members 6008A, 6008B can be controlled simultaneously such that the effective length of each of the one or more telescoping members 6008A, 6008B (e.g., the length of the one or more telescoping members 6008A, 6008B extending outside the main body portion 6004) is the same. In some embodiments, the one or more telescoping members 6008A, 6008B can be controlled independently such that the effective length of one of the one or more telescoping members 6008A, 6008B is independent of the effective length of the other one or more telescoping members 6008A, 6008B.

[0290] In some embodiments, the folded state can be used to store the telescoping drive table 6000. In some embodiments, the unfolded state can be used to provide greater length for driving one or more hubs and / or interventional devices during surgery.

[0291] In some embodiments, a sterility barrier may be positioned along or form the upper surface of the telescoping drive table 6000 (e.g., support surface 6006). The sterility barrier may be configured to prevent contamination of the surgical area. The sterility barrier may be a deployable or extendable (e.g., telescoping) sterility barrier. In some embodiments, the sterility barrier may be configured to extend with the one or more telescoping members 6008A, 6008B. In the collapsed state, the sterility barrier may have a length that corresponds to the sum of the length of the main body 6004 and the deployed length of the one or more telescoping members 6008A, 6008B. Thus, the sterility barrier may extend along the combined length of the telescoping drive table 6000. The sterility barrier can advantageously allow the hub to transition from a position above the main body portion 6004 to a position above one of the one or more telescoping members 6008A, 6008B (and vice versa).

[0292] The telescoping drive table 6000 can be either manually controlled or automatically controlled via a control system. In some embodiments, the telescoping drive table 6000 can remain in a folded position until activated prior to a medical procedure. For example, the telescoping drive table 6000 can be transitioned from a folded state to an unfolded state before the patient enters the operating room. Alternatively, the telescoping drive table 6000 can be transitioned from a folded state to an unfolded state after the patient is prepped for surgery and positioned on the operating table. Thus, the telescoping drive table 6000 can advantageously conserve space in the operating room when not in use, and can advantageously be extended when needed during a medical procedure.

[0293] Figure 24B illustrates a front perspective view of the internal components of the telescoping drive table 6000 in a folded position. The telescoping drive table 6000 can be the same as the telescoping drive table 6000 shown and described above with respect to Figure 24A.

[0294] As further shown in FIG. 24B, the main body portion 6004 can have a longitudinal length, shown in FIG. 24B as a first length L1. In some embodiments, the first length L1 of the main body portion 6004 can be between 3 feet and 5 feet. For example, the first length L1 can be 4 feet.

[0295] As further shown in FIG. 24B , the one or more telescoping members 6008A, 6008B can each have a longitudinal length represented by a second length L2 and a third length L3, respectively. In some embodiments, the second length L2 and the third length L3 can be half the length of the first length L1. For example, the second length L2 and the third length L3 can be 2 feet when the first length L1 is 4 feet. In some such embodiments, the one or more telescoping members 6008A, 6008B can be completely contained within the main body portion 6004 in the folded state. Additionally, the one or more telescoping members 6008A, 6008B can be twice the overall length of the telescoping drive table 6000 in the unfolded state. In some embodiments, the second length L2 of the one or more telescoping members 6008 is less than half the first length L1 of the main body portion 6004 (e.g., 1 / 3 of the length L1, 1 / 4 of the length L1, or any other suitable length). In some embodiments, the total length of the table 6000 when the telescoping members 6008A and 6008B are fully extended can be between 1 meter and 2.7 meters.

[0296] 24C-24E illustrate example internal components of the telescoping drive table 6000. The internal components of the telescoping drive table 6000 can include multiple linear actuator assemblies. The multiple linear actuator assemblies can include a first linear actuator assembly 6010, a second linear actuator assembly 6030, and one or more third linear actuator assemblies 6036A, 6036B. The multiple linear actuator assemblies 6010, 6030, 6036A, 6036B can be independently controlled.

[0297] The first linear actuator assembly 6010 can translate along the longitudinal length of the drive table 6000. In some embodiments, the first linear actuator assembly 6010 can translate within the main body portion 6004 and / or one or more telescoping members 6008A, 6008B to provide general positioning of internal components within the telescoping drive table 6000. Thus, the first linear actuator assembly 6010 can advantageously provide access to other internal components along the entire length of the telescoping drive table 6000. For example, the first linear actuator assembly 6010 can translate a shuttle 6012, described in more detail herein, between the two ends of the telescoping drive table 6000. As described in more detail herein, one or more hub adapters 6032 can be coupled to and / or translate along the shuttle 6012. Thus, the first linear actuator assembly 6010 can translate the shuttle 6012 to change the position of one or more of the hub adapters 6032 coupled to the shuttle 6012 and / or enable movement of one or more hub adapters 6032 within the extended portion of the telescoping drive table 6000 (e.g., within the telescoping members 6008A, 6008B) and / or along the entire length of the drive table 6000.

[0298] In some embodiments, the one or more hub adapters 6032 are capable of translating along the shuttle at a rate greater than 80 mm / sec, 100 mm / sec, or 120 mm / sec. In some embodiments, the one or more hub adapters 6032 are capable of translating along the shuttle at a rate of up to between 100 mm / sec and 160 mm / sec, or between 120 mm / sec and 140 mm / sec. In some embodiments, the one or more hub adapters 6032 are capable of translating along the shuttle at a rate of up to 80 mm / sec, 100 mm / sec, 110 mm / sec, 120 mm / sec, 130 mm / sec, 140 mm / sec, 150 mm / sec, or 160 mm / sec.

[0299] The second linear actuator assembly 6030 can translate along and relative to the first linear actuator assembly 6010 and / or along the shuttle 6012. In some embodiments, the second linear actuator assembly 6030 can provide local and / or precise positioning within the telescoping drive table 6000. For example, the second linear actuator assembly 6030 can translate one or more hub adapters 6032 along the shuttle 6012, as described in more detail herein. As described herein, movement of the one or more hub adapters 6032 can cause movement of one or more corresponding hubs along a drive or support surface of the drive table 6000. Thus, the one or more hubs can be translated relative to the first linear actuator assembly 6010 (e.g., via movement of the one or more hub adapters along the shuttle 6012).

[0300] The one or more third linear actuator assemblies 6036A, 6036B can translate the one or more telescoping members 6008A, 6008B between the folded and deployed states described above. For example, each of the third linear actuator assemblies 6036A, 6036B can control one of the one or more telescoping members 6008A, 6008B. In some embodiments, each of the one or more third linear actuator assemblies 6036A, 6036B can be controlled together. In some embodiments, each of the one or more third linear actuator assemblies 6036A, 6036B can be controlled separately.

[0301] In some embodiments, one or more of the telescoping members 6008A and 6008B can be configured to deploy (in response to one or more user inputs) to extend from the main body portion 6004 when setting up the drive table 6000 for a medical procedure. In some embodiments, the telescoping member 6008A can be configured to deploy to allow further distal movement of the shuttle 6012. For example, when distal movement of the shuttle 6012 beyond the distal end of the main body portion 6004 is commanded (e.g., to facilitate distal movement of one or more interventional devices coupled to the hub adapters 6032A-D beyond the distal end of the main body portion 6004), the telescoping member 6008A can extend distally from the main body portion 6008A. In some embodiments, the telescoping member 6008B can be configured to deploy to allow further proximal movement of the shuttle 6012. For example, when proximal movement of the shuttle 6012 beyond the proximal end of the main body portion 6004 is commanded (e.g., to facilitate proximal movement of one or more interventional devices coupled to the hub adapters 6032A-D beyond the proximal end of the main body portion 6004), the telescoping member 6008B can extend proximally from the main body portion 6008A.

[0302] FIG. 24C illustrates a front perspective view of additional internal components of the telescoping drive table 6000. In particular, FIG. 24C illustrates the first linear actuator assembly 6010 and the second linear actuator assembly 6030 contained within the main body portion 6004. The configuration of the internal components as shown in FIG. 24C can be the configuration of the internal components in the folded state. In some embodiments, in the folded state, the first linear actuator assembly 6010 and the second linear actuator assembly 6030 can be positioned within and / or behind one or more telescoping members 6008A, 6008B (not shown). The telescoping drive table 6000 can be the same as the telescoping drive table 6000 shown and described above with respect to FIGS. 24A and 24B.

[0303] The first linear actuator assembly 6010 can include a shuttle 6012, a cable management system 6014, a first screw 6016, a flanged nut 6018, a shuttle bracket 6020, a motor 6022, one or more endpoints 6024A, 6024B, an encoder 6026, and one or more stoppers 6028A, 6028B. The shuttle 6012 can be driven along the length of the first screw 6016 by the flanged nut 6018 and the shuttle bracket 6020. The shuttle bracket 6020 can be coupled to the center of the shuttle 6012. In some embodiments, the shuttle 6012 can be configured to extend beyond the longitudinal length of the main body portion 6004. In some embodiments, the shuttle 6012 can be configured to extend into one or more telescoping members in the deployed state.

[0304] The shuttle 6012 can be a base support for the first linear actuator assembly 6010. In some embodiments, the shuttle 6012 can be generally "U" shaped and have two side walls extending from a horizontal base.

[0305] The cable management system 6014 can further include two walls. The cable management system 6014 can be configured to prevent cables from engaging with moving parts within the telescoping drive table 6000.

[0306] The first screw 6016 can be a feed screw (e.g., a high-efficiency feed screw) with a helical thread extending along the length of the first screw 6016. The first screw 6016 can include a ball configured to provide a rolling motion between the screw axis and a corresponding nut. In some embodiments, the first screw 6016 can be a linear screw. The first screw 6016 can be configured to be rotated about its longitudinal axis.

[0307] The flanged nut 6018 can be a body with a lumen extending through a longitudinal axis of the body. The flanged nut 6018 can include a helical groove extending along the length of the lumen. The helical groove of the flanged nut 6018 can engage with the helical threads of the first screw 6016. The flanged nut 6018 can further include one or more mounting surfaces. The one or more mounting surfaces can further define one or more openings. In some embodiments, the flanged nut 6018 can be configured to traverse along the longitudinal length of the first screw 6016.

[0308] The shuttle bracket 6020 can be a body including two or more mounting surfaces. In some embodiments, the two or more mounting surfaces can define one or more openings. In some embodiments, the shuttle bracket 6020 can be "L" shaped, with a first mounting surface perpendicular to a second mounting surface.

[0309] The motor 6022 can be an electric motor. The motor 6022 can include an output shaft. The output shaft can be configured to rotate in response to an electric current passing through the motor 6022.

[0310] The one or more endpoints 6024A, 6024B can include a support and a bearing. The support can define an opening configured to couple to the bearing. In some embodiments, the one or more endpoints 6024A, 6024B can be two endpoints 6024A, 6024B.

[0311] The encoder 6026 can be any device configured to track a position. In some embodiments, the encoder 6026 can be a rotary encoder configured to track the rotation of the first screw 6016. By tracking the rotation of the first screw 6016, the linear position of the flanged nut 6018 can be determined.

[0312] The one or more stops 6028A, 6028B can be blocks that define a mounting surface. The one or more stops 6028A, 6028B can be formed from a hard material configured to prevent the flanged nut 6018 from passing through the one or more stops 6028A, 6028B. In some embodiments, the one or more stops 6028A, 6028B can include two stops 6028A, 6028B.

[0313] The first screw 6016 can be supported by one or more endpoints 6024A, 6024B. In some embodiments, an end of the first screw 6016 can extend through a bearing of a corresponding one or more endpoints 6024A, 6024B. Thus, the first screw 6016 can extend between the two endpoints 6024A, 6024B. In some embodiments, the first screw 6016 can be coupled to one or more endpoints 6024A, 6024B before being coupled to the motor 6022. In such embodiments, the motor 6022 can be positioned laterally from the one or more endpoints 6024A, 6024B.

[0314] The flanged nut 6018 can be movably coupled to the first screw 6016. A groove in the flanged nut 6018 can engage with the threads of the first screw 6016. The flanged nut 6018 can be configured to be linearly displaced along the first screw 6016 when the first screw 6016 is rotated. The rotational motion of the first screw 6016 can be translated into linear motion of the flanged nut 6018. In some embodiments, the flanged nut 6018 can be installed on the first screw 6016 before the first screw 6016 engages at least one of the one or more endpoints 6024A, 6024B.

[0315] The shuttle bracket 6020 can be coupled to the flanged nut 6018. In some embodiments, a first mounting surface of the shuttle bracket 6020 can be coupled to a mounting surface of the flanged nut 6018. In some embodiments, the first mounting surface of the shuttle bracket 6020 can extend perpendicularly from the flanged nut 6018, and the second mounting surface of the shuttle bracket 6020 can extend orthogonally from the first mounting surface of the shuttle bracket 6020.

[0316] The motor 6022 can be operably coupled to the first screw 6016. In some embodiments, a coupler can couple an output shaft of the motor 6022 to an end of the first screw 6016. The output shaft of the motor 6022 can be coaxial with the first screw 6016. The first screw 6016 can be configured to be rotated by rotation of the output shaft of the motor 6022.

[0317] The one or more endpoints 6024A, 6024B can be further coupled to a surface of the telescoping drive table 6000. In some embodiments, the one or more endpoints 6024A, 6024B can be coupled to a base of the telescoping drive table 6000. Thus, the one or more endpoints 6024A, 6024B can provide a foundation for the first linear actuation assembly 6010.

[0318] An encoder 6026 can be coupled to the first screw 6016. In some embodiments, the encoder 6026 can be coupled to the end of the first screw 6016 opposite the motor 6022. The encoder 6026 can be configured to track the rotation of the first screw 6016 to determine the linear position of the flanged nut 6018. Tracking of the flanged nut 6018 can be used to control the position of the shuttle 6012 within the telescoping drive table 6000. In some embodiments, tracking of the flanged nut 6018 can be used as feedback to a control system.

[0319] The one or more stops 6028A, 6028B can be configured to prevent the flanged nut 6018 from extending beyond a predetermined point. The one or more stops 6028A, 6028B can be coupled to the telescoping drive table 6000. In some embodiments, the one or more stops 6028A, 6028B can be positioned internally relative to the endpoints 6024A, 6024B. Thus, the one or more stops 6028A, 6028B can prevent the flanged nut 6018 from contacting the one or more endpoints 6024A, 6024B.

[0320] The cable management system 6014 can be coupled to the base of the shuttle 6012. Two walls of the cable management system 6014 can extend vertically from the base of the shuttle 6012.

[0321] In some embodiments, the shuttle bracket 6020 can be operably coupled to the base of the shuttle 6012. For example, the second mounting surface of the shuttle bracket 6020 can be coupled to the base of the shuttle 6012. Thus, the shuttle 6012 of the first linear actuator assembly 6010 can be actuated when the shuttle bracket 6020 is linearly actuated along the first screw 6016.

[0322] The first linear actuator assembly 6010 can be oriented longitudinally along the telescoping drive table 6000. In some embodiments, as shown in Figures 24C-24E, a portion of the first linear actuator assembly 6010 can be positioned along the base of the telescoping drive table 6000 and adjacent to a sidewall of the telescoping drive table 6000.

[0323] The second linear actuator assembly 6030 can include one or more hub adapters 6032 and one or more rails 6034. The second linear actuator assembly 6030 can actuate the one or more hub adapters 6032 along the longitudinal length of the shuttle 6012. Thus, the second linear actuator assembly 6030 can actuate the one or more hub adapters 6032 in response to actuation of the first linear actuator assembly 6010. Thus, in some embodiments, actuation of either or both of the first and second linear actuator assemblies can cause movement of the one or more hub adapters. The second linear actuator assembly 6030 can provide precise local positioning of the one or more hub adapters within the telescoping drive table 6000.

[0324] The one or more hub adapters 6032 may have any of the same or similar features and / or functionality as the hub adapter 4012 described above.

[0325] The one or more rails 6034 can each be a horizontally oriented beam. In some embodiments, the one or more rails 6034 can each include a groove along a top and bottom surface of the one or more rails 6034. The one or more rails 6034 can extend along the length of the shuttle 6012.

[0326] The second linear actuator assembly 6030 can be configured to linearly actuate the one or more hub adapters 6032. The one or more rails 6034 can be respectively attached to side walls of the shuttle 6012. In some embodiments, the one or more rails 6034 can be attached to opposing side walls of the shuttle 6012. For example, a first rail of the one or more rails 6034 can be attached to a first wall and a second rail of the one or more rails 6034 can be attached to a second wall opposite the first wall. In some embodiments, the one or more rails 6034 share the same elevation along the shuttle 6012. The one or more hub adapters 6032 can be actuated to translate along the length of the one or more rails 6034. Thus, the one or more hub adapters 6032 can translate between a first end and a second end of the shuttle 6012. In some embodiments, one or more hub adapters 6032 can be confined to a position between the first and second ends of the shuttle 6012 .

[0327] FIG. 24D illustrates a cross-sectional view of FIG. 24C , showing additional internal components of the telescoping drive table 6000. The configuration of the internal components as shown in FIG. 24C can be the configuration of the internal components in the folded state. In particular, FIG. 24D illustrates the first linear actuator assembly 6010 and one or more third linear assemblies 6036A, 6036B. In some embodiments, in the folded state, the first linear actuator assembly 6010 and the third linear actuator assemblies 6036A, 6036B can be contained within and / or behind one or more telescoping members 6008A, 6008B and a shuttle 6012 (not shown). The telescoping drive table 6000 can be the same as the telescoping drive table 6000 shown and described above with respect to FIGS. 24A-24C .

[0328] The first linear actuator assembly 6010 can include the first screw 6016, flanged nut 6018, shuttle bracket 6020, motor 6022, one or more endpoints 6024A, 6024B, encoder 6026, and one or more stops 6028A, 6028B described above. As further shown in FIG. 24D , the first screw 6016 can rotate along its longitudinal axis and drive the flanged nut 6018 along the longitudinal length of the first screw 6016.

[0329] The one or more third linear actuator assemblies 6036A, 6036B can include second screws 6038A, 6038B, flanged nuts 6040A, 6040B, brackets 6042A, 6042B, motors 6044A, 6044B, encoders 6046A, 6046B, and stops 6048A, 6048B, respectively. The one or more telescoping members 6008A, 6008B can be driven by the flanged nuts 6040A, 6040B along the length of the second screws 6038A, 6038B. The brackets 6042A, 6042B can be coupled to an inner edge of one of the one or more telescoping members 6008A, 6008B.

[0330] The second screws 6038A, 6038B, flanged nuts 6040A, 6040B, brackets 6042A, 6042B, motors 6044A, 6044B, encoders 6046A, 6046B, and stoppers 6048A, 6048B can be the same as or similar to the first screw 6016, flanged nut 6018, shuttle bracket 6020, motor 6022, encoder 6026, and stoppers 6028A, 6028B, respectively, described above. In some embodiments, the second screws 6038A, 6038B can be shorter than the first screw 6016. For example, the second screws 6038A, 6038B can be half the length of the first screw 6016. In some embodiments, the second screws 6038A, 6038B can be less than half the length of the first screw 6016.

[0331] The one or more third linear actuator assemblies 6036A, 6036B can be configured to linearly actuate the one or more telescoping members 6008A, 6008B of the telescoping drive table 6000 and translate the one or more telescoping members 6008A, 6008B relative to the main body portion 6004 of the telescoping drive table 6000. In some embodiments, the one or more third linear actuator assemblies 6036A, 6036B can include two third linear actuator assemblies 6036A, 6036B, as shown in FIG. 24D . The two third linear actuator assemblies 6036A, 6036B can mirror each other. For example, the two third linear actuator assemblies 6036A, 6036B can be operated simultaneously to actuate corresponding flanged nuts 6040A, 6040B in opposite directions along corresponding second screws 6038A, 6038B. In some embodiments, the two third linear actuator assemblies 6036A, 6036B can be collinear.

[0332] Figure 24E illustrates a cross-sectional view of the telescoping drive table 6000, showing additional internal components of the telescoping drive table 6000. In particular, Figure 24E illustrates the first linear actuator assembly 6010, the second linear actuator assembly 6030, and one of the one or more third linear actuator assemblies 6036A, 6036B. The telescoping drive table 6000 can be the same as the telescoping drive table 6000 shown and described above with respect to Figures 24A-24D.

[0333] 24E , the second linear actuator assembly 6030 can further include one or more linear slides 6050A, 6050B, a motor mount 6052, one or more motors 6054, a rack 6056, one or more gear trains 6058, an input gear 6060, and an output gear 6062. The one or more linear slides 6050A, 6050B, the motor mount 6052, the one or more motors 6054, the rack 6056, the one or more gear trains 6058, the input gear 6060, and the output gear 6062 can be used to actuate the second linear actuator assembly 6030. The one or more motors 6054 can be individually activated to individually control the translation of the one or more hub adapters 6032 along the longitudinal length of the shuttle 6012.

[0334] The one or more linear slides 6050A, 6050B can engage with at least one of the one or more rails 6034 and guide the one or more hub adapters 6032. The one or more linear slides 6050A, 6050B can be blocks. The one or more linear slides 6050A, 6050B can include a lumen with an internal protrusion. In some embodiments, the lumen can be open on one side, forming a groove. In some embodiments, the geometry of the lumen can correspond to and / or match the external geometry of the one or more rails 6034A, 6034B. In such embodiments, the internal protrusions of the one or more linear slides 6050A, 6050B can fit into the grooves of the one or more rails 6034A, 6034B. In some embodiments, the second linear actuator assembly 6030 can include the same number of linear slides 3050A, 3050B as the number of hub adapters 6032. In some embodiments, the second linear actuator assembly 6030 can include multiple linear slides 6050A, 6050B for each of the one or more hub adapters 6032. For example, the ratio of linear slides 6050A, 6050B to hub adapters 6032 can be 2:1.

[0335] The motor mounts 6052 can secure an individual motor to each of the one or more hub adapters 6032. The motor mounts 6052 can be a plate defining a plurality of openings. In some embodiments, the second linear actuator assembly 6030 can include the same number of motor mounts 6052 as the number of motors 6054. In some embodiments, the second linear actuator assembly 6030 can include the same number of motor mounts 6052 as the number of hub adapters 6032.

[0336] The one or more motors 6054 can provide operating power to each of the one or more hub adapters 6032. The one or more motors 6054 can be actuated to independently control the translation of the one or more hub adapters 6032. The one or more motors 6054 can have any of the same or similar features and / or functionality as the one or more motors 4030 described above. In some embodiments, the second linear actuator assembly 6030 can include a number of motors 6054 equal to the number of hub adapters 6032.

[0337] The rack 6056 can provide a structure for one or more hub adapters 6032 to traverse along the shuttle 6012. The rack 6056 can have any of the same or similar features and / or functionality as the rack 4032 described above.

[0338] The one or more gear trains 6058 can each drive a separate hub adapter along the longitudinal length of the shuttle 6012. The one or more gear trains 6058 can each transfer input motion from one of the one or more motors 6054 to an output gear 6062. In some embodiments, the second linear actuator assembly 6030 can include the same number of gear trains 6058 as the number of hub adapters 6032.

[0339] The input gear 6060 of the one or more gear trains 6058 can include an opening defined by an inner diameter that can correspond to the outer diameter of the output shaft of the corresponding motor 6054.

[0340] The output gear 6062 of the one or more gear trains 6058 may have any of the same or similar features and / or functionality as the pinion gear 4038 described above.

[0341] One or more linear slides 6050A, 6050B can be operably coupled to one or more rails 6034A, 6034B. In some embodiments, the one or more linear slides 6050A, 6050B can be linearly arranged along the one or more rails 6034A, 6034B. In some embodiments, a first set of linear slides 6050A can be slidably coupled along the first rail 6034A. In some embodiments, a second set of linear slides 6050B can be slidably coupled along the second rail 6034B.

[0342] One or more motor mounts 6052 can be coupled to corresponding linear slides 6050A, 6050B. In some embodiments, one or more motor mounts 6052 can be coupled to a first set of linear slides 6050A. In some embodiments, each of the one or more motor mounts 6052 can be coupled to multiple linear slides 6050A, 6050B. For example, each of the one or more motor mounts 6052 can be coupled to two linear slides 6050A.

[0343] The one or more motors 6054 can be coupled to a corresponding motor mount 6052. In some embodiments, the output shaft of the one or more motors 6054 can extend through an opening in the corresponding motor mount 6052. Thus, the one or more motors 6054 can be supported by the linear rails 6034A, 6034B.

[0344] The rack 6056 can be coupled to a side wall of the shuttle 6012. In some embodiments, the rack 6056 can be attached to a first side wall of the shuttle 6012 at a location below the rail 6034A. Thus, movement along the rack 6056 can be relative to the shuttle 6012.

[0345] The one or more gear trains 6058 can be operably coupled to the output shaft and rack 6056 of the corresponding motor 6054. In some embodiments, the input gear 6060 can be operably coupled to the output shaft of the corresponding motor 6054, and the output gear 6062 can be operably coupled to the rack 6056. In some embodiments, the output gear 6062 can be coupled to the input gear 6060. Thus, the one or more gear trains 6058 can transfer the output motion of the corresponding motor 6054 to motion along the rack 6056. The corresponding motion can be relative to the shuttle 6012.

[0346] The one or more hub adapters 6032 can be coupled to corresponding motor mounts 6052. In some embodiments, the bases of the one or more hub adapters 6032 can be operably coupled to the corresponding motor mounts 6052. Additionally and / or alternatively, the one or more hub adapters 6032 can be further coupled to a second set of linear slides 6050B. Thus, the hub adapters 6032 can be supported by all of the one or more rails 6034A, 6034B.

[0347] The second linear actuator assembly 6030 can provide motion within the shuttle 6012. The shuttle 6012 of the first linear actuator assembly can extend through the main body 6004 and the one or more telescoping members 6008 of the telescoping drive table 6000. Thus, the second linear actuator assembly 6030 can be supported by one or more rails 6034A, 6034B and configured to be linearly displaced along the length of the rails 6034A, 6034B via actuation of one or more motors 6045. As mentioned above, in some embodiments, the one or more hub adapters 6032 can be independently actuated.

[0348] The one or more third linear actuator assemblies 6036A, 6036B can further include a plurality of rails 6064 and a plurality of linear slides 6066. The plurality of rails 6064 and the plurality of linear slides 6066 can be used to laterally drive the one or more telescoping members 6008A, 6008B between the collapsed state and the deployed state.

[0349] The rails 6064 can provide structural support for the one or more telescoping members 6008A, 6008B as they transition between the folded and deployed states. Additionally, the rails 6064 can provide a guide or path for the one or more telescoping members 6008A, 6008B to traverse. The rails 6064 can be the same as or substantially similar to the rails 6034A, 6034B described above. The rails 6064 can be oriented horizontally. In some embodiments, the rails 6064 can extend along a longitudinal axis of the telescoping drive table. In some embodiments, the rails 6064 can be attached to the main body 6004. In some embodiments, the rails 6064 extend between a first end of the main body 6004 and a second end of the main body 6004. In some embodiments, multiple rails 6064 can be positioned on the front and rear walls of the main body portion 6004. In some embodiments, the front and rear walls can include one or more rails 6064.

[0350] The plurality of linear slides 6066 can couple the one or more telescoping members 6008A, 6008B to the plurality of rails 6064. The plurality of linear slides 6066 can be the same as or substantially similar to the linear slides 6050A, 6050B described above. The plurality of linear slides 6066 can be coupled to at least one of the one or more telescoping members 6008A, 6008B on one side. The plurality of linear slides 6066 can be coupled to at least one of the plurality of rails on another side. In some embodiments, each of the one or more telescoping members 6008A, 6008B can be operably coupled to the plurality of rails 6064 via the plurality of linear slides 6066.

[0351] The one or more third linear actuator assemblies 6036A, 6036B can be operatively coupled to the one or more telescoping members 6008A, 6008B of the telescoping drive table 6000. In some embodiments, the brackets 6042A, 6042B can be operatively coupled to the bases of the corresponding telescoping members 6008A, 6008B. Thus, the one or more telescoping members 6008A, 6008B can be actuated when the corresponding brackets 6042A, 6042B are linearly actuated along the corresponding second screws 6038A, 6038B.

[0352] The first linear actuator assembly 6010, the second linear actuator assembly 6030, and the one or more third linear actuator assemblies 6036A, 6036B can be oriented longitudinally along the telescoping drive table 6000. In some embodiments, as shown in Figures 24C-24E, the one or more third linear actuator assemblies 6036A, 6036B can be positioned along the base of the telescoping drive table 6000 adjacent to a sidewall of the telescoping drive table 6000 opposite the first linear actuator assembly. Additionally, the one or more third linear actuator assemblies 6036A, 6036B can be positioned below the first and second linear actuator assemblies 6010, 6030.

[0353] 24F-24G illustrate the telescoping drive table 6000 in an unfolded configuration in which the telescoping members 6008A and 6008B extend out from the main body portion 6004. The one or more hub adapters 6032 can include a first hub adapter 6032A, a second hub adapter 6032B, a third hub adapter 6032C, and a fourth hub adapter 6032D. The one or more hub adapters 6032 can be sequentially positioned along the shuttle 6012. In some embodiments, the first hub adapter 6032A can be positioned at the distal end of the shuttle 6012 and the fourth hub adapter 6032D can be positioned at the proximal end, or vice versa.

[0354] As described herein, the shuttle 6012 can be moved axially along the length of the telescoping drive table 6000 (e.g., by the first linear actuator assembly 6010). The shuttle 6012 can be translated between the ends of one or more telescoping members 6008A, 6008B. As shown in FIG. 24F, the shuttle 6012 can be translated to be positioned at least partially within the first telescoping member 6008A. As shown in FIG. 24G, the shuttle 6012 can be translated to be positioned at least partially within the second telescoping member 6008B.

[0355] In some embodiments, the length of the shuttle 6012 can be limited to the length of the main body portion 6004. The shuttle 6012 can be configured to extend along the entire length of the telescoping drive table 6000 when the one or more telescoping members 6008A and 6008B are fully extended (e.g., the combined length of the main body portion 6004 and one or more of the telescoping members 6008A, 6008B).

[0356] In some embodiments, the shuttle 6012 can be translated through the main body portion 6004 and / or the one or more telescoping members 6008A and 6008B, advantageously providing a full range of motion for the one or more hub adapters 6032 along the combined length of the main body portion 6004 and the one or more telescoping members 6008A, 6008B. In some embodiments, the shuttle 6012 can position the hub adapter 6032 in a general position.

[0357] As described above, the one or more hub adapters 6032 are capable of being translated along the length of the shuttle 6012 (e.g., by the second linear actuator assembly 6030). In some embodiments, each of the one or more hub adapters 6032 is capable of being translated along the shuttle 6012 to a local position. Thus, each of the one or more hub adapters 6032 can be precisely positioned within a general location provided by the shuttle 6012. As shown in FIG. 24F, at least some of the hub adapters 6032 are positioned within the telescoping member 6008A at a location distal to the distal end of the main body portion 6004. As shown in FIG. 24G, at least some of the hub adapters 6032 are positioned within the telescoping member 6008B at a location proximal to the proximal end of the main body portion 6004.

[0358] The shuttle 6012 can function similarly to the drive table 4002 described above. In some embodiments, the shuttle 6012 can move to a general position along the length of the telescoping drive table 6000 before the one or more hub adapters 6032 move to a local position along the length of the shuttle 6012. Additionally and / or alternatively, the one or more hub adapters 6032 can move relative to the shuttle 6012 simultaneously with the shuttle 6012 as the shuttle 6012 translates along the length of the telescoping drive table 6000. In some embodiments, the shuttle 6012 can move to adjust the axial position of at least one of the hub adapters 6032 to a desired axial position (e.g., adjust the position of a coupled interventional device to a desired axial position) either while at least one of the hub adapters 6032 is maintained at a fixed position along the shuttle 6012 or while at least one of the hub adapters 6032 moves along the shuttle 6012. Additionally and / or alternatively, one or more hub adapters 6032 may move relative to the shuttle 6012 before the shuttle 6012 translates along the length of the telescoping drive table 6000 .

[0359] In certain embodiments, the telescoping drive table 6000 can be configured to maintain at least one of the one or more hub adapters 6032 in a fixed position relative to a reference point when the shuttle 6012 is moved in a first axial direction by moving at least one of the one or more hub adapters 6032 relative to the shuttle 6012 in a second axial direction opposite the first axial direction when the shuttle 6012 is moved in a first axial direction relative to the reference point. The reference point can be a position along the main body portion 6004 and / or a designated location on the patient (e.g., a thigh access point). Similarly, the telescoping drive table 6000 can be configured to maintain the additional hub adapters 6032 in a fixed position relative to the reference point when the shuttle 6012 is moved. For example, when the shuttle 6012 is moved, such as to move the first hub adapter 6032A (and corresponding interventional device), the position of the second hub adapter 6032B (and corresponding interventional device) relative to the reference point can be maintained or fixed by moving the second hub adapter 6032B along the shuttle 6012 by an equal magnitude or speed compared to the movement of the shuttle 6012 in the opposite direction (e.g., if the movement of the shuttle 6012 is not intended to cause axial movement of the interventional device coupled to the hub adapter 6032B). The third hub adapter 6032C and / or the fourth hub adapter 6032D (and / or any other additional hub adapters) can similarly be maintained in a fixed position relative to the patient reference point when the shuttle 6012 is moved relative to the reference point (e.g., if the movement of the shuttle 6012 is not intended to cause axial movement of the interventional device coupled to the hub adapter 6032C and / or 6032D).

[0360] In some embodiments, in response to user actuation of a controller to move one or more hub adapters 6032, the telescoping drive table 6000 can cause the one or more hub adapters 6032 to adjust their positions relative to one another to correspond to the positions that the one or more hub adapters 6032 would be in if each were independently movable along the entire length of the telescoping drive table 6000 in the absence of the shuttle 6012. For example, in response to a user actuation of a control (e.g., manipulation of a first controller) to distally move an interventional device coupled to the first hub adapter 6032A by moving the shuttle 6012 distally, the telescoping drive table 6000 can adjust the positions of the remaining hub adapters 6032 (e.g., the second hub adapter 6032B, the third hub adapter 6032C, and / or the fourth hub adapter 6032D) so that they move proximally along the shuttle 6012 by an equal magnitude or speed.

[0361] In response to a control action to axially move the first hub adapter 6032A (via movement of the shuttle 6012) and to also axially move one or more of the other hub adapters 6032, the telescoping drive table 6000 can move the other hub adapters 6032 to the same positions relative to the reference point or relative to the first hub adapter 6032A that they would be moved to in the absence of movement of the shuttle 6012. For example, if a user performs a control action to move the first hub adapter 6032A and the second hub adapter 6032B distally by 5 mm, the telescoping drive table 6000 can move the shuttle 6012 distally by 5 mm without moving the second hub adapter 6032B relative to the shuttle 6012. If a user performs a control action to move the first hub adapter 6032A distally 5 mm and the second hub adapter 6032B distally 6 mm, the telescoping drive table 6000 may move the shuttle 6012 distally 5 mm and move the second hub adapter 6032B distally 1 mm along the shuttle 6012, such that the second hub adapter 6032B has moved distally a total of 6 mm relative to the reference point. Alternatively, the telescoping drive table 6000 may move the shuttle 6012 4 mm, the first hub adapter 6032A 1 mm, and the second hub adapter 6032B 2 mm, or any other suitable combination of shuttle 6012 movement and hub adapter movement to translate the hub adapters 6032A and 6032B into position.

[0362] In certain embodiments, the telescoping drive table 6000 can be configured to adjust the position of the hub adapter 6032 along the shuttle 6012 to maintain a desired relative position of an interventional device coupled to the hub adapter 6032 while the shuttle 6012 translates axially. For example, if the shuttle 6012 is translated in a first direction to cause a desired axial translation in the first direction of an interventional device coupled to the hub adapter 6032A relative to the interventional device coupled to the hub adapter 6032B-D, the hub adapters 6032B-D can be translated along the shuttle 6012 in a second direction opposite the first direction to maintain a desired relative positioning of the interventional device coupled to the hub adapter 6032B-D relative to the interventional device coupled to the hub adapter 6032A.

[0363] In certain embodiments, the movements of two or more interventional devices, two or more hubs, and / or two or more hub adapters can be linked when the controlled movement of one or more of the interventional devices, hubs, and / or hub adapters results in a relative position between the interventional devices, interventional device hubs, and / or hub adapters at a distance that is greater than the total available separation distance (e.g., due to the length of the drive surface of the drive table or the length of the shuttle along which the hub adapter translates).

[0364] In some embodiments, linked intervening devices, hubs, and / or hub adapters can include a primary device, hub, and / or hub adapter and one or more secondary devices, hubs, and / or hub adapters. Movement of the primary device, hub, and / or hub adapter can cause movement of the secondary device, hub, and / or hub adapter with the same magnitude and / or speed and in the same direction. Movement of a control to move a secondary device, hub, and / or hub adapter (but not move the primary device, hub, and / or hub adapter) can not move the primary device. In some embodiments, movement of the controller to move the secondary device, hub, and / or hub adapter in a direction that would increase the separation distance between the primary device, hub, and / or hub adapter and the secondary device, hub, and / or hub adapter (but not move the primary device, hub, and / or hub adapter) may not result in movement of either the primary device, hub, and / or hub adapter or the secondary device, hub, and / or hub adapter. In some embodiments, movement of the controller to move the secondary device, hub, and / or hub adapter in a direction that would decrease the separation distance between the primary device, hub, and / or hub adapter (but not move the primary device, hub, and / or hub adapter) may move the secondary device without moving the primary device, hub, and / or hub adapter and / or may unlink the secondary device, hub, and / or hub adapter from the primary device, hub, and / or hub adapter.

[0365] During some procedures, a user may perform a control action intended to move a distal-most interventional device (e.g., a guide catheter) coupled to the first hub adapter 6032A distally relative to a proximal-most interventional device (e.g., a guidewire) (e.g., coupled to the fourth hub adapter 6032D) a distance that results in a distance between the first hub adapter 6032A and the fourth hub adapter 6032D that is greater than the combined length of the shuttle 6012. As described above, when a user performs a control action to move the shuttle 6012 and the first hub adapter 6032A distally, the telescoping drive table 6000 may adjust the position of the fourth hub adapter 6032D by moving the fourth hub adapter 6032D proximally (preferably by an equal magnitude or speed). In some procedures, the shuttle 6012 may be able to move distally a greater amount than the fourth hub adapter 6032D can move proximally. In other words, while adjusting in response to movement of the shuttle 6012, the fourth hub adapter 6032D may reach a proximal-most position along the shuttle 6012 and be prevented from further movement while the shuttle 6012 continues to move distally. In response, the telescoping drive table 6000 may compensate by temporarily linking the movement of the fourth hub adapter 6032D with the movement of the first hub adapter 6032A such that the fourth hub adapter 6032D moves synchronously with the first hub adapter 6032A.

[0366] For example, when linked, if the first hub adapter 6032A is moved distally by the shuttle 6012 moving distally, the fourth hub adapter 6032D can move distally by the same amount and / or at the same speed. In this situation, the fourth hub adapter 6032D can move distally by the same amount and / or at the same speed as the first hub adapter 6032A by maintaining its position over the shuttle 6012 while the shuttle 6012 moves distally. Similarly, if the first hub adapter 6032A is moved proximally by the shuttle 6012 moving proximally, the fourth hub adapter 6032D can move proximally by the same amount and / or at the same speed. In this situation, the fourth hub adapter 6032D can move proximally by the same amount and / or at the same speed as the first hub adapter 6032A by maintaining its position on the shuttle 6012 while the shuttle 6012 moves proximally.

[0367] In some embodiments, the fourth hub adapter 6032D can be unlinked from the first hub adapter 6032A in response to user manipulation of a control for the fourth hub adapter 6032D to move the fourth hub adapter 6032D independently, or in response to another user input (e.g., adapted to adjust in response to movement of the first hub adapter 6032A). In certain embodiments, while the first hub adapter 6032A and the fourth hub adapter 6032D are linked, the telescoping drive table 6000 can track a desired relative position of the fourth hub adapter 6032D with respect to the first hub adapter 6032A and / or with respect to a reference point, and can adjust the fourth hub adapter 6032D to the desired position once sufficient space becomes available along the shuttle 6012.

[0368] Linking the distal-most hub adapter (e.g., the first hub adapter 6032A) and the proximal-most hub adapter (e.g., the fourth hub adapter 6032D) can allow for a shorter shuttle 6012. By way of example, in certain embodiments, the length of the shuttle 6012 can be approximately 130 cm long. The distal-most interventional device (e.g., a guide catheter) can have a length of approximately 127 cm. The length of the section of the distal-most interventional device that overlaps the drive shuttle 6012 (e.g., when coupled to a hub coupled to the distal-most hub adapter (e.g., the first hub adapter 6032A)) can be approximately 3 cm. The proximal-most interventional device (e.g., a guidewire) can have a length of approximately 265 cm. The section of the proximal-most interventional device can, in some embodiments, extend proximally from the proximal end of the proximal-most hub coupled to the proximal-most hub adapter (e.g., the fourth hub adapter 6032D). For example, in certain embodiments, the section of the most proximal interventional device can extend between about 2 cm and about 20 cm, between about 5 cm and about 15 cm, or about 10 cm from the proximal end of the most proximal hub. In some embodiments, the most proximal hub can extend proximally from the proximal end of the shuttle 6012 by about 2.5 cm at its most proximal position. In certain embodiments, the most proximal end of the most proximal interventional device can be positioned proximally from the proximal end of the shuttle 6012 by a distance of between about 4.5 cm and about 22.5 cm, between about 7.5 cm and about 17.5 cm, or about 12.5 cm when the most proximal hub adapter is in its most proximal position. In the initial configuration, the most distal end of the most proximal interventional device can be proximal to the most distal end of the most distal interventional device.

[0369] While linking of hub adapters is described herein, those skilled in the art will appreciate that corresponding hubs and / or corresponding intervening devices can also be linked. As described herein with respect to hub adapters, linked hubs and / or linked intervening devices can move in the same direction with the same magnitude and / or speed.

[0370] Although discussed with respect to the shuttle 6012, the linkages of the drive table's hub adapters and / or hubs (e.g., the linkages of the proximal and distal hub adapters and / or the linkages of the proximal and distal hubs) can be implemented by any of the shuttle 6012 embodiments described herein.

[0371] As described herein, the telescoping drive table 6000 can be configured such that each of the hub adapters 6032A-D is independently controllable and movable relative to the other hub adapters. For example, and without limitation, each of the hub adapters 6032 on the shuttle 6012 can have an independently controllable motor 6054 or other actuator configured to independently move the hub adapter 6032 relative to the shuttle 6012.

[0372] Alternatively, in some embodiments, the position of one of the hub adapters (e.g., the first hub adapter 6032A) may be fixed relative to the shuttle 6012. For example, in an embodiment having a first hub adapter 6032A, a second hub adapter 6032B, a third hub adapter 6032C, and a fourth hub adapter 6032D, the first hub adapter 6032A may be fixed to the shuttle 6012, and the second hub adapter 6032B, the third hub adapter 6032C, and the fourth hub adapter 6032D may have independently controllable motors 6054 or actuators configured to independently move the second hub adapter 6032B, the third hub adapter 6032C, and the fourth hub adapter 6032D relative to the shuttle 6012 and the first hub adapter 6032A, respectively.

[0373] As described above, in some embodiments, one or more of the first hub adapter 6032A, the second hub adapter 6032B, the third hub adapter 6032C, and the fourth hub adapter 6032D can each be configured to move axially relative to the shuttle 6012 in response to input provided by a user of the telescoping drive table 6000.

[0374] In some embodiments, one or more of the first hub adapter 6032A, the second hub adapter 6032B, the third hub adapter 6032C, and the fourth hub adapter 6032D can be configured to move axially relative to the shuttle 6012 via a linear actuator (e.g., a rack-and-pinion linear actuator) in response to input provided by a user of the telescoping drive table 6000. The rack-and-pinion arrangement can include a rack 6056 (or straight gear) and a pinion gear (e.g., an output gear 6062) coupled to the shaft of the motor 6054. For example, and without limitation, the second hub adapter 6032B can include a motor 6054B and an output gear 6062B that can engage the rack 6056. The third hub adapter 6032C can include a motor 6054C and an output gear 6062C that can engage the rack 6056. Similarly, a fourth hub adapter 6032D can have a motor 6054D and output gear 6062D that can also engage the rack 6056. Each hub adapter 6032 can have its own unique motor 6054 and output gear 6062 to allow independent movement of each hub adapter 6032.

[0375] In certain embodiments, the drive table 6000 can be configured to move the shuttle 6012 in certain circumstances instead of or in addition to moving one or more of the hub adapters 6032A-D. For example, the movement of the shuttle 6012 and the hub adapters 6032A-D can be controlled by a control system (e.g., operating using one or more algorithms to control the movement of the shuttle 6012 and the hub adapters 6032A-D). For example, in certain embodiments, the shuttle 6012 can be configured to move distally when the distal-most hub adapter 6032A reaches a distal-most position along the shuttle 6012 and further distal movement of the hub adapter 6032A is commanded (e.g., to cause further distal movement of an interventional device coupled to the hub adapter 6032A). In some embodiments, the shuttle 6012 can be configured to move proximally when the proximal-most hub adapter 6032D reaches a proximal-most position along the shuttle 6012 and further proximal movement of the hub adapter 6032D is commanded (e.g., to cause further proximal movement of an interventional device coupled to the hub adapter 6032D). In some embodiments, as described herein, the shuttle 6012 can not move proximally in response to the proximal-most hub adapter 6032D reaching a proximal-most position along the shuttle 6012 if further proximal movement of the hub adapter 6032D would cause undesired proximal movement of the distal-most hub adapter 6032A (e.g., when the distal-most hub adapter 6032A is at the distal-most position along the shuttle 6012). Instead, the proximal-most hub adapter 6032D can be temporarily linked to the distal-most hub adapter 6032A, as described herein.

[0376] In some embodiments, shuttle 6012 can be configured to move in a particular direction in response to a command (e.g., a control signal) that commands a plurality or majority of hub adapters 6032A-D coupled to shuttle 6012 to move in a particular direction.

[0377] 24F-24G, the top surface of the one or more telescoping members 6008A, 6008B can be vertically offset from the top surface of the main body portion 6004. The sterility barrier can extend from the top surface of the main body portion 6004 to the ends of the one or more telescoping members 6008A, 6008B. The sterility barrier can form the support surface 6006.

[0378] In some embodiments, the sterility barrier can provide a transition between the one or more telescoping members 6008A, 6008B and the main body portion 6004, providing a continuous surface along which the one or more hubs magnetically coupled to the hub adapters can translate. The sterility barrier can prevent the one or more driven hubs from getting stuck, dislodging, or displaced on the one or more telescoping members 6008A, 6008B. In some embodiments, the ends of the sterility barrier can be coupled to each end of the telescoping members 6008A, 6008B. In such embodiments, the sterility barrier can be extended when the telescoping members 6008A, 6008B are deployed. In some embodiments, the sterility barrier can be coupled to the ends of the telescoping members 6008A, 6008B via adhesive strips, double-sided tape, magnets, and / or other fastening means. The sterility barrier can be retractable.

[0379] 24H illustrates an embodiment of a deployable sterility barrier 6070 for the telescoping drive table 6000. The deployable sterility barrier 6070 can include a main section 6072, one or more deployable sections 6074A, 6074B, an upper guide 6076, a lower guide 6078, and a collection or gutter wall 6080.

[0380] The main section 6072 of the deployable sterility barrier 6070 can extend along the length of the main body portion 6004 of the telescoping drive table 6000. In some embodiments, the main section 6072 can have a static length. For example, the main section 6072 can have a constant length L1 that corresponds to the length of the main body portion 6004.

[0381] The one or more deployable sections 6074A, 6074B of the deployable sterility barrier 6070 can extend distally and proximally, respectively, from the end of the main section 6072. The one or more deployable sections 6074A, 6074B can have a static length. For example, the one or more deployable sections 6074A, 6074B can have a fixed length L2, L3, respectively, that corresponds to the length of the one or more telescoping members 6008A, 6008B. In some embodiments, the one or more deployable sections 6074A, 6074B can extend from a folded state to an deployed state. In the folded state, the one or more deployable sections 6074A, 6074B can be folded over the main section 6072. For example, the deployable sections 6074A, 6074B can be folded about a hinge 6075. In the deployed state, the one or more deployable sections 6074A, 6074B can be unfolded (eg, about hinges 6075) and extend linearly from the ends of the main section 6072.

[0382] In some embodiments, the one or more deployable sections 6074A, 6074B can be deployed when the one or more telescoping members 6008A, 6008B are in the deployed position such that the one or more deployable sections 6074A, 6074B can extend along a corresponding one of the one or more telescoping members 6008A, 6008B. In the deployed state, the one or more deployable sections 6074A, 6074B can advantageously provide a continuous surface along which the one or more driven hubs 6013 can translate. Thus, a difference in planar surface between the upper surface of the one or more telescoping members 6008A, 6008B and the upper surface of the main body portion 6004 can unhinder the one or more driven hubs 6013 from translating from one end of the telescoping table 6000 to the other in the deployed state.

[0383] The upper guide 6076 can be a linear protrusion along the length of the deployable sterile barrier 6070. The upper guide 6076 can be configured to prevent the one or more driven hubs 6013 from rotating or otherwise being unintentionally displaced (e.g., laterally) along the deployable sterile barrier 6070.

[0384] The lower guide 6078 can similarly be a linear protrusion extending along the length of the deployable sterile barrier 6070. The lower guide 6078 can be configured to prevent the one or more driven hubs 6013 from rotating or otherwise being unintentionally displaced along the deployable sterile barrier 6070. In some embodiments, the upper guide 6076 and the lower guide 6078 can be implemented to define a channel along which the one or more driven hubs 6013 can be driven by a corresponding hub adapter 6032. In other embodiments, the channel can be recessed into the sterile barrier 6070 and / or recessed into the drive table 6000 below the sterile barrier 6070.

[0385] The gutter wall 6080 can be a linear protrusion extending along the length of the deployable sterility barrier 6070. The gutter wall 6080 can be configured to support an interventional device. In some embodiments, one or more interventional devices can be decoupled from the one or more driven hubs. The collection wall 6080 can be configured to support one or more interventional devices in an inactive state.

[0386] A deployable sterility barrier 6070 can be positioned between the upper surface of the drive table 6000 and one or more driven hubs 6013. Additionally, a deployable sterility barrier 6070 can be positioned between one or more hub adapters 6032 and one or more corresponding driven hubs 6013.

[0387] The main section 6072 of the deployable sterility barrier 6070 can be secured to the main body 6004 of the deployable sterility barrier. In some embodiments, the main section 6072 can be fixedly secured to the main body 6004. For example, the main section 6072 can be fixedly secured to the main body 6004 via bonding and / or adhesive (e.g., double-sided adhesive tape). Additionally and / or alternatively, the deployable sterility barrier 6070 can be removably secured to the main body 6004 via mechanical fasteners. For example, the main section 6072 can be removably secured to the main body 6004 via a magnetic coupling, nuts and bolts, hook-and-loop fasteners, and / or by sliding the deployable sterility barrier 6070 into a mating surface of the main section 6072.

[0388] As further shown in FIG. 24H , the telescoping drive table 6000 can include a first rail 6082 and a second rail 6084. The first rail 6082 can extend along the length of the main body portion 6004, and the second rail 6082 can extend along the width of the one or more telescoping members 6008A, 6008B. In some embodiments, the first rail 6082 and the second rail 6084 can each provide a gripping surface for interacting with the telescoping drive table 6000. In some embodiments, one or both of the first rail 6082 and the second rail 6084 can be gripped by a user and manipulated to move the drive table 6000 superiorly, inferiorly, proximally, distally, and / or laterally. For example, in some embodiments, the rail 6082 can be used for vertical movement (e.g., superior and inferior movement). In some embodiments, the second rail 6084 can be used for horizontal movement in the proximal or distal direction, hi some embodiments, the rail 6082 can be used for horizontal movement transverse to the longitudinal axis of the drive table 6000 (e.g., from the proximal axis to the distal axis).

[0389] Angular drive table: 25-29 illustrate an embodiment of an angled drive table 7000 that includes an angled support surface for supporting one or more hubs.

[0390] Figure 25 illustrates an angled drive table 7000 set up in an operating room with a sterile barrier 7070 and an operating table 7072. As shown in Figure 25, the robotic surgical system can further include a monitor 7074 and fluid 7076.

[0391] The angled drive table 7000 may include an angled support surface 7006 for supporting one or more hubs 7013. The angled support surface 7006 may further include an upper surface 7007.

[0392] The angled drive table 7000 can provide support for driving interventional devices and access systems relative to a patient, as described herein. The angled drive table 7000 can include any of the same or similar features and / or functionality as any of the drive tables described. For example, the angled drive table 7000 can include any of the same or similar features and / or functionality as the drive support table 20 or the telescoping drive table 6000 described above. For example, the angled drive table 7000 can include one or more telescoping members, such as telescoping member 6008 as described with respect to drive table 6000.

[0393] The drive table 7000 can include an elongated frame extending between a proximal end and a distal end. At least one support table support can be provided to stabilize the drive table 7000 relative to a patient (not shown). The support can further include one or more legs or preferably articulating arms configured to allow movement and positioning of the frame on or adjacent to the patient. In some embodiments, the angled drive table 7000 can include any of the same or similar features and / or functionality as any of the drive tables described herein with an angled top surface.

[0394] In some embodiments, the angled support surface 7006 can include any of the same or similar features and / or functionality as the above-described support surface 104 or support surface 6006. The angled support surface 7006 can be configured to support one or more hubs 7013. The one or more hubs 7013 can include any of the same and / or similar features as any of the hubs described herein. For example, in certain embodiments, the one or more hubs 7013 can include a guide catheter hub, a treatment catheter hub, an access catheter hub, and / or a guidewire hub.

[0395] In some embodiments, the angled support surface 7006 can be a substantially planar surface. The angled support surface 7006 can be defined by one or more segments. In some embodiments, the angled support surface 7006 can be a single body spanning the length of the angled drive table 7000. In some embodiments, the angled support surface 7006 can be formed by multiple...

Claims

1. A drive table, - a main body part; an extendable member configured to be at least partially received within the main body portion and extendable from a proximal or distal end of the main body portion; a drive table including: one or more hub adapters coupled to the drive table; Including, each of the one or more hub adapters is configured to be coupled to a corresponding hub, such that axial movement of each of the one or more hub adapters drives axial movement of the corresponding hub, the one or more hub adapters including a first hub adapter configured to be coupled to a first hub, such that axial movement of the first hub adapter drives axial movement of the first hub, and the first hub adapter is configured to translate from a first axial position within the main body to a second axial position within the extendable member, beyond the proximal end or the distal end of the main body.

2. 2. The robotic drive system of claim 1, wherein the first hub adapter is configured to drive movement of the first hub from a first axial position on a drive surface of the main body to a second axial position on a drive surface of the extendable member.

3. The robotic drive system of claim 1 , wherein the first hub is a guide catheter hub.

4. One or more of the hub adapters include: a second hub adapter configured to be coupled to the treatment catheter hub; a third hub adapter configured to be coupled to the access catheter hub; The robot drive system of claim 3 , comprising:

5. The robotic drive system of claim 4 , wherein the one or more hub adapters include a fourth hub adapter configured to couple to a guidewire hub.

6. The robotic drive system of claim 3 , wherein the extendable member is extendable from the distal end of the main body portion.

7. The robotic drive system of claim 1 , wherein the first hub is a guidewire hub.

8. The robotic drive system of claim 7 , wherein the extendable member is extendable from the proximal end of the main body portion.

9. 10. The robotic drive system of claim 1, further comprising a shuttle configured to move axially through the main body and the extendable member, wherein one or more of the hub adapters are configured to move axially along the shuttle.

10. The drive table is a first linear actuator assembly configured to control axial movement of the shuttle within the main body and the extendable member; a second linear actuator assembly configured to control axial movement of one or more of the hub adapters relative to the shuttle; a third linear actuator assembly configured to control axial movement of the extendable member; The robot drive system of claim 9 , comprising:

11. The robotic drive system of claim 9 , further comprising a cable management system configured to position one or more cables within an interior section of the shuttle.

12. 12. The robotic drive system of claim 11, further comprising one or more motors configured to drive one or more of the hub adapters axially along the shuttle, and wherein the cable management system is configured to prevent engagement of one or more of the cables with one or more of the motors.

13. 2. The robotic drive system of claim 1, wherein the extendable member is a first extendable member, the first extendable member extendable from the distal end of the main body portion, and the drive table further includes a second extendable member extendable from the proximal end of the main body portion.

14. 14. The robotic drive system of claim 13, wherein the first extendable member and the second extendable member each have a length that is approximately half the length of the main body portion.

15. 14. The robotic drive system of claim 13, wherein the one or more hub adapters include a second hub adapter for translating from a first axial position within the main body portion, beyond the proximal end of the main body portion, to a second axial position within the second extendable member.

16. a base structure; an arm coupled to the base structure and the drive table, the arm configured to move the drive table axially and / or vertically relative to the base structure; The robot drive system of claim 1 further comprising:

17. The robotic drive system of claim 1 , wherein the drive table includes a drive surface oriented at an angle relative to a horizontal plane.

18. 1. A method of driving an interventional device assembly, comprising: axially advancing an extendable member from a proximal end or a distal end of a main body portion of the drive table; axially advancing a hub adapter from a first axial position within the main body portion, past the proximal end or the distal end of the main body portion, to a second axial position within the extendable member, the hub adapter configured to couple to a corresponding hub such that axial movement of the hub adapter drives axial movement of the corresponding hub; A method comprising:

19. 20. The method of claim 18, wherein the hub adapter is configured to drive movement of the hub from a first axial position on a drive surface of the main body to a second axial position on a drive surface of the extendable member.

20. The method of claim 18, wherein the hub is a guide catheter hub.

21. the hub adapter is a first hub adapter, and the method includes: axially advancing a second hub adapter configured to be coupled to the access catheter; axially advancing a third hub adapter configured to be coupled to a treatment catheter; 21. The method of claim 20, further comprising:

22. 22. The method of claim 21, further comprising axially advancing a fourth hub adapter configured to be coupled to the guidewire hub.

23. 21. The method of claim 20, wherein the extendable member is extendable from the distal end of the main body portion.

24. The method of claim 18 , wherein the hub is a guidewire hub.

25. 25. The method of claim 24, wherein the extendable member is extendable from the proximal end of the main body portion.

26. 20. The method of claim 18, further comprising a shuttle configured to move axially through the main body and the extendable member, the hub adapter configured to move axially along the shuttle.

27. The drive table is a first linear actuator assembly configured to control axial movement of the shuttle within the main body and the extendable member; a second linear actuator assembly configured to control axial movement of the hub adapter relative to the shuttle; a third linear actuator assembly configured to control axial movement of the extendable member; 27. The method of claim 26, comprising:

28. 27. The method of claim 26, wherein the drive table further comprises a cable management system configured to position one or more cables within an interior section of the shuttle.

29. 29. The method of claim 28, wherein the drive table further includes a motor configured to drive the hub adapter axially along the shuttle, and the cable management system configured to prevent engagement of one or more of the cables with the motor.

30. 20. The method of claim 18, wherein the extendable member is a first extendable member, the first extendable member extendable from the distal end of the main body portion, the method further comprising axially advancing a second extendable member from the proximal end of the main body portion of the drive table.

31. 31. The method of claim 30, wherein the first extendable member and the second extendable member each have a length that is approximately half the length of the main body portion.

32. 31. The method of claim 30, wherein the hub adapter comprises a first hub adapter, the method further comprising axially advancing a second hub adapter from a first axial position within the main body portion, beyond the proximal end of the main body portion, to a second axial position within the second extendable member.

33. 20. The method of claim 18, further comprising moving the drive table axially and / or vertically relative to the base structure by an arm coupled to the base structure.

34. The method of claim 18 , wherein the drive table includes a drive surface oriented at an angle relative to a horizontal plane.

35. a drive table including a support surface oriented at an angle relative to a horizontal plane; one or more hub adapters coupled to the drive table; Including, each of the one or more hub adapters is connectable to a corresponding one of the one or more hubs, and each hub is connectable to an interventional device of the one or more interventional devices; The support surface is positioned between one or more of the hub adapters and a corresponding one of the hubs.

36. 36. The robotic drive system of claim 35, wherein the support surface is oriented between 20 and 70 degrees from the horizontal plane.

37. 37. The robotic drive system of claim 36, wherein the support surface is oriented at 55 degrees from the horizontal plane.

38. 36. The robotic drive system of claim 35, wherein each of the one or more hub adapters is magnetically coupleable with a corresponding one of the hubs.

39. 36. The robotic drive system of claim 35, wherein the drive table includes a main body portion and one or more extendable members.

40. 40. The robotic drive system of claim 39, wherein one or more of the extendable members are configured to transition between a collapsed state and an deployed state.

41. 36. The robotic drive system of claim 35, wherein at least a portion of at least one of the one or more hubs is configured to extend laterally and inferiorly relative to a lower edge of the support surface when the hub is positioned on the support surface.

42. 36. The robotic drive system of claim 35, wherein at least one of the one or more interventional devices is configured to be positioned laterally and inferiorly relative to a lower edge of the support surface when the hub to which the interventional device is coupled is positioned above the support surface.

43. a drive table; a shuttle configured to move axially within the drive table; one or more hub adapters coupled to the shuttle; Including, one or more hub adapters configured to move axially along the shuttle, each of the one or more hub adapters configured to be coupled to a corresponding hub, such that axial movement of each of the one or more hub adapters drives axial movement of the corresponding hub.

44. One or more of the hub adapters include: a first hub adapter configured to be coupled to a guide catheter hub; a second hub adapter configured to be coupled to the treatment catheter hub; a third hub adapter configured to be coupled to the access catheter hub; 44. The robotic drive system of claim 43, comprising:

45. 45. The robotic drive system of claim 44, wherein the one or more hub adapters further include a fourth hub adapter configured to couple to a guidewire hub.

46. 44. The robotic drive system of claim 43, wherein each of the one or more hub adapters is configured to be magnetically coupled to a corresponding one of the hubs through a sterile barrier.

47. a first linear actuator assembly configured to control axial movement of the shuttle; a second linear actuator assembly configured to control axial movement of one or more of the hub adapters relative to the shuttle; 44. The robotic drive system of claim 43, further comprising:

48. 44. The robotic drive system of claim 43, further comprising a cable management system configured to position one or more cables within an interior section of the shuttle.

49. 49. The robotic drive system of claim 48, further comprising one or more motors configured to drive one or more of the hub adapters axially along the shuttle, and wherein the cable management system is configured to prevent engagement of one or more of the cables with one or more of the motors.

50. 44. The robotic drive system of claim 43, wherein movement of a most proximal hub adapter of one or more hub adapters is configured to be temporarily linked to a most distal hub adapter of the plurality of hub adapters such that the most proximal hub adapter and the most distal hub adapter move in the same direction and at the same speed.

51. 44. The robotic drive system of claim 43, further comprising a control system configured to control movement of the shuttle and one or more of the hub adapters in response to user input.

52. 52. The robotic drive system of claim 51 , wherein the control system is configured to axially translate the shuttle a first distance in a first direction in response to a user input to move a first hub adapter in the first direction.

53. 53. The robotic drive system of claim 52, wherein the control system is configured to, in response to the user input to move the first hub adapter in the first direction, axially move a second hub adapter a second distance in a second direction opposite the first direction, the second distance being the same as the first distance.

54. 52. The robotic drive system of claim 51 , wherein the one or more hub adapters include a first hub adapter and a second hub adapter, and the control system is configured to temporarily link movement of the first hub adapter and the second hub adapter so that the first hub adapter and the second hub adapter move at the same speed and in the same direction in response to user input to move one or both of the first hub adapter and the second hub adapter, and such that an axial distance between the first hub adapter and the second hub adapter is greater than an axial length of the shuttle.

55. The drive table is a main body portion; an extendable member configured to be at least partially received within the main body portion and extendable from a proximal end or a distal end of the main body portion; 44. The robotic drive system of claim 43, comprising:

56. 56. The robotic drive system of claim 55, wherein the shuttle is configured to translate from a first axial position to a second axial position within the main body portion, wherein in the second axial position at least a portion of the shuttle is positioned within the extendable member, beyond the proximal end or the distal end of the main body portion.

57. 56. The robotic drive system of claim 55, wherein the extendable member is a first extendable member, the first extendable member extendable from the distal end of the main body portion, and the drive table further includes a second extendable member extendable from the proximal end of the main body portion.

58. 58. The robotic drive system of claim 57, wherein the first extendable member and the second extendable member each have a length that is approximately half the length of the main body portion.

59. 58. The robotic drive system of claim 57, wherein the shuttle is configured to translate from a first axial position to a second axial position within the main body portion, wherein in the second axial position at least a portion of the shuttle is positioned beyond the distal end of the main body portion and within the first extendable member.

60. 58. The robotic drive system of claim 57, wherein the shuttle is configured to translate from a first axial position within the main body to a second axial position wherein at least a portion of the shuttle is positioned beyond the proximal end of the main body and within the second extendable member.

61. 58. The robotic drive system of claim 57, wherein the shuttle is configured to translate from a first axial position to a second axial position, wherein at least a portion of the shuttle is positioned within the first extendable member distal to the main body, and wherein at least a portion of the shuttle is positioned within the second extendable member proximal to the main body, in the first axial position.

62. a base structure; a drive table coupled to the base structure and configured to rotate between at least a first position and a second position; Including, 1. A robotic drive system, wherein in the first position, a longitudinal axis of the drive table is oriented at a first angle with respect to a ground surface, and in the second position, the longitudinal axis of the drive table is oriented at a second angle with respect to the ground surface, the second angle being different from the first angle.

63. 63. The robotic drive system of claim 62, wherein the longitudinal axis of the drive table in the second position is perpendicular to the longitudinal axis of the drive table in the first position.

64. 64. The robotic drive system of claim 63, wherein the longitudinal axis of the drive table is parallel to the ground surface in the first position.

65. 65. The robotic drive system of claim 64, wherein the drive table includes a planar drive surface that extends in a horizontal plane.

66. 63. The robotic drive system of claim 62, further comprising an arm coupled to the base structure and the drive table, the arm configured to rotate the drive table about an axis perpendicular to the longitudinal axis of the drive table.

67. 67. The robotic drive system of claim 66, wherein the arm is further configured to move the drive table horizontally relative to the base structure and / or vertically relative to the ground surface.

68. 67. The robotic drive system of claim 66, wherein the arm includes a first arm segment connected directly or indirectly at its proximal end to the base structure, a second arm segment connected at its proximal end to a distal end of the first arm segment, and a third arm segment connected at its proximal end to a distal end of the second arm segment.

69. 67. The robotic drive system of claim 66, wherein the arm is configured to rotate the drive table in a vertical plane.

70. 70. The robotic drive system of claim 69, wherein the arm includes a joint configured to rotate the drive table in the vertical plane, the joint including a selectable brake that can be actuated to lock the joint in a fixed position.

71. 71. The robotic drive system of claim 70, wherein the selectable brakes can be manually or electronically actuated.

72. 63. The robotic drive system of claim 62, wherein the drive table includes a main body portion and an extendable member, the extendable member configured to be at least partially received within the main body portion and extendable from a proximal end or a distal end of the main body portion.

73. 73. The robotic drive system of claim 72, further comprising one or more hub adapters coupled to the drive table, each of the one or more hub adapters configured to be coupled to a corresponding hub, such that axial movement of each of the one or more hub adapters drives axial movement of the corresponding hub, the one or more hub adapters including a first hub adapter configured to be coupled to a first hub, such that axial movement of the first hub adapter drives axial movement of the first hub, the first hub adapter configured to translate from a first axial position within the main body, beyond the proximal end or the distal end of the main body, to a second axial position within the extendable member.

74. 73. The robotic drive system of claim 72, wherein the first hub adapter is configured to drive movement of the first hub from a first axial position on a drive surface of the main body portion to a second axial position on a drive surface of the extendable member.

75. 73. The robotic drive system of claim 72, further comprising a shuttle configured to move axially through the main body and the extendable member, wherein one or more of the hub adapters are configured to move axially along the shuttle.

76. 73. The robotic drive system of claim 72, wherein the extendable member is a first extendable member, the first extendable member extendable from the distal end of the main body portion, and the drive table further includes a second extendable member extendable from the proximal end of the main body portion.

77. 77. The robotic drive system of claim 76, wherein the first extendable member and the second extendable member each have a length that is approximately half the length of the main body portion.

78. 77. The robotic drive system of claim 76, wherein the one or more hub adapters include a second hub adapter for translating from a first axial position within the main body portion, beyond the proximal end of the main body portion, to a second axial position within the second extendable member.

79. a shuttle configured to move axially within the drive table; one or more hub adapters coupled to the shuttle; further comprising 63. The robotic drive system of claim 62, wherein one or more of the hub adapters are configured to move axially along the shuttle, and each of the one or more hub adapters is configured to be coupled to a corresponding hub such that axial movement of each of the one or more hub adapters drives axial movement of the corresponding hub.

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