Controller for a robotic catheter drive system

Abstract

A method for robotically controlling interventional devices includes providing an interventional device assembly having a plurality of interventional devices, advancing a first subset of the plurality of interventional devices into an ostium of the descending aorta in a first operating mode in response to movement of a control unit of a controller, wherein the first subset of the plurality of interventional devices is linked to the control unit in the first operating mode, and switching from the first operating mode to a second operating mode in response to user input using the controller. Switching from the first operating mode to the second operating mode links the second subset of the plurality of interventional devices to the control unit of the controller. The method further includes advancing the second subset of the plurality of interventional devices to a treatment site in the second operating mode.

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 / 429,502, entitled "CONTROLLER FOR ROBOTIC CATHETER DRIVE SYSTEM," 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 various challenges. For example, there are not enough trained interventionalists and centers to meet the current demand for neurointerventions. Neurointerventions are difficult, with complex setup requirements and demands on the surgeon's dexterity. Using both hands, the surgeon must exercise precise control over three or four coaxial catheters while managing the fluoroscopy system and patient position. 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. The 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.

[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 communication with the control console or in 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.

[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 reside on a support table adjacent to the patient, with an upper surface of the base within the sterile field and a lower surface of the base 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 an intracranial procedure, the method including 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 intracranial procedure using the subset of the assemblies.

[0030] The intracranial procedure can include intracranial thrombectomy. 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 that can include providing an assembly including a guidewire, an access catheter, a guide catheter, and a treatment catheter, advancing the assembly to achieve supra-aortic access, advancing a subset of the assemblies to a neurovascular site, the subset including the guidewire, the guide catheter, and the treatment catheter, and performing the neurovascular procedure using the subset of the assemblies.

[0032] The neurovascular procedure can include neurovascular thrombectomy. 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 to facilitate percutaneous valve repair or replacement. The treatment catheter can be an ablation catheter.

[0033] Also provided is a method for robotically controlling an interventional device, the method comprising providing an interventional device assembly including a plurality of interventional devices, the plurality of interventional devices including a first interventional device and a second interventional device, the method comprising advancing the first interventional device and the second interventional device from a first set of positions to a second set of positions in response to movement of a control portion of a controller, wherein a relative distance between a distal end of the first interventional device and a distal end of the second interventional device at the second set of positions is different from a relative distance between the distal end of the first interventional device and a distal end of the second interventional device at the first set of positions.

[0034] A method for robotically controlling an interventional device is provided, comprising providing an interventional device assembly including a plurality of interventional devices, the plurality of interventional devices including a first interventional device and a second interventional device, the first interventional device coupled to a first controller such that movement of the first controller causes responsive movement of the first interventional device, and the second interventional device coupled to a second controller such that movement of the second controller causes responsive movement of the second interventional device. The method includes linking movement of the second interventional device to movement of the first interventional device, such that the second interventional device moves in the same direction and at the same speed as the first interventional device when movement of the first controller causes responsive movement of the first interventional device that results in a separation distance between the first interventional device and the second interventional device that is greater than allowed by a drivable surface of a drive table.

[0035] In some embodiments, the method can include determining, by one or more hardware processors, that movement of the first control unit will cause a responsive movement of the first interventional device that will result in a separation distance between the first interventional device and the second interventional device that is greater than allowed by a drivable surface of the drive table. In some embodiments, the first interventional device is a guide catheter and the second interventional device is a guidewire. In some embodiments, the method can include unlinking the second interventional device from the first interventional device in response to movement of the second control unit, causing a responsive movement of the second interventional device in that direction.

[0036] A method for robotically controlling an interventional device is provided. The method includes providing an interventional device assembly including a plurality of interventional devices, the plurality of interventional devices including a first interventional device coupled to a first hub and a second interventional device coupled to a second hub, the first hub coupled to a first controller such that movement of the first controller causes responsive movement of the first hub, and the second hub coupled to a second controller such that movement of the second controller causes responsive movement of the second hub. The method includes linking movement of the second hub to movement of the first hub such that the second hub moves in the same direction and at the same speed as the first hub when movement of the first controller causes responsive movement of the first hub that results in a separation distance between the first hub and the second hub that is greater than allowed by a drivable surface of a drive table.

[0037] In some embodiments, the method can include determining, by one or more hardware processors, that movement of the first control will cause a responsive movement of the first hub that will result in a separation distance between the first hub and the second hub that is greater than allowed by the drivable surface of the drive table. In some embodiments, the first hub is a guide catheter hub and the second hub is a guidewire hub. In some embodiments, the method can include unlinking the second hub from the first hub in response to movement of the second control, causing a responsive movement of the second hub in that direction.

[0038] A method for robotically controlling an interventional device is provided, the method comprising providing an interventional device assembly including a plurality of interventional devices, the plurality of interventional devices including a first interventional device coupled to a first hub adapter and a second interventional device coupled to a second hub adapter, the first hub adapter coupled to a first controller such that movement of the first controller causes responsive movement of the first hub adapter, and the second hub adapter coupled to a second controller such that movement of the second controller causes responsive movement of the second hub adapter. The method includes linking movement of the second hub adapter to movement of the first hub adapter such that the second hub adapter moves in the same direction and at the same speed as the first hub adapter when movement of the first controller causes responsive movement of the first hub adapter that results in a separation distance between the first hub adapter and the second hub adapter that is greater than allowed by a drivable surface of a drive table.

[0039] In some embodiments, the method can include determining, by one or more hardware processors, that movement of the first control will cause a responsive movement of the first hub adapter that will result in a separation distance between the first hub adapter and the second hub adapter that is greater than allowed by the drivable surface of the drive table. In some embodiments, the first interventional device is a guide catheter and the second interventional device is a guidewire. In some embodiments, the method can include unlinking the second hub adapter from the first hub adapter in response to movement of the second control, causing a responsive movement of the second hub adapter in that direction. In some embodiments, the drivable surface is a shuttle configured to move axially within the drive table.

[0040] Also provided is a robotic catheter control system including a first controller associated with a first interventional device and a second controller associated with a second interventional device; axial movement of the first controller from a starting axial position causes responsive movement of the first interventional device in a corresponding axial direction, with an axial velocity of the first interventional device in the corresponding axial direction or an amount of axial movement of the first interventional device in the corresponding axial direction corresponding to the amount of axial movement of the first controller in the axial direction; and rotational movement of the first controller from a starting rotational position causes responsive movement of the first interventional device in the corresponding rotational direction, with a rotational velocity of the first interventional device in the corresponding rotational direction or an amount of rotational movement of the first interventional device in the corresponding rotational direction corresponding to the amount of rotational movement of the first controller in the rotational direction.

[0041] In some aspects, the axial orientation of the first and second interventional devices can correspond to the corresponding axial orientation of the first and second controls. The second interventional device can be positioned distal to the first interventional device, and the second control can be positioned distal to the first control.

[0042] In some embodiments, the robotic catheter control system can include one or more hardware processors configured to generate a user interface including information about the first interventional device and the second interventional device. In some embodiments, the robotic catheter control system can further include at least one sensor configured to detect movement of at least one of the first interventional device and the second interventional device and one or more hardware processors configured to receive motion data from the at least one sensor. The motion data can indicate whether the first interventional device and the second interventional device are moving. In some embodiments, the one or more hardware processors can be further configured to generate a user interface including an instrument window based on the motion data, the instrument window including a first representation of the first interventional device and a second representation of the second interventional device; and a first interventional device marker associated with the first representation and a second interventional device marker associated with the second representation. The first representation and the second representation can be configured to provide a visual indication of the positions of the first and second interventional devices relative to each other.

[0043] Also provided is a robotic catheter control system including a first controller operable to control movement of a first interventional device, the first controller including a unique first indicator identifying the first interventional device, a second controller operable to control movement of a second interventional device, the second controller including a unique second indicator identifying the second interventional device, and an axial orientation of the first and second interventional devices corresponding to the corresponding axial orientation of the first and second controllers.

[0044] In some embodiments, the robotic catheter control system can include one or more hardware processors configured to generate a user interface including information about the first interventional device and the second interventional device. In some embodiments, the robotic catheter control system can further include at least one sensor configured to detect movement of at least one of the first interventional device and the second interventional device and one or more hardware processors configured to receive motion data from the at least one sensor. The motion data can indicate whether the first interventional device and the second interventional device are moving. In some embodiments, the one or more hardware processors can be further configured to generate a user interface including an instrument window based on the motion data, the instrument window including a first representation of the first interventional device and a second representation of the second interventional device; and a first interventional device marker associated with the first representation and a second interventional device marker associated with the second representation. The first representation and the second representation can be configured to provide a visual indication of the positions of the first and second interventional devices relative to each other.

[0045] Also provided is a robotic catheter user interface method that includes detecting, with a sensor, movement of a first control associated with a first interventional device; determining, with at least one processor, a first position of the first control; and presenting, in a first display view, the first position and a first orientation of the first interventional device based at least in part on the first position of the first control.

[0046] In some aspects, presenting the position of the first interventional device may include presenting an axial position bar including a first end, a second end, and a length extending between the first and second ends. The method may further include presenting a first axial position indicator in the axial position bar corresponding to a position of the first interventional device inside the patient. The method may further include presenting at least one of a second position and a second orientation of the first interventional device corresponding to a second position of the first control in a second display view, the first control transitioning from the first position to the second position as the first control is moved. The method may further include generating, using at least one processor, a signal to move the first interventional device in accordance with the movement of the first interventional device. The method may further include acquiring fluoroscopic imaging representative of the patient's vasculature and the first interventional device and presenting the fluoroscopic imaging in the first display view.

[0047] Also provided is a robotic catheter control system including a display; a first controller associated with a first interventional device; at least one processor adapted to cause at least one view to be displayed on the display, the at least one view presenting data representing a position of the first interventional device within the patient's vasculature; and a first sensor configured to detect movement of the first controller and determine a position of the first controller. The first view presents a first position of the first interventional device, and the second view presents a second position of the first interventional device. The processor determines a change in the position of the first controller based on the position of the first controller and transitions the display from the first view to the second view.

[0048] In some embodiments, the position of the interventional device can be presented along an axial position bar including a first end, a second end, and a first position indicator. The first position indicator can be configured to move along the axial position bar as the display transitions from the first view to the second view. In some embodiments, the rotational position of the first interventional device can be presented in the rotational position indicator. In some embodiments, the processor can be further configured to receive fluoroscopic imaging representing the patient's vasculature and the first interventional device and present the fluoroscopic imaging on the display.

[0049] Also provided is a method for generating a user interface for a robotic catheter system, comprising receiving a user input configured to move a first interventional device; detecting a first position of the first interventional device; and generating a first user interface for display. The first user interface includes an image video portion configured to present a visual representation of a region of interest; a position bar including a first end representing a proximal direction of the patient and a second end representing a distal direction of the patient; and a first position indicator included in association with the position bar, the first position indicator corresponding to the detected first position of the first interventional device.

[0050] Also provided is a method for robotically controlling interventional devices, comprising: providing an interventional device assembly including a plurality of interventional devices; advancing a first subset of the plurality of interventional devices into an ostium of the descending aorta in a first operating mode in response to movement of a control unit of a controller, the first subset of the plurality of interventional devices being linked to the control unit in the first operating mode; switching from the first operating mode to a second operating mode in response to user input using the controller, the switching from the first operating mode to the second operating mode linking the second subset of the plurality of interventional devices to the control unit of the controller, the second subset of the plurality of interventional devices being different from the first subset of the plurality of interventional devices; and advancing the second subset of the plurality of interventional devices to a treatment site in the second operating mode in response to movement of the control unit of the controller.

[0051] In some aspects, the first subset of the plurality of interventional devices includes a guide catheter, a treatment catheter, and an access catheter. In some aspects, the guide catheter, the treatment catheter, and the access catheter can be configured to move simultaneously in response to movement of the controller in a first mode of operation. In some aspects, the second subset of the plurality of interventional devices can include a guide catheter and a treatment catheter. In some aspects, the guide catheter and the treatment catheter can be configured to move simultaneously in a second mode of operation. In some aspects, the controller includes a first controller, and the method further includes advancing the guidewire into the ostium in the first mode of operation in response to movement of a second controller of the controller. In some aspects, the first controller can include a first joystick, and the second controller can include a second joystick. In some aspects, the techniques described herein relate to a method, the method further including linking one of the guide catheter, the treatment catheter, and the access catheter to a second controller in response to user input, wherein movement of the second controller causes movement of the one of the guide catheter, the treatment catheter, and the access catheter. In some embodiments, advancing the guidewire into the ostium in the first mode of operation in response to movement of the second control can include advancing the guidewire in response to movement of the second control along a first axis, and the method further includes rotating the guidewire in response to movement of the second control along a second axis perpendicular to the first axis. In some embodiments, the method further includes performing a neurovascular procedure at the treatment site with the treatment catheter in response to receiving a user input on the controller. In some embodiments, performing the neurovascular procedure can include aspirating a blood clot.In some aspects, in a first operating mode, movement of the control unit can be configured to cause responsive movement of a first subset of the plurality of interventional devices through a first speed range. In a second operating mode, movement of the control unit can be configured to cause responsive movement of a second subset of the plurality of interventional devices through a second speed range different from the first speed range. In some aspects, the controller can be in communication with a control system having one or more hardware processors. The control system can further be in communication with a drive table configured to drive movement of the plurality of interventional devices. The one or more hardware processors can control movement of the plurality of interventional devices in response to user input using the controller. The one or more hardware processors can additionally generate a user interface including information about the plurality of interventional devices. The control system can receive information about the plurality of interventional devices or the drive table from one or more sensors of a sensor system. The one or more sensors can include sensors configured to detect movement of the first interventional device and the second interventional device and provide motion data to the control system. The one or more hardware processors are capable of generating a user interface including a representation of the first interventional device and the second interventional device, configured to provide an indication of the relative positions of the first interventional device and the second interventional device based on the motion data.

[0052] Also provided is a method for robotically controlling an interventional device, the method comprising the steps of providing a multi-catheter assembly including an access catheter, a guide catheter, and a treatment catheter; actuating the multi-catheter assembly to achieve supra-aortic access in response to movement of a control of a controller; actuating a subset of the multi-catheter assembly to a neurovascular site in response to movement of the control of the controller, the subset including the guide catheter and the treatment catheter; and performing a neurovascular procedure using the treatment catheter in response to user input on the controller.

[0053] In some aspects, driving the multi-catheter assembly to achieve supra-aortic access can include simultaneously advancing the access catheter, the guide catheter, and the treatment catheter in response to movement of a control unit of the controller. In some aspects, driving a subset of the multi-catheter assembly to the neurovascular site can include simultaneously advancing the guide catheter and the treatment catheter in response to movement of a control unit of the controller. In some aspects, the control unit can include a first control unit, and the method includes driving the guidewire to achieve supra-aortic access in response to movement of a second control unit of the controller. In some aspects, the first control unit can include a first joystick, and the second control unit can include a second joystick. In some aspects, the method can further include linking one of the access catheter, the guide catheter, and the treatment catheter to the second control unit in response to user input, wherein movement of the second control unit causes movement of one of the guide catheter, the treatment catheter, and the access catheter. In some aspects, the neurovascular procedure can include aspirating a clot. In some embodiments, the controller can be in communication with a control system having one or more hardware processors. The control system can further be in communication with a drive table configured to drive movement of the multi-catheter assembly. The one or more hardware processors can control movement of the multi-catheter assembly in response to user input using the controller. The one or more hardware processors can additionally generate a user interface including information about the multi-catheter assembly. The control system can receive information about the multi-catheter assembly or the drive table from one or more sensors of a sensor system.The one or more sensors can include a sensor configured to detect movement of the first interventional device and the second interventional device and provide motion data to the control system. The one or more hardware processors can generate a user interface including a representation of the first interventional device and the second interventional device, configured to provide an indication of the relative positions of the first interventional device and the second interventional device based on the motion data.

[0054] Also provided is a method for robotically controlling an interventional device, the method including the steps of: actuating a first interventional device of an interventional device assembly in response to movement of a joystick of a controller, the first interventional device being linked to the joystick such that movement of the joystick causes responsive movement of the first interventional device; receiving user input; and linking a second interventional device of the interventional device assembly to the joystick in response to receiving the user input such that movement of the joystick causes responsive movement of the second interventional device.

[0055] In some embodiments, the method may further include linking the second interventional device to the joystick and then using the joystick to actuate the second interventional device. In some embodiments, linking the second interventional device to the joystick may include linking the second interventional device to the joystick such that movement of the joystick causes simultaneous, responsive movement of both the first and second interventional devices. In some embodiments, the first interventional device may include a guidewire, and the second interventional device may include a guide catheter. In some embodiments, the first interventional device may include a guide catheter or a treatment catheter, and the second interventional device may include an access catheter. In some embodiments, the user input may include actuation of a button on the controller. The controller may be configured to link the second interventional device to the joystick while the button is actuated. In some embodiments, actuating the first interventional device of the interventional device assembly in response to movement of the joystick may include actuating the first interventional device of the interventional device assembly in response to movement of the joystick along a first axis. The method may further include rotating a first interventional device of the interventional device assembly in response to movement of the joystick along a second axis different from the first axis. In some embodiments, the second axis may be perpendicular to the first axis. In some embodiments, the first interventional device may be a guidewire. In some embodiments, the first interventional device may be an access catheter. In some embodiments, driving the first interventional device of the interventional device assembly in response to movement of the joystick of the controller may include advancing the first interventional device to achieve supra-aortic access.In some aspects, the method may further include driving a second interventional device to the treatment site to perform a neurovascular procedure in response to movement of the joystick. In some aspects, the method may further include performing a neurovascular procedure in response to user input on the controller. In some aspects, performing the neurovascular procedure may include aspirating a clot. In some aspects, the controller may be in communication with a control system having one or more hardware processors. The control system may further be in communication with a drive table configured to drive movement of the multiple interventional devices. The one or more hardware processors may control movement of the interventional devices in response to user input using the controller. The one or more hardware processors may additionally generate a user interface including information about the interventional devices. The control system may receive information about the interventional devices or the drive table from one or more sensors of a sensor system. The one or more sensors may include sensors configured to detect movement of the first interventional device and the second interventional device and provide motion data to the control system. The one or more hardware processors are capable of generating a user interface including a representation of the first interventional device and the second interventional device, configured to provide an indication of the relative positions of the first interventional device and the second interventional device based on the motion data.

[0056] Also provided is a robotic device control system including a controller in communication with a plurality of hubs, each of the plurality of hubs coupled to one of a plurality of interventional devices, the controller including a controller and an operational mode actuator; the controller configured to transition between a first operational mode and a second operational mode in response to actuation of the operational mode actuator; in the first operational mode, the controller is linked to a first subset of the plurality of hubs, such that movement of the controller causes responsive movement of the first subset of the plurality of hubs; and in the second operational mode, the controller is linked to a second subset of the plurality of hubs, such that movement of the controller causes responsive movement of the second subset of the plurality of hubs, the second subset of the plurality of hubs being different from the first subset of the plurality of hubs.

[0057] In some embodiments, the first subset of the plurality of hubs can include a guide catheter hub, a treatment catheter hub, and an access catheter hub. In some embodiments, when the controller is linked to the first subset of the plurality of hubs, movement of the controller can be configured to simultaneously move each of the guide catheter hub, the treatment catheter hub, and the access catheter hub. In some embodiments, when the controller is linked to the first subset of the plurality of hubs, movement of the controller can be configured to sequentially move each of the guide catheter hub, the treatment catheter hub, and the access catheter hub over the same distance. In some embodiments, the second subset of the plurality of hubs can include a guide catheter hub and a treatment catheter hub. In some embodiments, when the controller is linked to the second subset of the plurality of hubs, movement of the controller can be configured to simultaneously move each of the guide catheter hub and the treatment catheter hub. In some embodiments, when the controller is linked to the second subset of the plurality of hubs, movement of the controller can be configured to sequentially move each of the guide catheter hub and the treatment catheter hub over the same distance. In some aspects, the controller can include a first controller, and the system can include a second controller linked to a third subset of the plurality of hubs in the first mode of operation. In some aspects, the first subset of the plurality of hubs can include one or more of a guide catheter hub, a treatment catheter hub, and an access catheter hub. The third subset of the plurality of hubs can include a guidewire hub. In some aspects, the first controller can include a first joystick, and the second controller can include a second joystick.In some embodiments, the control unit can be configured to move along a first axis and a second axis different from the first axis, where movement of the control unit along the first axis can be configured to cause responsive axial movement of hubs of the plurality of hubs linked to the control unit, and movement of the control unit along the second axis can be configured to cause rotational movement of at least some of the interventional devices coupled to the hubs linked to the control unit. In some embodiments, the controller can be in communication with a control system having one or more hardware processors. The control system can further be in communication with a drive table configured to drive movement of the plurality of hubs. The one or more hardware processors can control movement of the plurality of hubs in response to user input using the controller. The one or more hardware processors can additionally generate a user interface including information regarding the plurality of interventional devices or hubs. The control system can receive information regarding the plurality of interventional devices, the plurality of hubs, or the drive table from one or more sensors of the sensor system. The one or more sensors can include a sensor configured to detect movement of a first hub coupled to the first interventional device and a second hub coupled to the second interventional device and provide motion data to the control system. The one or more hardware processors can generate a user interface including a representation of the first interventional device and the second interventional device, configured to provide an indication of the relative positions of the first interventional device and the second interventional device based on the motion data.

[0058] Also provided is a robotic device control system that may include a controller in communication with a plurality of interventional devices, the controller including a controller and an operational mode actuator; the controller configured to transition between a first operational mode and a second operational mode in response to actuation of the operational mode actuator; in the first operational mode, the controller is linked to a first subset of the plurality of interventional devices such that movement of the controller causes responsive movement of the first subset of the plurality of interventional devices; and in the second operational mode, the controller is linked to a second subset of the plurality of interventional devices such that movement of the controller causes responsive movement of the second subset of the plurality of interventional devices, the second subset of the plurality of interventional devices being different from the first subset of the plurality of interventional devices.

[0059] In some aspects, the first subset of the plurality of interventional devices can include a guide catheter, a treatment catheter, and an access catheter. In some aspects, when the controller is linked to the first subset of the plurality of interventional devices, movement of the controller can be configured to simultaneously move each of the guide catheter, the treatment catheter, and the access catheter. In some aspects, when the controller is linked to the first subset of the plurality of interventional devices, movement of the controller can be configured to sequentially move each of the guide catheter, the treatment catheter, and the access catheter over the same distance. In some aspects, the second subset of the plurality of interventional devices can include a guide catheter and a treatment catheter. In some aspects, when the controller is linked to the second subset of the plurality of interventional devices, movement of the controller can be configured to simultaneously move each of the guide catheter and the treatment catheter. In some aspects, when the controller is linked to the second subset of the plurality of interventional devices, movement of the controller can be configured to sequentially move each of the guide catheter and the treatment catheter over the same distance. In some aspects, the controller can include a first controller. The system may include a second controller linked to a third subset of the plurality of interventional devices in the first mode of operation. In some aspects, the first subset of the plurality of interventional devices may include one or more of a guide catheter hub, a treatment catheter, and an access catheter. The third subset of the plurality of interventional devices may include a guidewire. In some aspects, the first controller may include a first joystick and the second controller may include a second joystick.In some embodiments, the control unit can be configured to move along a first axis and a second axis different from the first axis, wherein movement of the control unit along the first axis is configured to cause responsive axial movement of interventional devices linked to the control unit, and movement of the control unit along the second axis is configured to cause rotational movement of at least some of the interventional devices linked to the control unit.

[0060] In some aspects, the controller can be in communication with a control system having one or more hardware processors. The control system can further be in communication with a drive table configured to drive movement of the multiple interventional devices. The one or more hardware processors can control movement of the multiple interventional devices in response to user input using the controller. The one or more hardware processors can additionally generate a user interface including information about the multiple interventional devices. The control system can receive information about the multiple interventional devices or the drive table from one or more sensors of a sensor system. The one or more sensors can include sensors configured to detect movement of the first and second interventional devices and provide motion data to the control system. The one or more hardware processors can generate a user interface including representations of the first and second interventional devices configured to provide an indication of the relative positions of the first and second interventional devices based on the motion data.

[0061] Also provided is a robotic device control system that may include a controller in communication with a plurality of hubs, each of the plurality of hubs coupled to one of a plurality of interventional devices, the controller including a joystick and a plurality of hub actuators, wherein actuation of each of the plurality of hub actuators links the joystick with one of the plurality of hubs, such that movement of the joystick causes a corresponding responsive movement of one of the plurality of hubs.

[0062] In some aspects, simultaneous actuation of a first hub actuator of the multiple hub actuators and a second hub actuator of the multiple hub actuators can link a joystick with a first hub associated with the first hub actuator and a second hub associated with the second hub actuator, such that movement of the joystick causes corresponding responsive movement of the first hub and the second hub. In some aspects, the system can further include a velocity actuator. Actuation of the velocity actuator can vary the range of axial velocities over which responsive movement of one of the multiple hubs linked to the joystick occurs in response to movement of the joystick. In some aspects, the system can further include a second joystick. The second joystick can be linked to at least one of the multiple hubs, such that movement of the second joystick causes responsive movement of at least one of the multiple hubs linked to the second joystick. In some aspects, the system can further include at least one additional hub actuator. Actuation of the at least one additional hub actuator can be configured to link a second joystick to a different one of the plurality of hubs, such that movement of the second joystick causes a responsive movement of the different one of the plurality of hubs. In some aspects, the joystick can be configured to move along a first axis and a second axis different from the first axis. Movement of the joystick along the first axis can be configured to cause responsive axial movement of the hubs linked to the joystick. Movement of the joystick along the second axis can be configured to cause rotational movement of at least some of the interventional devices coupled to the hubs linked to the joystick.The multiple hubs can include a guide catheter hub configured to couple to a guide catheter, an access catheter hub configured to couple to an access catheter, and a treatment catheter hub configured to couple to a treatment catheter. The multiple hubs can include a guidewire hub configured to couple to a guidewire. In some embodiments, the controller can be in communication with a control system having one or more hardware processors. The control system can further be in communication with a drive table configured to drive movement of the multiple hubs. The one or more hardware processors can control movement of the multiple hubs in response to user input using the controller. The one or more hardware processors can additionally generate a user interface including information regarding the multiple interventional devices or hubs. The control system can receive information regarding the multiple interventional devices, the multiple hubs, or the drive table from one or more sensors of a sensor system. The one or more sensors can include a sensor configured to detect movement of a first hub coupled to a first interventional device and a second hub coupled to a second interventional device and provide motion data to the control system. The one or more hardware processors are capable of generating a user interface including a representation of the first interventional device and the second interventional device, configured to provide an indication of the relative positions of the first interventional device and the second interventional device based on the motion data.

[0063] Also provided is a robotic device control system including a controller in communication with a plurality of interventional devices, the controller including a joystick; and a plurality of interventional device actuators, wherein actuation of each of the plurality of interventional device actuators links the joystick with one of the plurality of interventional devices, and movement of the joystick causes a corresponding responsive movement of one of the plurality of interventional devices.

[0064] In some aspects, simultaneous actuation of a first interventional device actuator of the plurality of interventional device actuators and a second interventional device actuator of the plurality of interventional device actuators can link a joystick to a first interventional device associated with the first interventional device actuator and a second interventional device associated with the second interventional device actuator, such that movement of the joystick causes corresponding responsive movement of the first interventional device and the second interventional device. In some aspects, the system can further include a velocity actuator. Actuation of the velocity actuator can vary a range of axial velocities at which responsive movement of one of the plurality of interventional devices linked to the joystick occurs in response to movement of the joystick. In some aspects, the system can further include a second joystick. The second joystick can be linked to at least one of the plurality of interventional devices, such that movement of the second joystick causes responsive movement of at least one of the plurality of interventional devices linked to the second joystick. In some aspects, the system can further include at least one additional interventional device actuator. Actuation of the at least one additional interventional device actuator can be configured to link a second joystick to a different one of the plurality of interventional devices, such that movement of the second joystick causes a responsive movement of the different one of the plurality of interventional devices. In some aspects, the joystick can be configured to move along a first axis and a second axis different from the first axis. Movement of the joystick along the first axis can be configured to cause responsive axial movement of the interventional devices linked to the joystick. Movement of the joystick along the second axis can be configured to cause rotational movement of at least some of the interventional devices linked to the joystick.The multiple interventional devices may include a guide catheter, an access catheter, and a treatment catheter. The multiple interventional devices may include a guidewire. In some embodiments, the controller may be in communication with a control system having one or more hardware processors. The control system may further be in communication with a drive table configured to drive movement of the multiple interventional devices. The one or more hardware processors may control movement of the multiple interventional devices in response to user input using the controller. The one or more hardware processors may additionally generate a user interface including information about the multiple interventional devices. The control system may receive information about the multiple interventional devices or the drive table from one or more sensors of a sensor system. The one or more sensors may include sensors configured to detect movement of the first interventional device and the second interventional device and provide motion data to the control system. The one or more hardware processors may generate a user interface including representations of the first interventional device and the second interventional device configured to provide an indication of the relative positions of the first interventional device and the second interventional device based on the motion data.

[0065] Also provided is a robotic interventional device control system, comprising: a first interventional device having a first distal end; a second interventional device having a second distal end, the first interventional device configured to be concentrically nested within the second interventional device; a sensor system configured to detect a first position of the first interventional device and a second position of the second interventional device; and one or more hardware processors configured to generate a user interface, the user interface including an instrument window, the instrument window including a first representation of the first interventional device and a second representation of the second interventional device, the first representation of the first interventional device including a first visual indicator of the first distal end of the first interventional device. The system may include one or more hardware processors that provide an indication on a user interface of how far the first distal end of the first interventional device is from the second distal end of the second interventional device, where the second representation of the second interventional device includes a second visual indication of a second distal end of the second interventional device, the second visual indication of the second distal end being positioned relative to the first visual indication of the first distal end of the first interventional device based on the detected first and second positions received from the sensor system, whereby the first and second visual indications provide an indication on a user interface of how far the first distal end of the first interventional device is from the second distal end of the second interventional device; and a display configured to display the user interface.

[0066] In some embodiments, the user interface may further include a first window configured to display a fluoroscopic image from the patient's vasculature; a second window configured to display one or more messages indicating the operational status of the robotic interventional device control system; and a third window including a live feed. The instrument window may be positioned in a central portion of the user interface. In some cases, the user interface may include some but not all of the first, second, and third windows. In some embodiments, the first, second, and third windows may be positioned around the instrument window. In some embodiments, the first visual indication may correspond to a shape of a first distal end of the first interventional device. In some embodiments, the shape of the first distal end of the first interventional device may include a beveled surface. In some embodiments, the first visual indication may correspond to a first shape of a first distal end of the first interventional device. The second visual indication may correspond to a second shape of a second distal end of the second interventional device. The first shape and the second shape may be different from one another. In some embodiments, the second visual indication can correspond to a shape of the second distal end of the second interventional device. In some embodiments, the first representation of the first interventional device and the second representation of the second interventional device can extend along a central longitudinal axis. In some embodiments, the first representation of the first interventional device can include a first shape. In some embodiments, the first shape can correspond to a shape of a portion of the first interventional device. In some embodiments, the first shape can include a cylindrical shape. In some embodiments, the second representation of the second interventional device can include a second shape that is different from the first shape of the first representation. In some embodiments, the second representation of the second interventional device can include a second shape.In some embodiments, the second shape corresponds to a shape of a portion of the second interventional device. In some embodiments, the first visual indication of the first distal end can include a beveled edge. In some embodiments, the first visual indication of the first distal end can include a first point on a distal edge of the shape. In some embodiments, the second visual indication can correspond to a second shape of the second distal end of the second interventional device, the second visual indication of the second distal end including a second point on a second distal edge of the second shape, and a first distance between the first point and the second point provides a visual indication of a second distance between the first distal end of the first interventional device and the second distal end of the second interventional device. In some embodiments, the first distance can include a scaled distance of the second distance. In some embodiments, the first distance and the second distance can be the same. In some aspects, the system can further include a controller having one or more controls configured to cause movement of at least one of the first interventional device and the second interventional device in response to user input. In some aspects, the controller can be configured to transition between a first mode of operation and a second mode of operation in response to user input. In the first mode of operation, one of the controls can be linked to a first subset of the plurality of interventional devices or intervention device hubs, such that movement of the control causes responsive movement of the first subset of the plurality of interventional devices or intervention device hubs. In the second mode of operation, the control can be linked to a second subset of the plurality of interventional devices or intervention device hubs, such that movement of the control causes responsive movement of the second subset of the plurality of interventional devices or intervention device hubs, the second subset of the plurality being different from the first subset.

[0067] Also provided is a robotic intervention device control system including: an interventional device; a controller in communication with the interventional device, the controller including a first controller and a second controller; and one or more hardware processors in communication with the interventional device and the controller, the one or more hardware processors configured to selectively link the interventional device to the first controller or the second controller, such that movement of the selected controller causes a corresponding responsive movement of the interventional device, and the one or more hardware processors configured to generate a user interface, the user interface including an instrument window including a representation of the interventional device and an intervention device marker positioned relative to the representation of the interventional device, a position of the intervention device marker relative to the representation of the interventional device indicating whether the interventional device is linked to the first controller or the second controller; and the robotic intervention device control system may further include a display configured to display the user interface.

[0068] In some aspects, the controller can include a first side and a second side, with the first control positioned on the first side of the controller and the second control positioned on the second side of the controller. In some aspects, the representation of the interventional device can extend along a central longitudinal axis. In some aspects, the interventional device marker can be configured to be positioned on the first side of the central longitudinal axis when the interventional device is linked to the first control, and the interventional device marker is configured to be positioned on the second side of the central longitudinal axis when the interventional device is linked to the second control. In some aspects, the first side of the central longitudinal axis can mirror the first side of the controller, and the second side of the central longitudinal axis mirrors the second side of the controller. In some aspects, the instrument window can be configured to display an indicator on a top portion of the interventional device marker, the indicator configured to extend outside of the top portion of the interventional device marker when axial movement of the interventional device in a distal direction is restricted. In some aspects, the instrument window can be configured to display an indicator on a bottom portion of the interventional device marker, the indicator configured to extend outside of the bottom portion of the interventional device marker when axial movement of the interventional device in a proximal direction is restricted. In some aspects, the interventional device marker can include a first animation state and a second animation state. In some aspects, the interventional device marker can be configured to transition from the first animation state to the second animation state upon the occurrence of an interventional device event. In some aspects, the interventional device event can include suction being available at the interventional device. In some aspects, the interventional device event can include suction not being available at the interventional device. In some aspects, the interventional device event can include suction being active at the interventional device.In some aspects, the interventional device event can include contrast injection being available at the interventional device. In some aspects, the interventional device event can include contrast injection not being available at the interventional device. In some aspects, the interventional device event can include contrast injection being active at the interventional device. In some aspects, at least one of the first and second controls of the controller can be configured to cause movement of the interventional device in response to a user input. In some aspects, the controller can be configured to transition between a first and a second operating mode in response to a user input. In the first operating mode, one of the controls can be linked to a first subset of a plurality of interventional devices or interventional device hubs, such that movement of the control causes responsive movement of the first subset of the plurality of interventional devices or interventional device hubs. In the second operating mode, the control can be linked to a second subset of a plurality of interventional devices or interventional device hubs, such that movement of the control causes responsive movement of the second subset of the plurality of interventional devices or interventional device hubs, the second subset of the plurality being different from the first subset.

[0069] Also provided is a robotic interventional device control system including an interventional device; a controller configured to control axial movement of the interventional device along a drive table; a sensor system configured to detect axial movement of the interventional device along the drive table; and one or more hardware processors configured to receive motion data from the sensor system, the motion data indicating whether the interventional device is moving axially along the drive table, the one or more hardware processors further configured to generate a user interface including an instrument window based on the motion data, the instrument window including a representation of the interventional device and an interventional device marker associated with the representation of the interventional device, the interventional device marker configured to transition from a first configuration to a second configuration as the interventional device is moving axially along the drive table; and the robotic interventional device control system may further include a display configured to display the user interface.

[0070] In some embodiments, the instrument window can further include a speed indicator configured to indicate a speed at which the interventional device is configured to move distally or proximally. In some embodiments, the representation of the interventional device can extend along the central longitudinal axis. In some embodiments, in the first configuration, the interventional device marker can be at a first position. In the second configuration, the interventional device marker can be at a second position. In some embodiments, the first position can be closer to the central longitudinal axis than the second position. In some embodiments, the interventional device marker can be configured to be in the first configuration when the interventional device is not moving axially along the drive table. In some embodiments, the representation of the interventional device can include a visual indication of a distal end of the interventional device. In some embodiments, the visual indication can correspond to a shape of the distal end of the interventional device. In some embodiments, the representation of the interventional device can extend along the central longitudinal axis. In some embodiments, the representation of the interventional device can include a shape corresponding to a shape of a portion of the interventional device. In some embodiments, the instrument window can further include an interventional device marker positioned relative to the representation of the interventional device. The location of the interventional device marker relative to the representation of the interventional device can indicate whether the interventional device is linked to a first control or a second control of the controller. In some aspects, the controller can include a first side and a second side, where the first control is positioned on the first side of the controller and the second control is positioned on the second side of the controller. In some aspects, the representation of the interventional device can extend along a central longitudinal axis. The interventional device marker can be configured to be positioned on the first side of the central longitudinal axis when the interventional device is linked to the first control.The interventional device marker can be configured to be positioned on a second side of the central longitudinal axis when the interventional device is linked to the second control unit. In some embodiments, the instrument window can further include a pointer extending between the representation of the interventional device and the interventional device marker. In some embodiments, the pointer can include a line. When the interventional device marker is in a first configuration, the line can include a first length. When the interventional device marker is in a second configuration, the line can include a second length different from the first length. In some embodiments, the controller can be further configured to control rotational movement of the interventional device about the longitudinal axis of the interventional device. In some embodiments, the interventional device marker can further include a radial progress indicator configured to provide a visual indication of a degree of rotation of the interventional device about the longitudinal axis relative to a threshold value. In some embodiments, the controller can be configured to control axial movement of the interventional device along the drive table in response to user input. In some embodiments, the controller can be configured to transition between a first operating mode and a second operating mode in response to user input. In a first mode of operation, one of the controllers can be linked to a first subset of the plurality of interventional devices or intervention device hubs, such that movement of the controller causes responsive movement of the first subset of the plurality of interventional devices or intervention device hubs. In a second mode of operation, the controller can be linked to a second subset of the plurality of interventional devices or intervention device hubs, such that movement of the controller causes responsive movement of the second subset of the plurality of interventional devices or intervention device hubs, the second subset of the plurality being different from the first subset.

[0071] Also provided is a robotic interventional device control system including: an interventional device including a longitudinal axis and configured to rotate about the longitudinal axis; a controller configured to control rotational movement of the interventional device about the longitudinal axis; at least one sensor configured to detect rotational movement of the interventional device about the longitudinal axis; and one or more hardware processors configured to receive motion data from the at least one sensor, the motion data indicating whether the interventional device is rotating about the longitudinal axis, the one or more hardware processors further configured to generate a user interface including an instrument window based on the motion data, the instrument window including a representation of the interventional device and an interventional device marker associated with the representation of the interventional device, the interventional device marker including a radial progress indicator configured to provide a visual indication of the extent of rotation of the interventional device about the longitudinal axis relative to a threshold value.

[0072] In some aspects, the threshold value can represent a maximum rotation of the interventional device. In some aspects, the radial progress indicator can include a ring-shaped progress bar configured to fill. The ring-shaped progress bar can be further configured to empty when the interventional device is not rotating. The ring-shaped progress bar can be further configured to fill when the interventional device completes a full rotation about the longitudinal axis. In some aspects, the radial progress indicator can include a ring-shaped progress bar configured to fill in at least one of a clockwise direction and a counterclockwise direction. A radial progress indicator that fills in a clockwise direction can provide a visual indication that the interventional device is rotating in a clockwise direction. A radial progress indicator that fills in a counterclockwise direction can provide a visual indication that the interventional device is rotating in a counterclockwise direction. In some aspects, the representation of the interventional device can extend along the central longitudinal axis. In some aspects, the controller can be further configured to control axial movement of the interventional device along the drive table. The representation of the interventional device can be configured to transition from a first configuration to a second configuration along the central longitudinal axis as the interventional device moves axially along the drive table. In some embodiments, in the first configuration, the representation of the interventional device can be in a first position. In the second configuration, the representation of the interventional device can be in a second position. In some embodiments, the first position can be closer to a bottom end of the central longitudinal axis than the second position. In some embodiments, the first position can be closer to a top end of the central longitudinal axis than the second position. In some embodiments, the interventional device marker can include a first animation state and a second animation state.In some embodiments, the interventional device marker can be configured to transition from a first animation state to a second animation state upon the occurrence of an interventional device event. In some embodiments, the interventional device event can include suction being available at the interventional device. In some embodiments, the interventional device event can include suction not being available at the interventional device. In some embodiments, the interventional device event can include suction being active at the interventional device. In some embodiments, the interventional device event can include contrast injection being available at the interventional device. In some embodiments, the interventional device event can include contrast injection not being available at the interventional device. In some embodiments, the controller can be configured to control rotational movement of the interventional device about the longitudinal axis in response to a user input. In some embodiments, the controller can be configured to transition between a first operational mode and a second operational mode in response to a user input. In the first operational mode, one of the controls can be linked to a first subset of the multiple interventional devices or interventional device hubs, such that movement of the control causes responsive movement of the first subset of the multiple interventional devices or interventional device hubs. In a second operating mode, the controller can be linked to a second subset of the plurality of interventional devices or interventional device hubs, such that movement of the controller causes responsive movement of the second subset of the plurality of interventional devices or interventional device hubs, the second subset of the plurality being different from the first subset.

[0073] Also provided is a robotic intervention device control system including: a robotic drive system; an intervention device assembly including a plurality of intervention devices configured to couple to the robotic drive system, each of the plurality of intervention devices including an identifier; a plurality of sensors, each of the plurality of sensors configured to identify one of the plurality of intervention devices based on the identifier when one of the plurality of intervention devices is coupled to the robotic drive system; one or more hardware processors configured to receive intervention device identity data from the plurality of sensors and to generate a user interface including an instrument window based on the intervention device identity data, the instrument window including a plurality of intervention device representations and a plurality of intervention device markers, each of the plurality of intervention device representations representing one of the plurality of intervention devices, each of the plurality of intervention device markers being associated with one of the plurality of intervention device representations and configured to indicate a type of the intervention device represented by one of the plurality of intervention device representations; and a display configured to display the user interface. The one or more controls can include a first control linked to a first interventional device, such that movement of the first control causes responsive movement of the first interventional device, and a second control linked to a second interventional device, such that movement of the second control causes responsive movement of the second interventional device. The first interventional device can be a guide catheter, and the second interventional device can be a guidewire. The controller can further include an interventional device actuator, such that actuation of the interventional device actuator links the first interventional device to the second control, such that movement of the second control causes responsive movement of the first interventional device.The one or more controllers may include a first controller operable in a first drive mode and a second drive mode, wherein movement of the first controller is configured to cause responsive movement of a first subset of the plurality of interventional devices in the first drive mode and operation of the first controller is configured to cause responsive movement of a second subset of the plurality of interventional devices in the second drive mode. The first subset of the plurality of interventional devices may be a guide catheter, a treatment catheter, and an access catheter. The second subset of the plurality of interventional devices may include a guide catheter and a treatment catheter.

[0074] In some embodiments, the user interface can further include a window configured to display a fluoroscopic image from the patient's vasculature. In some embodiments, the user interface can further include a window configured to display one or more messages indicating an operational status of the robotic interventional device control system. In some embodiments, the user interface can further include a window configured to display a live feed. In some embodiments, the instrument window can be positioned in a central portion of the user interface. In some embodiments, each of the plurality of interventional device markers can be configured to transition from a first configuration to a second configuration when the plurality of interventional devices are moving axially along the drive table. In some embodiments, in the first configuration, each of the plurality of interventional device markers can be at a first position. In the second configuration, each of the plurality of interventional device markers can be at a second position. In some embodiments, the first position can be closer to a central longitudinal axis of the representation of the plurality of interventional devices than the second position. In some embodiments, the plurality of interventional device markers can be configured to be in the first configuration when the plurality of interventional devices are not moving axially along the drive table. In some aspects, the system may further include a plurality of interventional device hubs, where each of the plurality of interventional devices is coupled to one of the plurality of interventional device hubs; a plurality of hub adapters, where each of the plurality of interventional device hubs is configured to be coupled to one of the plurality of hub adapters; and a support table, where the plurality of hub adapters are configured to move along the support table to drive the interventional device assemblies. In some aspects, the plurality of interventional device representations may be arranged based on an arrangement of the plurality of hub adapters on the support table.In some embodiments, the system may further include a controller having one or more controls configured to cause movement of at least one of the plurality of interventional devices in response to a user input. In some embodiments, the controller may be configured to transition between a first mode of operation and a second mode of operation in response to a user input. In the first mode of operation, one of the controls may be linked to a first subset of the plurality of interventional devices or intervention device hubs, such that movement of the control causes responsive movement of the first subset of the plurality of interventional devices or intervention device hubs. In the second mode of operation, the control may be linked to a second subset of the plurality of interventional devices or intervention device hubs, such that movement of the control causes responsive movement of the second subset of the plurality of interventional devices or intervention device hubs, the second subset of the plurality being different from the first subset.

[0075] Also provided is a method for robotically controlling an interventional device, the method comprising: driving a first hub adapter coupled to a first interventional device of an interventional device assembly in response to movement of a control of a controller, the first hub adapter linked to the control such that movement of the control causes responsive movement of the first hub adapter; a second hub adapter coupled to a second interventional device not linked to the first control; the first and second hub adapters axially movably coupled to a shuttle configured to move axially through a drive table; driving the first hub adapter in response to movement of the control comprises driving movement of the shuttle a first distance in a first direction to move the first hub adapter; and in response to movement of the hub adapter the first distance in the first direction in response to movement of the control, the second hub adapter is configured to move a second distance equal to the first distance in a second direction opposite the first direction.

[0076] A robotic intervention device control system may include one or more of the features described above.

[0077] A method of using a robotic intervention device control system may include one or more of the features described above.

[0078] The intervention device controller may include one or more of the features described above.

[0079] A method of using an intervention device controller may include one or more of the features described above.

[0080] A robotic interventional device control system can include one or more of the above-described features for use in cardiovascular procedures.

[0081] A method of using a robotic interventional device control system can include one or more of the features described above for use in a cardiovascular procedure.

[0082] An interventional device controller can include one or more of the above-described features for use in cardiovascular procedures.

[0083] Any feature, component, or detail of any of the arrangements or embodiments disclosed in this application (including, but not limited to, any of the controllers, control mechanisms, and user interfaces disclosed below) may be interchangeably combined with any other feature, component, or detail of any of the arrangements or embodiments disclosed herein to form new arrangements and embodiments. [Brief explanation of the drawings]

[0084] [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] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 19B] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 19C] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 20] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 21] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 22A] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 22B] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 22C] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 23A] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 23B] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 23C] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 24A] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 24B] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 24C] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 24D] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 24E] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 25A]10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 25B] FIG. 25B is a cross-sectional view of the control mechanism shown in FIG. 25A. [Figure 25C] FIG. 25B is a cross-sectional view of the control mechanism shown in FIG. 25A. [Figure 25D] FIG. 25B is a cross-sectional view of the control mechanism shown in FIG. 25A. [Figure 25E] 25A-25D illustrate an alternative embodiment of the controller shown in FIGS. 25A-25D. [Figure 26A] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 26B] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 26C] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 27] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 28A] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 28B] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 28C] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 29A] FIG. 1 is a simplified block diagram of a medical device operating environment. [Figure 29B] 10A-10C illustrate an embodiment of a process for displaying the position and movement of an interventional device. [Figure 30A] 1A-1C illustrate embodiments of a user interface for controlling an interventional device. [Figure 30B]1A-1C illustrate embodiments of a user interface for controlling an interventional device. [Figure 30C] 1A-1C illustrate embodiments of a user interface for controlling an interventional device. [Figure 30D] 1A-1C illustrate embodiments of a user interface for controlling an interventional device. [Figure 30E] 1A-1C illustrate embodiments of a user interface for controlling an interventional device. [Figure 30F] 1A-1C illustrate embodiments of a user interface for controlling an interventional device. [Figure 30G] 1A-1C illustrate embodiments of a user interface for controlling an interventional device. [Figure 30H] 1A-1C illustrate embodiments of a user interface for controlling an interventional device. [Figure 30I] 1A-1C illustrate embodiments of a user interface for controlling an interventional device. [Figure 30J] 1A-1C illustrate embodiments of a user interface for controlling an interventional device. [Figure 30K] 1A-1C illustrate embodiments of a user interface for controlling an interventional device. [Figure 31] 10A-10C illustrate alternative embodiments of user interfaces for controlling interventional devices. [Figure 32] 10A-10C illustrate alternative embodiments of user interfaces for controlling interventional devices. [Figure 33] 10A-10C illustrate alternative embodiments of user interfaces for controlling interventional devices. [Figure 34] 10A-10C illustrate alternative embodiments of user interfaces for controlling interventional devices. [Figure 35] 10A-10C illustrate alternative embodiments of user interfaces for controlling interventional devices. [Figure 36] 10A-10C illustrate alternative embodiments of user interfaces for controlling interventional devices. [Figure 37] 10A-10C illustrate alternative embodiments of user interfaces for controlling interventional devices. [Figure 38] 10A-10C illustrate alternative embodiments of user interfaces for controlling interventional devices. [Figure 39] 10A-10C illustrate alternative embodiments of user interfaces for controlling interventional devices. [Figure 40] 10A-10C illustrate alternative embodiments of user interfaces for controlling interventional devices. [Figure 41] 10A-10C illustrate alternative embodiments of user interfaces for controlling interventional devices. [Figure 42] 10A-10C illustrate alternative embodiments of user interfaces for controlling interventional devices. [Figure 43A] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 43B] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 43C] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 44A] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 44B] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 44C] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 45A] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 45B] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 46A] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 46B] 10A-10C illustrate exemplary control mechanisms for operating interventional devices driven by respective hubs. [Figure 47] 10A-10C illustrate additional embodiments of user interfaces for controlling interventional devices. [Figure 48] 10A-10C illustrate additional embodiments of user interfaces for controlling interventional devices. [Figure 49] 10A-10C illustrate additional embodiments of user interfaces for controlling interventional devices. [Figure 50] 10A-10C illustrate additional embodiments of user interfaces for controlling interventional devices. [Figure 51] 10A-10C illustrate additional embodiments of user interfaces for controlling interventional devices. [Figure 52] 10A-10C illustrate additional embodiments of user interfaces for controlling interventional devices. [Figure 53] 10A-10C illustrate additional embodiments of user interfaces for controlling interventional devices. [Figure 54] 10A-10C illustrate additional embodiments of user interfaces for controlling interventional devices. [Figure 55] 10A-10C illustrate additional embodiments of user interfaces for controlling interventional devices. [Figure 56] 10A-10C illustrate additional embodiments of user interfaces for controlling interventional devices. [Figure 57] 10A-10C illustrate additional embodiments of user interfaces for controlling interventional devices. [Figure 58] 10A-10C illustrate additional embodiments of user interfaces for controlling interventional devices. [Figure 59] 10A-10C illustrate additional embodiments of user interfaces for controlling interventional devices. [Figure 60A] 10A-10C illustrate an embodiment of a telescoping drive table. [Figure 60B] 10A-10C illustrate an embodiment of a telescoping drive table. [Figure 60C] 10A-10C illustrate an embodiment of a telescoping drive table. [Figure 60D] 10A-10C illustrate an embodiment of a telescoping drive table. [Figure 61] FIG. 1 illustrates a system diagram of an embodiment of a control system. [Figure 62] 1A-1C are diagrams illustrating schematically embodiments of mechanical couplings between a driving mechanism and a driven mechanism. DETAILED DESCRIPTION OF THE INVENTION

[0085] 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.

[0086] In some implementations, the system can additionally be configured to robotically obtain intracranial vascular access and to perform aspiration thrombectomy or other neurovascular procedures.

[0087] The drive table can be positioned on or near the patient and can be 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.

[0088] 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.

[0089] 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).

[0090] 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.

[0091] 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.

[0092] 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).

[0093] 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.

[0094] 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.

[0095] 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).

[0096] 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.

[0097] 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 or 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 and can protect against wear, buckling, or damage at the input and output of the hub. In some embodiments, the hollow extending elements can be hollow flexible coatings attached to the hub. The hollow extending elements (e.g., hollow flexible coatings) can cover a portion of the device shaft when threaded through the hub. In some embodiments where the hollow extending element is a coating, the coating can be attached to a portion of the hub such that passing the catheter device through the hub 26, 28, or 30 also passes the catheter device through the coating. In some implementations, an anti-buckling device can be placed on, 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 laser-cut hypotube, a spring, telescoping tubing, tensioned split tubing, or the like.

[0098] 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.

[0099] 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 capable of providing lubricity and hydraulic sealing. In some embodiments, this proximal segment can be formed from a polymer such as polyetheretherketone (PEEK). Alternatively, the wall thickness or diameter of the interventional device can be increased in the anti-buckling zone.

[0100] In certain embodiments, a device shaft with high stiffness (e.g., axially and torsionally) can provide improved transmission of motion 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.

[0101] 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.

[0102] 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.

[0103] 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.

[0104] 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.

[0105] 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.

[0106] 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.

[0107] 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.

[0108] 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.

[0109] 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.

[0110] 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.

[0111] 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.

[0112] In certain embodiments, catheter 31 can be a "large bore" access or guide catheter having a diameter of at least about 0.075 or at least about 0.080 inches. Catheter 120 can be an aspiration catheter having a 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 a diameter in the range of about 0.025 inches to about 0.050 inches. Guidewire 27 can have a diameter in the range of about 0.014 inches to about 0.020 inches. In one example, catheter 31 can have a diameter of about 0.088 inches, catheter 120 can have a diameter of about 0.071 inches, catheter 124 can have a diameter of about 0.035 inches, and guidewire 27 can have a diameter of about 0.018 inches.

[0113] 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.

[0114] 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.

[0115] 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.

[0116] 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.

[0117] 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.

[0118] 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.

[0119] 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.

[0120] 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.

[0121] 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.

[0122] 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.

[0123] 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.

[0124] 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.

[0125] 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.

[0126] 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.

[0127] 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 described in additional detail below. The hub adapter is capable of acting as a robotic drive for an interventional device coupled to it.

[0128] 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.

[0129] 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.

[0130] 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.

[0131] 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.

[0132] 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.

[0133] 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.

[0134] 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.

[0135] 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.

[0136] 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.

[0137] 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.

[0138] 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 or 0.5 or 1 millimeter or 2 millimeters or more shorter than the axial length of the leading sidewall portion 1168 depending on the desired performance.

[0139] 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).

[0140] 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.

[0141] 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.

[0142] 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.

[0143] 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.

[0144] 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.

[0145] 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).

[0146] 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.

[0147] 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.

[0148] 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.

[0149] 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.

[0150] 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.

[0151] 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.

[0152] 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.

[0153] 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.

[0154] 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.

[0155] 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.

[0156] 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.

[0157] At least a first helical capacitor can have at least one, five, ten, or more complete turns of each 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.

[0158] 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.

[0159] 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.

[0160] 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 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 hub.

[0161] 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.

[0162] 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.

[0163] 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.

[0164] 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.

[0165] 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.

[0166] 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.

[0167] Alternatively, the above 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.

[0168] 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.

[0169] 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.

[0170] 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.

[0171] 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.

[0172] 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.

[0173] 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.

[0174] 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.

[0175] 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.

[0176] 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.

[0177] 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.

[0178] 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.

[0179] 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 quickly 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.

[0180] 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 times, or about five times, or more than 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.

[0181] 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.

[0182] 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.

[0183] 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.

[0184] In manual catheterization procedures, the physician often stands on the patient's right side and inserts the interventional device from the physician's right to the physician's left as they face the patient. Certain embodiments of the robotic control mechanisms described herein can be configured to mimic the movements performed by a physician in manual catheterization procedures. For example, certain embodiments of the robotic control mechanisms described herein include a control that is operated by a side-to-side motion from the perspective of a user (e.g., a physician) who operates the control to command the insertion or removal of the interventional device. Certain embodiments of the robotic control mechanisms described herein include a control that is operated by a rolling or rotating motion from the perspective of a user (e.g., a physician) who operates the control to command the roll or rotation of the interventional device.

[0185] 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.

[0186] 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 can be advanced distally or retracted proximally on the shaft 2210, as indicated by arrow 2218 and arrow 2216. Additionally, each control unit 2202-2208 can 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.

[0187] 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.

[0188] 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.

[0189] 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.

[0190] Other axes and degrees of freedom can be defined to enable the controller 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. The control mechanism can further be provided with one or more fluidics controls to control components of the fluidics system, for example, to initiate and / or terminate the introduction of fluid (e.g., saline, contrast, etc.) into the catheter and / or to initiate and / or terminate the aspiration of fluid from the catheter.

[0191] 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 2202 distally along the shaft 2210 approximately 5 millimeters, the corresponding hub can move 5 millimeters distally in response.

[0192] If the user 2230 rotates the control 2202 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.

[0193] 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.

[0194] 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.

[0195] 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.

[0196] 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.

[0197] Controlling the speed of the corresponding hub, 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.

[0198] 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. In some embodiments, it is possible to simultaneously control components of the fluidics system (eg, for the introduction and / or aspiration of fluid) while controlling the axial and / or rotational movement of the catheter.

[0199] 19A-19C illustrate another example of a control mechanism for manipulating an interventional device driven by (or otherwise associated with) a respective hub. In certain embodiments, each hub and / or interventional device can be manipulated and / or otherwise moved using at least one controller mounted in the control mechanism. Each controller can be adapted to move a particular hub and / or interventional device during an interventional procedure. For example, movement of each controller can trigger a responsive movement in the corresponding hub and / or interventional device. In certain embodiments, movement of at least some of the respective controllers can trigger a responsive movement in a corresponding carriage on the support table, which can drive movement of the corresponding hub.

[0200] As shown in FIG. 19A , the control mechanism 2200a can include a first control unit 2202a, a second control unit 2204a, a third control unit 2206a, and a fourth control unit 2208a. More or fewer controls can be provided depending on the intended interventional device configuration. Each control unit 2202a-2208a can be movably carried on a shaft 2210a, which is coupled to a distal bracket 2212a and a proximal bracket 2214a. The control units 2202a-2208a can be advanced distally or retracted proximally along the shaft 2210a, as indicated by arrow 2218a and arrow 2216a, respectively. Additionally or alternatively, each control unit 2202a-2208a can be rotated about the shaft 2210a, as indicated by arrow 2220a.

[0201] Each control 2202a-2208a can have a starting axial and / or rotational position, and the control mechanism can be configured to return each control 2202a-2208a to its starting axial and / or rotational position when the control 2202a-2208a is not manipulated by a user.

[0202] The control mechanism 2200a 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 2200a 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.

[0203] Each controller 2202a-2208a can correspond to and drive the movement of a hub and / or interventional device. In certain embodiments, controller 2202a can be configured to move (e.g., axially and / or rotationally) an interventional device, such as, for example, a 0.088 inch guide catheter (e.g., guide catheter 31 or guide catheter 2906) by driving a hub (e.g., hub 30 or hub 2914) associated with the interventional device. Similarly, controller 2204a can be configured to move (e.g., axially and / or rotationally) an interventional device, such as, for example, a 0.071 inch treatment catheter (e.g., catheter 29, catheter 120, or catheter 2904) by driving a hub (e.g., hub 28, hub 122, or hub 2912) associated with the interventional device. Controller 2206a can be configured to move (e.g., axially and / or rotationally) an interventional device such as a steerable access catheter (e.g., catheter 124 or catheter 2902), for example, by actuating a hub associated with the interventional device (e.g., hub 126 or hub 2910). Controller 2208a can be configured to move (e.g., axially and / or rotationally) an interventional device such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example, by actuating a hub associated with the interventional device (e.g., hub 26 or hub 2909).

[0204] In operation, when a user moves the control unit 2202a axially and distally along the shaft 2210a, as shown by arrow 2218a, or proximally, as shown by arrow 2116a, the corresponding coupled hub and / or interventional device can responsively move in the same direction at a predefined axial or linear velocity. The corresponding coupled hub and / or interventional device can continue to move in the same direction at a predefined linear velocity until the user releases (e.g., stops manipulating) the control unit 2202a or moves the control unit further. When the user stops manipulating the control unit 2202a, the control unit 2202a can return to its starting axial position. When a user moves the control unit 2202a rotationally (e.g., clockwise or counterclockwise) about the shaft 2210a, as shown by arrow 2220a, the corresponding interventional device can be rotationally driven (e.g., by the corresponding hub) in the same direction at a predefined angular velocity. When the user stops manipulating the control unit 2202a, the control unit 2202a can return to its starting rotational position. When the user rotates the control unit 2202a about the shaft 2210a and advances the control unit axially (either distally or proximally), the corresponding coupled interventional device can responsively move rotationally at a predefined angular velocity and proximally at a predefined linear velocity. The corresponding coupled interventional device can continue to move rotationally at a predefined angular velocity and axially at a predefined linear velocity until the user releases the control unit 2202a (e.g., stops manipulating it) or further moves the control unit. When the user stops manipulating the control unit 2202a, the control unit 2202a can return to its starting axial and rotational position.

[0205] One or more linear position sensors can be used to measure the axial movement of each control 2202a-2208a relative to the start position of the respective control. For example, the one or more linear sensors can be configured to measure the distance (e.g., 5 mm) traveled by a control from its start position. In some embodiments, a predefined linear velocity at which the corresponding hub and / or interventional device will travel can depend on measurements by the one or more linear position sensors. The one or more linear position sensors can include, for example, a linear potentiometer. In some cases, the control mechanism 2200a can include a linear position sensor for each control.

[0206] Similarly, one or more rotational sensors can be used to measure the rotational movement of each control 2202a-2208a relative to the start position of the respective control. For example, one or more rotational sensors can be configured to measure the rotational movement (e.g., 5 degrees) of a control from its start position. The predefined angular velocity at which the corresponding interventional device will move can depend on measurements by the one or more rotational sensors. The one or more rotational sensors can include, for example, an encoder, a potentiometer, a Hall effect sensor, or a combination thereof. In some cases, the control mechanism 2200a can include a rotational sensor for each control.

[0207] The axial movement of the control unit can be configured to move the corresponding hub and / or interventional device at a predefined linear velocity. For example, if a user advances the control unit 2202a distally approximately 5 millimeters along the shaft 2210a, the corresponding hub and / or interventional device can responsively move distally at a linear velocity of 5 mm / sec. The predefined linear velocity can change according to the user's movement of the control unit. For example, if a user advances the control unit 2202a proximally approximately 10 millimeters along the shaft 2210a, the corresponding hub and / or interventional device can responsively move proximally at a linear velocity of 10 mm / sec. The corresponding hub and / or interventional device can continue to move in the direction of the axial movement of the control unit 2202a at the predefined linear velocity as long as the user maintains the control in the same axial position. The corresponding hub and / or interventional device can stop moving when the user stops manipulating the control unit and when the control returns to its starting axial position.

[0208] Axial movement of a control can be configured to move the corresponding hub and / or interventional device on a 1:1 or non-1:1 scaled basis. For example, if a user advances control 2202a distally along shaft 2210a approximately 5 millimeters, the corresponding hub can move distally at a predefined linear velocity of 5 mm / sec in response.

[0209] The rotational movement of the control can be configured to move the coupled hub at a predefined rotational velocity. For example, if a user rotates the control 2202a clockwise about the shaft 2210a by approximately 5 degrees, the corresponding interventional device can responsively rotate clockwise at an angular velocity of 5 degrees per second. The predefined angular velocity can change according to the user's movement of the control. For example, if a user rotates the control 2202a counterclockwise about the shaft 2210a by approximately 10 degrees, the corresponding interventional device can responsively rotate counterclockwise at an angular velocity of 10 degrees per second. The corresponding interventional device can continue to move in the direction of the rotational movement of the control 2202a at the predefined angular velocity as long as the user maintains the control in the same rotational position. The interventional device can stop moving when the user stops manipulating the control and when the control returns to its starting rotational position.

[0210] The rotational movement of the control unit can be configured to move the coupled interventional device on a 1:1 basis or on a non-1:1 scaled basis. For example, if a user rotates the control unit 2202a by 5 degrees about its axis of rotation, the corresponding interventional device can move in response at a predefined angular velocity of 5 degrees / second.

[0211] The control mechanism 2200a can be configured to allow a clinician to adjust a predefined linear velocity and / or a predefined angular velocity. For example, as described herein, distal advancement of the treatment catheter and access catheter through the guide catheter and to the selected ostium can desirably be achieved in a “fast” mode. More distal travel into the neurovasculature can desirably be achieved in a slower mode by actuation of the velocity control. For example, for a stage of the procedure in which the clinician wishes to proceed in a “fast” mode, the clinician can adjust the predefined linear velocity to 10 mm / sec when the control moves 5 mm distally or proximally along the shaft. For a stage of the procedure in which the clinician wishes to proceed in a slower mode, the clinician can adjust the predefined linear velocity to 2 mm / sec when the control moves 5 mm distally or proximally along the shaft.

[0212] While the above describes an exemplary operation of controller 2202a, it will be understood by those skilled in the art that any of controllers 2204a, 2206a, and 2208a can be operated in a similar manner. In certain embodiments, controllers 2202a, 2204a, 2206a, and 2208a can each control axial and rotational movement of a corresponding interventional device. In other embodiments, one or more of controllers 2202a, 2204a, 2206a, and 2208a can control only axial or only rotational movement of a corresponding interventional device.

[0213] FIG. 20 illustrates an additional embodiment of a control mechanism 2200b for manipulating an interventional device driven by (or otherwise associated with) a respective hub. The control mechanism of FIG. 20 can include any of the same or similar features and / or functionality as any of the other control mechanisms described herein. For example, each hub and / or interventional device can be manipulated and / or otherwise moved using at least one control mounted within the control mechanism. Each control can include a joystick (e.g., a two-axis joystick). In certain embodiments, the joystick can provide improved grip and more precise movement compared to other controls. The size and feel of the joystick can be customized to suit the particular needs of the physician. For example, some physicians may prefer a larger or smaller joystick. Each control can be adapted to move a specific hub and / or interventional device during an interventional procedure.

[0214] As shown in FIG. 20 , the control mechanism 2200b can include a first control unit 2202b, a second control unit 2204b, a third control unit 2206b, and a fourth control unit 2208b. More or fewer controls can be provided depending on the intended interventional device configuration. Each control unit 2202b-2208b can rotate about a first axis 2217b, as indicated by arrow 2216b, to cause axial movement of the corresponding hub and / or interventional device. Additionally, each control unit 2202b-2208b can rotate about a second axis 2219b, as indicated by arrow 2220b, to cause rotational movement of the corresponding hub and / or interventional device. The second axis 2219b can be the same axis for each control unit 2202b-2208b. The first axis 2217b for each control 2202b-2208b can be transverse to the second axis 2219b. Movement of each control can trigger responsive movement in the corresponding hub and / or interventional device. In certain embodiments, movement of at least some of each control can trigger responsive movement in a corresponding carriage on the support table, which can drive movement of the corresponding hub.

[0215] Each control 2202b-2208b may have a starting position, and the control mechanism may be configured such that each control 2202b-2208b returns to its starting position when the control 2202b-2208b is not being manipulated by a user.

[0216] The control mechanism 2200b 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 2200b 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.

[0217] Each controller 2202b-2208b can correspond to and drive the movement of a hub and / or interventional device. In certain embodiments, controller 2202b can be configured to move (e.g., axially and / or rotationally) an interventional device, such as, for example, a 0.088 inch guide catheter (e.g., guide catheter 31 or guide catheter 2906) by driving a hub (e.g., hub 30 or hub 2914) associated with the interventional device. Similarly, controller 2204b can be configured to move (e.g., axially and / or rotationally) an interventional device, such as, for example, a 0.071 inch treatment catheter (e.g., catheter 29, catheter 120, or catheter 2904) by driving a hub (e.g., hub 28, hub 122, or hub 2912) associated with the interventional device. Controller 2206b can be configured to move (e.g., axially and / or rotationally) an interventional device such as a steerable access catheter (e.g., catheter 124 or catheter 2902), for example, by actuating a hub associated with the interventional device (e.g., hub 126 or hub 2910). Controller 2208b can be configured to move (e.g., axially and / or rotationally) an interventional device such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example, by actuating a hub associated with the interventional device (e.g., hub 26 or hub 2909).

[0218] In operation, when a user rotates control 2202b about axis 2217b (e.g., counterclockwise or clockwise), as shown by arrow 2216b, the corresponding coupled hub and / or interventional device can responsively move axially (e.g., proximally for counterclockwise movement of control 2202b and distally for clockwise movement of control 2217b) at a predefined linear velocity. The corresponding coupled hub and / or interventional device can continue to move in the same direction at the predefined linear velocity until the user releases (e.g., stops manipulating) control 2202b or further moves control 2202b. When the user stops manipulating control 2202b, control 2202b can return to its starting position. When a user moves control 2202b rotationally (e.g., clockwise or counterclockwise) about axis 2219b, as shown by arrow 2220b, the corresponding interventional device can be rotationally driven (e.g., by a corresponding hub) in the same direction at a predefined angular velocity. When the user stops manipulating control 2202b, control 2202b can return to its starting position. When a user moves control 2202b rotationally about axis 2217b, as shown by arrow 2216b, and rotationally about axis 2219b, as shown by arrow 2220b, the corresponding coupled interventional device can responsively move rotationally at a predefined angular velocity (in response to movement of control 2202b about axis 2219b) and move axially at a predefined linear velocity (in response to movement of control 2202b about axis 2217b). The corresponding coupled interventional device can continue to move rotationally at a predefined angular velocity and axially at a predefined linear velocity until the user releases (e.g., stops manipulating) the control 2202b or moves the control 2202b further, when the user stops manipulating the control 2202b, the control 2202b can return to its starting position.

[0219] One or more rotational sensors can be used to measure the rotational movement of each control 2202b-2208b about axis 2217b and / or axis 2219b relative to a starting position of the respective control. For example, one or more rotational sensors can be configured to measure the rotational movement (e.g., 5 degrees) of a control from its starting position. The linear velocity and / or predefined angular velocity at which the corresponding interventional device will move can depend on measurements by the one or more rotational sensors. The one or more rotational sensors can include, for example, an encoder, a potentiometer, a Hall effect sensor, or a combination thereof. In some cases, the control mechanism 2200b can include one or more rotational sensors for each control. In some embodiments, the control mechanism 2200b can include separate rotational sensors for measuring rotation about axis 2217b and rotation about axis 2219b.

[0220] As shown by arrow 2216b, rotational movement of the control unit about axis 2217b can be configured to move the corresponding hub and / or interventional device at a predefined linear velocity. For example, if a user moves control unit 2202b about axis 2217b (e.g., counterclockwise) approximately 5 degrees, the corresponding hub and / or interventional device can move (e.g., proximally) at a linear velocity of 5 mm / sec in response. The predefined linear velocity can change according to the user's movement of the control unit. For example, if a user moves control unit 2202b about axis 2217b approximately 10 degrees, the corresponding hub can move axially at a linear velocity of 10 mm / sec in response. The corresponding hub and / or interventional device can continue to move axially at the predefined linear velocity as long as the user maintains the control in the same rotational position. The corresponding hub can stop moving as soon as the user stops manipulating the control unit, and the control can return to its starting position.

[0221] Rotational movement of the control about axis 2217b can be configured to move the corresponding hub and / or interventional device on a 1:1 or non-1:1 scaled basis. For example, if a user rotates control 2202b in the direction of arrow 2216b by approximately 5 degrees, the corresponding hub can respond by moving in the corresponding direction at a predefined linear velocity of 5 mm / sec.

[0222] The rotational movement of the control unit about axis 2219b can be configured to move the coupled hub at a predefined rotational velocity. For example, if a user rotates control unit 2202b clockwise about axis 2219b approximately 5 degrees, the corresponding interventional device can responsively rotate clockwise at an angular velocity of 5 degrees per second. The predefined angular velocity can change according to the user's movement of the control unit. For example, if a user rotates control unit 2202b counterclockwise about axis 2219b approximately 10 degrees, the corresponding interventional device can responsively rotate counterclockwise at an angular velocity of 10 degrees per second. The corresponding interventional device can continue to move in the direction of the rotational movement of control unit 2202b at the predefined angular velocity as long as the user maintains the control in the same rotational position. The interventional device can stop moving when the user stops manipulating the control unit and when the control returns to its starting rotational position.

[0223] Rotational movement of the control unit about axis 2219b can be configured to rotate the corresponding interventional device on a 1:1 basis or on a non-1:1 scaled basis. For example, if a user moves control unit 2202b about axis 2219b approximately 5 millimeters, the corresponding interventional device can move in response at a predefined angular velocity of 5 degrees / second.

[0224] Control mechanism 2200b can be configured to allow a clinician to adjust a predefined linear velocity and / or a predefined angular velocity. For example, as described herein, advancement of the treatment catheter and access catheter through the guide catheter and to the selected ostium can desirably be achieved in a “fast” mode. Distal travel into the neurovasculature can desirably be achieved in a slower mode by actuation of the velocity control. For example, for a procedure phase that the clinician wishes to proceed in “fast” mode, the clinician can adjust the predefined linear velocity to 10 mm / sec when the control is moved 5 degrees about axis 2217b. For a procedure phase that the clinician wishes to proceed in a slower mode, the clinician can adjust the predefined linear velocity to 2 mm / sec when the control is moved 5 degrees about axis 2217b.

[0225] While the above describes an exemplary operation of controller 2202b, it will be understood by those skilled in the art that any of controllers 2204b, 2206b, and 2208b can be operated in a similar manner. In certain embodiments, controllers 2202b, 2204b, 2206b, and 2208b can each control the axial and rotational movement of a corresponding interventional device. In other embodiments, one or more of controllers 2202b, 2204b, 2206b, and 2208b can control only the axial or only the rotational movement of a corresponding interventional device.

[0226] FIG. 21 illustrates an alternative embodiment of a control mechanism 2200b for manipulating an interventional device driven by (or otherwise associated with) a respective hub shown in FIG. 20. The control mechanism of FIG. 21 can include any of the same or similar features and / or functions as the control mechanism 2200b described herein and shown in FIG. 20. For example, each hub and / or interventional device can be manipulated and / or otherwise moved using at least one control mounted within the control mechanism. Each control can include a joystick (e.g., a two-axis joystick). In certain embodiments, the joystick can provide improved grip and more precise movement compared to other controls. The size and feel of the joystick can be customized to suit the particular needs of the physician. For example, some physicians may prefer a larger or smaller joystick. Each control can be adapted to move a specific hub and / or interventional device during an interventional procedure.

[0227] As shown in FIG. 21 , the control mechanism 2200c can include a first control unit 2202c, a second control unit 2204c, a third control unit 2206c, and a fourth control unit 2208c. More or fewer controls can be provided depending on the intended interventional device configuration. Each control unit 2202c-2208c can rotate about a first axis 2217c, as indicated by arrow 2216c, to cause axial movement of the corresponding hub and / or interventional device. Additionally, each control unit 2202c-2208c can rotate about a second axis 2219c, as indicated by arrow 2220c, to cause rotational movement of the corresponding hub and / or interventional device. The second axis 2219c can be the same axis for each control unit 2202c-2208c. The first axis 2217c for each control 2202c-2208c can be transverse to the second axis 2219c. Movement of each control can trigger responsive movement in the corresponding hub and / or interventional device. In certain embodiments, movement of at least some of each control can trigger responsive movement in a corresponding carriage on the support table, which can drive movement of the corresponding hub.

[0228] 22A-22C illustrate another example of a control mechanism for manipulating an interventional device driven by (or otherwise associated with) a respective hub. The control mechanism of FIGS. 22A-22C can include any of the same or similar features and / or functionality as any of the other control mechanisms described herein. In certain embodiments, each hub can be manipulated and / or otherwise moved using at least one controller mounted in the control mechanism. Each controller can be adapted to move a particular hub and / or interventional device during an interventional procedure. For example, movement of each controller can trigger responsive movement in the corresponding hub and / or interventional device. In certain embodiments, movement of at least some of the respective controllers can trigger responsive movement in a corresponding carriage on the support table, which can drive movement of the corresponding hub.

[0229] As shown in FIG. 22A , the control mechanism 2200d can include a first control unit 2202d, a second control unit 2204d, a third control unit 2206d, and a fourth control unit 2208d. More or fewer controls can be provided depending on the intended interventional device configuration. Each control unit 2202d-2208d can be movably carried on a support structure 2210d. The control units 2202d-2208d can be advanced distally or retracted proximally, as indicated by arrow 2216d. Additionally or alternatively, each control unit 2202d-2208d can be rotated within the support structure 2210d, as indicated by arrow 2220d.

[0230] Each control section 2202d-2208d can have a starting axial position, and the control mechanism can be configured to return each control section 2202d-2208d to its starting axial position when the control section 2202d-2208d is not being advanced along the support structure 2210d.

[0231] The control mechanism 2200d 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 2200d 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.

[0232] Each controller 2202d-2208d can correspond to and drive the movement of a hub and / or hub and / or interventional device. In certain embodiments, controller 2202d can be configured to move (e.g., axially and / or rotationally) an interventional device, such as, for example, a 0.088 inch guide catheter (e.g., guide catheter 31 or guide catheter 2906) by driving a hub associated with the interventional device (e.g., hub 30 or hub 2914). Similarly, controller 2204d can be configured to move (e.g., axially and / or rotationally) an interventional device, such as, for example, a 0.071 inch treatment catheter (e.g., catheter 29, catheter 120, or catheter 2904) by driving a hub associated with the interventional device (e.g., hub 28, hub 122, or hub 2912). Controller 2206d can be configured to move (e.g., axially and / or rotationally) an interventional device such as a steerable access catheter (e.g., catheter 124 or catheter 2902), for example, by actuating a hub associated with the interventional device (e.g., hub 126 or hub 2910). Controller 2208d can be configured to move (e.g., axially and / or rotationally) an interventional device such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example, by actuating a hub associated with the interventional device (e.g., hub 26 or hub 2909).

[0233] In operation, when a user moves the control unit 2202d axially (e.g., proximally or distally) along the support structure 2210d, as shown by arrow 2216d, the corresponding coupled hub and / or interventional device can responsively move in the same direction at a predefined linear velocity. The corresponding coupled hub and / or interventional device can continue to move in the same direction at the predefined linear velocity until the user releases (e.g., stops manipulating) the control unit 2202d or moves the control unit further. When the user stops manipulating the control unit 2202d, the control unit 2202d can return to its starting axial position. When a user moves the control unit 2202d rotationally (e.g., clockwise or counterclockwise) within the support structure 2210d, as shown by arrow 2220d, the corresponding interventional device can be rotationally driven (e.g., by the corresponding hub) in the same direction and / or by the same or a scaled amount. When a user rotates the control unit 2202d within the support structure 2210d and advances the control unit axially (either distally or proximally), the corresponding coupled interventional device will responsively move rotationally by the same or a scaled amount and axially at a predefined linear velocity. The corresponding coupled interventional device can continue to move axially at the predefined linear velocity until the user releases (e.g., stops manipulating) the control unit 2202d or further moves the control unit 2202d axially. When the user stops manipulating the control unit 2202d, the control unit 2202d can return to its starting axial position.

[0234] As shown in FIG. 22C , the control mechanism 2200d can include at least one linear position sensor (also referred to herein as a linear sensor) and at least one rotational sensor. The one or more linear position sensors can be used to measure the axial movement of each control 2202d-2208d relative to the start position of the respective control. For example, the one or more linear sensors can be configured to measure the distance (e.g., 5 mm) traveled by the control from its start position. The linear position sensors can command the velocity of the corresponding hub and / or interventional device. For example, in some embodiments, the predefined linear velocity at which the corresponding hub and / or interventional device will travel can depend on measurements by the one or more linear position sensors. The one or more linear position sensors can include, for example, a linear potentiometer. In some cases, the control mechanism 2200d can include a linear position sensor for each control.

[0235] Similarly, one or more rotational sensors 2215d can be used to measure the rotational movement of each control 2202d-2208d relative to the start position of the respective control. In some cases, the one or more rotational sensors can be supported by a support structure, such as support structure 2210d, as shown in FIG. 22C. The one or more rotational sensors can be configured to measure the rotational movement (e.g., 5 degrees) of a control from its start position. The rotational sensors can command the orientation of the corresponding hub and / or interventional device. For example, in some embodiments, the angular distance that the corresponding hub will travel depends on measurements by the one or more rotational sensors. The one or more rotational sensors can include, for example, an encoder, a potentiometer, a Hall effect sensor, or a combination thereof. In some cases, control mechanism 2200d can include a rotational sensor for each control.

[0236] The axial movement of the control unit can be configured to move the corresponding hub and / or interventional device at a predefined linear velocity. For example, if a user advances the control unit 2202d distally along the support structure 2210d approximately 5 millimeters, the corresponding hub and / or interventional device can responsively move distally at a linear velocity of 5 mm / sec. The predefined linear velocity y can vary according to the user's movement of the control unit. For example, if a user advances the control unit 2202d proximally along the support structure 2210d approximately 10 millimeters, the corresponding hub and / or interventional device can responsively move proximally at a linear velocity of 10 mm / sec. The corresponding hub and / or interventional device can continue to move axially at the predefined linear velocity as long as the user manipulates the control unit to maintain the same axial position. The corresponding hub can stop moving when the user stops manipulating the control unit, and the control will return to its starting axial position.

[0237] The axial movement of the control unit can be configured to move the corresponding hub and / or interventional device on a 1:1 or non-1:1 scaled basis. For example, if a user advances the control unit 2202d distally along the support structure 2210d approximately 5 millimeters, the corresponding hub and / or interventional device can move distally at a predefined linear velocity of 5 mm / sec in response.

[0238] Rotational movement of the control can be configured to move the corresponding interventional device on a 1:1 basis or on a non-1:1 scaled basis. For example, if a user rotates the control 2202d about its axis of rotation by 5 degrees, the corresponding interventional device can move an angular distance of 5 degrees in response. In certain embodiments, when the user stops manipulating the control in a rotational direction, the control maintains its position and does not return to its previous initial rotational position. In certain embodiments, each rotational position of the control can correspond to a unique rotational position of the corresponding interventional device.

[0239] The control mechanism 2200d can be configured to allow a clinician to adjust a predefined linear speed and / or rotational distance or position. For example, as described herein, distal advancement of the treatment catheter and access catheter through the guide catheter and to the selected ostium can desirably be achieved in a “fast” mode. More distal travel into the neurovasculature can desirably be achieved in a slower mode by actuation of the speed control. For example, for a stage of the procedure in which the clinician wishes to proceed in a “fast” mode, the clinician can adjust the predefined linear speed to 10 mm / sec when the control moves distally or proximally 5 mm along the shaft. For a stage of the procedure in which the clinician wishes to proceed in a slower mode, the clinician can adjust the predefined linear speed to 2 mm / sec when the control moves distally or proximally 5 mm along the shaft.

[0240] While the above describes an exemplary operation of controller 2202d, it will be understood by those skilled in the art that any of controllers 2204d, 2206d, and 2208d can be operated in a similar manner. In certain embodiments, controllers 2202d, 2204d, 2206d, and 2208d can each control the axial and rotational movement of a corresponding interventional device. In other embodiments, one or more of controllers 2202d, 2204d, 2206d, and 2208d can control only the axial or only the rotational movement of a corresponding interventional device.

[0241] 23A-23C illustrate another example of a control mechanism for manipulating an interventional device driven by (or otherwise associated with) a respective hub. The control mechanism of FIGS. 23A-23C can include any of the same or similar features and / or functions as any of the other control mechanisms described herein. For example, each hub can be manipulated and / or otherwise moved using at least one controller mounted in the control mechanism. Each controller can be adapted to move a particular hub and / or interventional device during an interventional procedure. For example, movement of each controller can trigger responsive movement in the corresponding hub and / or interventional device. In certain embodiments, movement of at least some of the respective controllers can trigger responsive movement in a corresponding carriage on the support table, which can drive movement of the corresponding hub.

[0242] As shown in FIG. 23A , the control mechanism 2200e can include a first control unit 2202e, a second control unit 2204e, a third control unit 2206e, and a fourth control unit 2208e. More or fewer controls can be provided depending on the intended interventional device configuration. Each control unit 2202e-2208e can be movably carried on a shaft assembly 2210e. The control units 2202e-2208e can be advanced distally or retracted proximally within the shaft assembly 2210e, as indicated by arrow 2216e. Additionally or alternatively, each control unit 2202e-2208e can be rotated within the shaft assembly 2210e, as indicated by arrow 2220e.

[0243] Each control 2202e-2208e can have a starting axial position, and the control mechanism can be configured to return each control 2202e-2208e to its starting axial position when the control 2202e-2208e is not advanced or retracted within the shaft assembly 2210e.

[0244] As shown in FIGS. 23A-23B, controls 2202e-2208e can be arranged in a coaxial configuration. Each control 2202e-2208e can be carried on a unique shaft of assembly 2210e. In some embodiments, shaft assembly 2210e can have one or more shafts with different diameters, thereby allowing, for example, at least one shaft associated with a unique control to fit into and extend through another shaft associated with a unique control. For example, and as shown in FIG. 23A, a first shaft 2210e' can be associated with control 2202e, a second shaft 2210e" can be associated with control 2204e", a third shaft 2210e'" can be associated with control 2206e, and a third shaft 2210e"" can be associated with control 2208e. The shafts 2210e'-2210e'''' can be configured to move axially and / or rotationally with their associated controls. For example, the second shaft 2210e'' can have a smaller diameter than the first shaft 2210e', thereby allowing the second shaft 2210e'' to extend at least partially inside and move within the first shaft 2210e'. In some embodiments, each control 2202e-2208e can be associated with a unique shaft having a different diameter from one another. The smaller shaft can extend at least partially inside and move / rotate within the larger shaft, thereby allowing telescopic movement of the two or more shaft sections. The shaft assembly 2210e can further include a shaft 2210e''''', which can extend through each of the shafts 2210e'-2210e'''' and provide structural support.

[0245] The control mechanism 2200e 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 2200e 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.

[0246] Each controller 2202e-2208e can correspond to and drive the movement of a hub and / or interventional device. In certain embodiments, controller 2202e can be configured to move (e.g., axially and / or rotationally) an interventional device, such as, for example, a 0.088 inch guide catheter (e.g., guide catheter 31 or guide catheter 2906) by driving a hub (e.g., hub 30 or hub 2914) associated with the interventional device. Similarly, controller 2204e can be configured to move (e.g., axially and / or rotationally) an interventional device, such as, for example, a 0.071 inch treatment catheter (e.g., catheter 29, catheter 120, or catheter 2904) by driving a hub (e.g., hub 28, hub 122, or hub 2912) associated with the interventional device. Controller 2206e can be configured to move (e.g., axially and / or rotationally) an interventional device such as a steerable access catheter (e.g., catheter 124 or catheter 2902), for example, by actuating a hub associated with the interventional device (e.g., hub 126 or hub 2910). Controller 2208e can be configured to move (e.g., axially and / or rotationally) an interventional device such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example, by actuating a hub associated with the interventional device (e.g., hub 26 or hub 2909).

[0247] In operation, when a user moves the control unit 2202e (and, consequently, the shaft 2210e′) axially (e.g., proximally or distally) within the shaft assembly 2210e, as shown by arrow 2216e, the corresponding coupled hub and / or interventional device can responsively move in the same direction at a predefined linear velocity. The corresponding coupled hub and / or interventional device can continue to move in the same direction at the predefined linear velocity until the user releases (e.g., stops manipulating) the control unit 2202e or moves the control unit further. When the user stops manipulating the control unit 2202e, the control unit 2202e can return to its starting axial position. When a user moves the control unit 2202e (and, consequently, the shaft 2210e′) rotationally (e.g., clockwise or counterclockwise) within the shaft assembly 2210e, as shown by arrow 2220e, the corresponding interventional device can be rotationally driven in the same direction and / or by the same or a scaled amount (e.g., by the corresponding hub). When a user rotates the control unit 2202e within the shaft assembly 2210e and advances the control unit axially (either distally or proximally), the corresponding coupled interventional device can responsively move rotationally by the same or a scaled amount and axially at a predefined linear velocity. The corresponding coupled interventional device can continue to move axially at the predefined linear velocity until the user releases (e.g., stops manipulating) the control unit 2202e or further axially moves the control unit 2202e. When the user stops manipulating the control unit 2202e, the control unit 2202e can return to its starting axial position.

[0248] In some embodiments, and as shown in FIG. 23A , control mechanism 2200e can include first housing section 2241e and second housing section 2243e. First housing section 2241e and second housing section 2243e can receive and support one or more shafts 2210e′-2210e′′″, respectively. For example, in certain embodiments, housing section 2241e can receive and support shafts 2210e′ and 2210e″, and housing section 2243e can receive and support shafts 2210e′″ and 2210e′″. Shaft 2210e′′″ can extend through both housing sections 2241e and 2243e.

[0249] One or more linear position sensors 2213e can be used to measure the axial movement of each control 2202e-2208e relative to its start position (e.g., by measuring the axial movement of the corresponding shaft 2210e′-2210e′″ relative to its start position), as shown in FIG. 23B. The one or more linear position sensors can be included as part of the first and second housing sections 2241e, 2243e. In some embodiments, the one or more linear sensors 2213e can be configured to measure a distance (e.g., 5 mm) traveled by a control from its start position. In some embodiments, a predefined linear velocity at which the corresponding hub will travel can depend on measurements by the one or more linear position sensors. The one or more linear position sensors can include, for example, a linear potentiometer. In some cases, the control mechanism 2200e can include a linear position sensor 2213e for each control.

[0250] Similarly, one or more rotational sensors 2215e can be used to measure the rotational movement of each control 2202e-2208e relative to its starting position (e.g., by measuring the rotational movement of the corresponding shaft 2210e'-2210e'''' relative to its starting position), as shown in FIG. 23B. For example, one or more rotational sensors can be configured to measure the rotational movement (e.g., 5 degrees) of a control from its starting position. The angular distance that the corresponding hub will travel depends on the measurement by the one or more rotational sensors. The one or more rotational sensors can include, for example, an encoder, a potentiometer, a Hall effect sensor, or a combination thereof. In some cases, the control mechanism 2200e can include a rotational sensor for each control.

[0251] The axial movement of the control unit can be configured to move the corresponding hub and / or interventional device at a predefined linear velocity. For example, if a user advances the control unit 2202e distally within the shaft assembly 2210e approximately 5 millimeters, the corresponding hub and / or interventional device can responsively move distally at a linear velocity of 5 mm / sec. The predefined linear velocity can change according to the user's movement of the control unit. For example, if a user advances the control unit 2202e proximally within the shaft assembly 2210e approximately 10 millimeters, the corresponding hub and / or interventional device can responsively move proximally at a linear velocity of 10 mm / sec. The corresponding hub and / or interventional device can continue to move axially at the predefined linear velocity as long as the user manipulates the control unit to maintain the same axial position. The corresponding hub and / or interventional device can stop moving when the user stops manipulating the control unit, and the control can return to its starting axial position. 23B, a centering mechanism 2211e can facilitate returning the control to its starting axial position. For example, the centering mechanism 2211e can be configured to move the control distally or proximally (by moving the corresponding shaft), depending on whether the user moved the control distally or proximally, and return the control to its starting axial position when the user stops manipulating the control.

[0252] Axial movement of a control can be configured to move a corresponding hub and / or interventional device on a 1:1 or non-1:1 scaled basis. For example, if a user advances the control 2202e distally approximately 5 millimeters, the corresponding hub and / or interventional device can move distally at a predefined linear velocity of 5 mm / sec in response.

[0253] Rotational movement of the control can be configured to move the corresponding interventional device on a 1:1 basis or on a non-1:1 scaled basis. For example, if a user rotates the control 2202e about its axis of rotation by 5 degrees, the corresponding interventional device can move an angular distance of 5 degrees in response. In certain embodiments, when the user stops manipulating the control in a rotational direction, the control maintains its position and does not return to its previous initial rotational position. In certain embodiments, each rotational position of the control can correspond to a unique rotational position of the corresponding interventional device.

[0254] The control mechanism 2200e can be configured to allow a clinician to adjust a predefined linear speed and / or rotational distance or position. For example, as described herein, distal advancement of the treatment catheter and access catheter through the guide catheter and to the selected ostium can desirably be achieved in a “fast” mode. More distal travel into the neurovasculature can desirably be achieved in a slower mode by actuation of the speed control. For example, for a stage of the procedure in which the clinician wishes to proceed in a “fast” mode, the clinician can adjust the predefined linear speed to 10 mm / sec when the control is moved distally or proximally 5 mm. For a stage of the procedure in which the clinician wishes to proceed in a slower mode, the clinician can adjust the predefined linear speed to 2 mm / sec when the control is moved distally or proximally 5 mm.

[0255] While the above describes an exemplary operation of controller 2202e, it will be understood by those skilled in the art that any of controllers 2204e, 2206e, and 2208e can be operated in a similar manner. In certain embodiments, controllers 2202e, 2204e, 2206e, and 2208e can each control axial and rotational movement of a corresponding interventional device. In other embodiments, one or more of controllers 2202e, 2204e, 2206e, and 2208e can control only axial or only rotational movement of a corresponding interventional device.

[0256] 23C illustrates an alternative embodiment of control mechanism 2200e in which each of shafts 2210e'-2210e'''' is received and supported within a single housing section 2241e. Housing section 2241e can include a linear sensor 2213e and a rotational sensor 2215e for each control.

[0257] In certain embodiments, shafts 2210e'-2210e'''' and / or controls 2202e, 2204e, 2206e, and 2208e can be removably received within housing section 2241e. Shafts 2210e'-2210e'''' and / or controls 2202e, 2204e, 2206e, and 2208e can be single-use and / or disposable components. Housing section 2241e and internal components (e.g., sensors 2213e, 2215e, centering mechanism 2211e, etc.) can be configured for multiple uses and can be coupled to multiple shafts 2210e'-2210e'''' and / or controls 2202e, 2204e, 2206e, and 2208e.

[0258] 24A-24E illustrate additional examples of control mechanisms for manipulating interventional devices driven by (or otherwise associated with) their respective hubs. The control mechanisms of FIGS. 24A-24E can include any of the same or similar features and / or functionality as any of the other control mechanisms described herein. In certain embodiments, each hub can be manipulated and / or otherwise moved using at least one controller mounted in the control mechanism. Each controller can be adapted to move a particular hub and / or interventional device during an interventional procedure. For example, movement of each controller can trigger responsive movement in the corresponding hub and / or interventional device. In certain embodiments, movement of at least some of the respective controllers can trigger responsive movement in a corresponding carriage on the support table, which can drive movement of the corresponding hub.

[0259] 24A, the control mechanism 2200f can include a first control unit 2202f, a second control unit 2204f, a third control unit 2206f, and a fourth control unit 2208f. More or fewer controls can be provided depending on the intended interventional device configuration. Each control unit 2202f-2208f can include a capacitive screen, a resistive screen, a touchpad, or other touch-based sensing device.

[0260] The control mechanism 2200f 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 2200f 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.

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

[0262] In operation, when a user swipes a finger along a horizontal axis (either proximally or distally) across the touchpad of the control unit 2202f, as shown by axis X, the corresponding coupled hub and / or interventional device can move axially in the same direction by the same or a scaled amount. When a user swipes a finger along a vertical axis across the touchpad of the control unit 2202f, as shown by axis Y, the corresponding coupled hub and / or interventional device can move rotationally by the same or a scaled amount. For example, when a user swipes a finger vertically upward across the touchpad, the interventional device can rotate clockwise, and when a user swipes a finger vertically downward across the touchpad, the interventional device can rotate counterclockwise.

[0263] When a user 2230 swipes a finger across the touchpad of the control unit 2202f in a direction having both horizontal and vertical components (e.g., along a substantially diagonal axis as shown by axis D), the corresponding coupled hub and / or interventional device can move axially in the same direction by the same or a scaled amount as the horizontal component and can move rotationally by the same or a scaled amount as the vertical component. The axial and rotational movement of the corresponding coupled hub and / or interventional device when a user swipes a finger along diagonal axis D across the touchpad can depend on the horizontal distance traveled by the user's finger along axis X and the vertical distance traveled along axis Y along the touchpad. In certain embodiments, a user can swipe a finger along a non-linear path across the touchpad to adjust the axial and rotational movement at different rates during different portions of a procedure.

[0264] In other embodiments, rotational control of the corresponding interventional device can be achieved by performing a substantially circular motion on the touchpad. For example, and without limitation, when a user performs a circular motion (e.g., clockwise or counterclockwise) on the touchpad, the interventional device can rotate in the same direction by the same or scaled amount. That is, if a user performs a circular motion three times in a clockwise direction, the corresponding hub and / or interventional device can rotate three times in a clockwise direction. As another example, when a user performs a semicircular motion counterclockwise (i.e., 180 degrees), the corresponding hub and / or interventional device can rotate 180 degrees in a counterclockwise direction.

[0265] In some embodiments, when a user clicks on the touchpad surface of the controller 2202 along the edge of the touchpad, the corresponding coupled hub and / or interventional device can move in response at a predefined linear velocity. The corresponding coupled hub and / or interventional device can continue to move at the predefined linear velocity until the user clicks on the touchpad surface again.

[0266] The touchpad of each controller 2202f-2208f can be configured to move the associated hub at a predefined linear velocity. For example, if a user clicks the touchpad along the edge of the touchpad, the corresponding hub can move distally or proximally at a linear velocity of 5 mm / sec in response. For example, clicking the left edge of controller 2202f can advance the associated hub distally at a predefined linear velocity. Similarly, clicking the right edge of controller 2202f can advance the associated hub proximally at a predefined linear velocity. The predefined linear velocity can be adjusted by the clinician. For example, and without limitation, clicking the edge of the touchpad can move the associated hub at a linear velocity of approximately 5 mm / sec, 6 mm / sec, 8 mm / sec, 10 mm / sec, 12 mm / sec, 14 mm / sec, etc. The associated hub can continue to move distally or proximally at the predefined linear velocity until the user clicks the surface of the touchpad again.

[0267] The controls can be configured to move the coupled hubs axially on a 1:1 basis or on a non-1:1 scaled basis. For example, if a user swipes their finger 10 mm along axis X across the touchpad, the corresponding hub can move a distance of 10 mm proximally or distally in response.

[0268] The controls can be configured to rotationally move the coupled hubs on a 1:1 basis or on a non-1:1 scaled basis. For example, if a user swipes their finger 10 mm across the touchpad along axis Y, the corresponding hub can rotationally move by 10 degrees in response.

[0269] The control mechanism 2200f can be configured to allow the clinician to adjust the predefined linear velocity. For example, distal advancement of the treatment catheter and access catheter through the guide catheter and to the selected ostium can desirably be achieved in a “fast” mode. However, more distal travel into the neurovasculature can desirably be achieved in a slower mode by actuation of the velocity control. For example, for a stage of the procedure in which the clinician wishes to proceed in “fast” mode, the clinician can adjust the predefined linear velocity to 10 mm / sec as the user clicks along the edge of the touchpad. For a stage of the procedure in which the clinician wishes to proceed in a slower mode, the clinician can adjust the predefined linear velocity to 2 mm / sec as the user clicks along the edge of the touchpad.

[0270] In some cases, the touchpad of each control 2202f-2208f can include one or more guided areas to assist a clinician in operating the respective control 2202f-2208f. For example, and as shown in FIG. 24B, the touchpad of each control 2202f-2208f can include two guided areas 2239f, 2240f and a non-guided area 2242f. The first and second guided areas 2239f, 2240f can provide visual and tactile assistance to the clinician as they operate the respective control 2202f-2208f. The first guided area 2239f can include a substantially horizontal region. The horizontal region of the first guided area 2239f can beneficially prevent a clinician from accidentally swiping their finger vertically. The second guided area 2240f can include a substantially vertical region. The vertical region of the second guided area 2240f can beneficially prevent a clinician from accidentally swiping their finger horizontally. In operation, a clinician can swipe their finger across the first guided area 2239f or the second guided area 2240f to control the corresponding hub and / or interventional device in a particular direction. For example, a clinician can swipe their finger across the first guided area 2239f to move the corresponding hub and / or interventional device axially. Because the first guided area limits the clinician's ability to swipe their finger vertically, the probability of a clinician accidentally or erroneously controlling the hub and / or interventional device in an undesirable manner (e.g., rotating instead of axially advancing or retracting) can be reduced. Similarly, the second guided area 2240f limits the clinician's ability to swipe their finger horizontally, thereby reducing the probability that the clinician will accidentally or erroneously control the hub and / or interventional device in an undesirable manner (e.g., advancing or retracting axially instead of rotating).

[0271] In some cases, the touchpad can also include a non-guided area 2242f, as shown in FIG. 24B and FIG. 24C. The non-guided area can be used by the clinician to simultaneously control the axial and rotational movement of the corresponding hub and / or interventional device. For example, if the clinician desires that the corresponding hub and / or interventional device move both axially and rotationally, the clinician can perform a swipe gesture on the non-guided area of ​​the touchpad. A diagonal swipe gesture will cause the corresponding hub and / or interventional device to move both axially and rotate. However, in some cases, the clinician can use two fingers to simultaneously perform a swipe gesture on the first guided area 2239f and the second guided area 2240f, which can move the corresponding hub and / or interventional device axially and rotationally.

[0272] In some cases, the touchpad can include a circular guided area 2244f, as shown in FIGURE 24C. The circular guided area can improve a user's accuracy when operating controls 2202f-2208f configured to rotate corresponding hubs and / or interventional devices when substantially circular gestures are performed on the touchpad.

[0273] FIG. 24D shows additional examples of touchpad configurations and swiping gestures that can move the corresponding hub and / or interventional device axially and rotationally. In some embodiments, vertical, circular, or semicircular gestures can rotate the corresponding hub and / or interventional device. The controls can include guided areas that include vertical, circular, and semicircular areas. In some embodiments, vertical or horizontal gestures can move the corresponding hub and / or interventional device axially. The controls can include guided areas that include vertical and / or horizontal areas.

[0274] 24E shows additional example configurations of guided areas 2251f, 2253f for the control. The control can include guided areas 2251f including horizontal areas. The control can also include guided areas 2253f including vertical, circular, or semicircular areas. In some embodiments, the control can include one or more parallel ridges. Each parallel ridge can be used to control the movement of a different interventional device.

[0275] While the above describes an exemplary operation of controller 2202f, it will be understood by those skilled in the art that any of controllers 2204f, 2206f, and 2208f can be operated in a similar manner. In certain embodiments, each of controllers 2202f, 2204f, 2206f, and 2208f can control axial and rotational movement of a corresponding interventional device. In other embodiments, one or more of controllers 2202f, 2204f, 2206f, and 2208f can control only axial or only rotational movement of a corresponding interventional device.

[0276] 25A-25D illustrate another example of a control mechanism for manipulating an interventional device driven by (or otherwise associated with) a respective hub. The control mechanism of FIGS. 25A-25C can include any of the same or similar features and / or functions as any of the other control mechanisms described herein. In certain embodiments, each hub can be manipulated and / or otherwise moved using at least one controller mounted in the control mechanism. Each controller can be adapted to move a particular hub and / or interventional device during an interventional procedure. For example, movement of each controller can trigger responsive movement in the corresponding hub and / or interventional device. In certain embodiments, movement of at least some of the respective controllers can trigger responsive movement in a corresponding carriage on the support table, which can drive movement of the corresponding hub.

[0277] As shown in FIG. 25B, the control mechanism 2200g can include a first control unit 2202g, a second control unit 2204g, a third control unit 2206g, and a fourth control unit 2208g. More or fewer controls can be provided depending on the intended interventional device configuration. Each control unit 2202g-2208g can include a surface 2258g having a capacitive screen, a resistive screen, a touchpad, or other touch-based sensing device. The control mechanism 2200g 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 2200g can be positioned remotely from the support table, such as behind a radiation shield or in a different room or geographic location, for example, in a telemedicine implementation.

[0278] Each controller 2202g-2208g can correspond to and drive the movement of a hub and / or interventional device. In certain embodiments, controller 2202g can be configured to move (e.g., axially and / or rotationally) an interventional device, such as, for example, a 0.088 inch guide catheter (e.g., guide catheter 31 or guide catheter 2906) by driving a hub (e.g., hub 30 or hub 2914) associated with the interventional device. Similarly, controller 2204g can be configured to move (e.g., axially and / or rotationally) an interventional device, such as, for example, a 0.071 inch treatment catheter (e.g., catheter 29, catheter 120, or catheter 2904) by driving a hub (e.g., hub 28, hub 122, or hub 2912) associated with the interventional device. Controller 2206g can be configured to move (e.g., axially and / or rotationally) an interventional device such as a steerable access catheter (e.g., catheter 124 or catheter 2902), for example, by actuating a hub associated with the interventional device (e.g., hub 126 or hub 2910). Controller 2208g can be configured to move (e.g., axially and / or rotationally) an interventional device such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example, by actuating a hub associated with the interventional device (e.g., hub 26 or hub 2909).

[0279] In operation, when a user swipes a finger (e.g., distally or proximally) across surface 2258g of control unit 2202g, as indicated by the direction of arrow 2216g, the corresponding coupled hub and / or interventional device can move in the same direction by the same or a scaled amount. When a user rotates control unit 2202g (e.g., clockwise or counterclockwise), as indicated by arrow 2220g, the corresponding interventional device can be rotationally driven (e.g., by the corresponding hub) in the same direction and / or by the same or a scaled amount. When a user rotates control unit 2202g about the axis of the controller, as indicated by arrow 2220g, and swipes a finger across a capacitive touch area of ​​control unit 2202g, as indicated by arrow 2216g, the corresponding coupled interventional device can responsively move rotationally by the same or a scaled amount and axially by the same or a scaled amount.

[0280] Each control unit 2202g-2208g may include a slip ring 2257g and a stationary cylinder 2251g. Beneficially, the slip ring 2257g may enable infinite rotation of each control unit 2202g-2208g relative to the stationary cylinder 2251g. The stationary cylinder 2251g of each control unit 2202g-2208g may include a diameter smaller than the diameter of the controller 2202g-2208g. In operation, when a user rotates the control unit 2202g, the control unit 2202g may rotate relative to the stationary cylinder 2251g.

[0281] The control can be configured to move the coupled hub axially on a 1:1 basis or on a non-1:1 scaled basis. For example, if a user swipes their finger 10 mm across a capacitive touch area of ​​the control, the corresponding hub can move a distance of 10 mm proximally or distally in response.

[0282] The control can be configured to rotationally move the coupled hub on a 1:1 basis or on a non-1:1 scaled basis. For example, if a user rotates the control 2202g about the stationary cylinder 2251g by 5 degrees, the corresponding hub can move an angular distance of 5 degrees in response.

[0283] The control mechanism can be configured to allow a clinician to adjust the linear displacement and / or rotational distance. For example, distal advancement of the treatment catheter and access catheter through the guide catheter and to the selected ostium can desirably be achieved in a “fast” mode. However, more distal travel into the neurovasculature can desirably be achieved in a slower mode by actuation of the speed control. For example, for a stage of the procedure in which the clinician wishes to proceed in a “fast” mode, the clinician can adjust the control so that a 5 mm swipe across a capacitive touch area on the control moves the corresponding hub and / or interventional device by 10 mm in the same direction. For a stage of the procedure in which the clinician wishes to proceed in a slower mode, the clinician can adjust the control so that a 5 mm swipe across a capacitive touch area on the control moves the corresponding hub and / or interventional device by 1 mm in the same direction. In some embodiments, one or more of the controller 2202g, the second controller 2204g, the third controller 2206g, and the fourth controller 2208g can be mounted together on a platform (e.g., a sled) that is axially movable and can translate together in a "fast" mode during either insertion or retraction of each of the corresponding interventional devices. In such embodiments, the capacitive touch areas of the individual controllers can be used to move their corresponding interventional devices in a "slow" mode.

[0284] One or more rotation sensors 2253g can be used to measure the rotational movement of the control relative to the stationary cylinder 2251g, as shown in FIGS. 25B-25D. Each control 2202g-2208g can include a stationary cylinder 2251g. The one or more rotation sensors 2253g can be configured to measure the rotational movement (e.g., 5 degrees) of the control relative to the stationary cylinder 2251g corresponding to the respective control. The rotational distance that the corresponding interventional device will travel can depend, among other things, on the rotational movement measurement by the one or more rotation sensors. The one or more rotation sensors can include, for example, a magnet 2255g, a magnetoresistive element, an encoder, a potentiometer, a Hall effect sensor, or a combination thereof, as shown in FIG. 25D. The control mechanism 2200g can include a rotation sensor for each control.

[0285] While the above describes an exemplary operation of controller 2202g, it will be understood by those skilled in the art that any of controllers 2204g, 2206g, and 2208g can be operated in a similar manner. In certain embodiments, controllers 2202g, 2204g, 2206g, and 2208g can each control axial and rotational movement of a corresponding interventional device. In other embodiments, one or more of controllers 2202g, 2204g, 2206g, and 2208g can control only axial or only rotational movement of a corresponding interventional device.

[0286] Control unit 2202g' shown in Figure 25E is an alternative embodiment of one of controls 2202g-2208g shown in Figures 25A-25D. Similarly, control unit 2202g' can include surface 2258g' having a capacitive screen, a resistive screen, a touchpad, or other touch-based sensing device.

[0287] 26A-26B illustrate another example of a control mechanism for manipulating an interventional device driven by (or otherwise associated with) a respective hub. The control mechanism of FIGS. 26A-26C can include any of the same or similar features and / or functionality as any of the other control mechanisms described herein. In certain embodiments, each hub can be manipulated and / or otherwise moved using at least one controller. Each controller can be adapted to move its own hub and associated interventional device during an interventional procedure. For example, movement of each controller can trigger responsive movement in the corresponding hub and / or interventional device. In certain embodiments, movement of at least some of each controller can trigger responsive movement in a corresponding carriage on the support table, which can drive movement of the corresponding hub.

[0288] As shown in FIG. 26A , the control mechanism 2200h can include a first control 2202h, a second control 2204h, a third control 2206h, and a fourth control 2208h. More or fewer controls can be provided depending on the intended interventional device configuration. Each control can include a spinning wheel 2270h and multiple knobs 2272ah, 2272bh. The multiple knobs 2272ah, 2272bh can be linked together. Beneficially, this can allow a user to control the multiple knobs 2272ah, 2272bh using either their right or left hand. Each spinning wheel 2270h can rotate about a first axis 2217h, as indicated by arrow 2216h, to cause axial movement of the corresponding hub and / or interventional device. Additionally, knobs 2272ah, 2272bh can rotate about second axis 2219h, as indicated by arrow 2220h, to cause rotational movement of the corresponding hub and / or interventional device. Manipulating spinning wheel 2270h and / or any of knobs 2272ah, 2272bh can move the corresponding hub and / or interventional device.

[0289] The control mechanism 2200h, including the controls 2202h, 2204h, 2206h, 2208h, 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 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.

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

[0291] In operation, when a user rotates the spinning wheel 2270h of the first control unit 2202h (e.g., by a half rotation (e.g., 180°)), the corresponding hub and / or interventional device can move axially in the corresponding direction by the same or a scaled amount. For example, when a user rotates the spinning wheel 2270h counterclockwise, the corresponding hub and / or interventional device can move proximally, and when a user rotates the spinning wheel 2270h clockwise, the corresponding hub can move distally. When a user rotates either knob 2272ah, 2272bh of the first control unit 2202h (e.g., clockwise or counterclockwise), the corresponding interventional device can be rotationally driven (e.g., by the corresponding hub) in the same direction and / or by the same or a scaled amount. When a user rotates the spinning wheel 2270h of the first control unit 2202h and rotates either knob 2272ah, 2272bh of the first control unit 2202h, the corresponding connected interventional device can respond by moving rotationally by the same or a scaled amount and axially by the same or a scaled amount in the corresponding direction.

[0292] The controller can be configured to axially move the corresponding hub and / or interventional device on a 1:1 or non-1:1 scaled basis. For example, if a user rotates a wheel approximately 5 degrees, the corresponding hub and / or interventional device can move an axial distance of 5 mm in response.

[0293] The controls can be configured to rotationally move the corresponding interventional device on a 1:1 scale or non-1:1 scaled basis. For example, if a user rotates either knob 2072ah, 2072bh of the first control 2202h by 5 degrees, the corresponding hub can move an angular distance of 5 degrees in response.

[0294] The control mechanism 2200 can be configured to allow a clinician to adjust the scale of linear and / or rotational displacement of the corresponding hub and / or interventional device relative to movement of the control. For example, distal advancement of the treatment catheter and access catheter through the guide catheter and to the selected ostium can desirably be achieved in a “fast” mode. More distal travel into the neurovasculature can desirably be achieved in a slower mode by actuation of the speed control. For example, for a stage of the procedure in which the clinician wishes to proceed in “fast” mode, the clinician can adjust the control so that a 180° rotational movement of the spinning wheel 2270h moves the corresponding coupled hub and / or interventional device by 50 mm in the same direction. For a stage of the procedure in which the clinician wishes to proceed in a slower mode, the clinician can adjust the control so that the same 180° rotational movement of the spinning wheel moves the corresponding coupled hub and / or interventional device by 10 mm in the same direction.

[0295] The control unit 2202h' shown in Figure 26C is an alternative embodiment of one of the controls 2202h-2208h shown in Figures 26A-26B. Like the controls 2202h-2208h, the control unit 2202h' can include a spinning wheel 2270h' and a plurality of knobs 2272ah', 2272bh'. The positions of the plurality of knobs 2272ah', 2272bh' relative to the spinning wheel 2270h' can be different from the positions of the plurality of knobs 2272ah, 2272bh relative to the spinning wheel 2270h.

[0296] One or more rotation sensors can be used to measure the rotational movement of the spinning wheel 2270h and the plurality of knobs 2272ah, 2272bh, as shown in FIG. 26B. For example, one or more rotation sensors 2251h, 2253h can be configured to measure the rotational movement (e.g., 180 degrees) of the spinning wheel 2270 and / or the plurality of knobs 2272ah, 2272bh. For example, the rotation sensor 2251h can be configured to measure the rotational movement of the spinning wheel 2270h, while the rotation sensor 2253h can be configured to measure the rotational movement of the plurality of knobs 2272ah, 2272bh. The rotational distance and / or distal travel that the corresponding hub and / or interventional device will travel depends, among other things, on the rotational movement measured by the one or more rotation sensors 2251h, 2253h. The one or more rotation sensors can include, for example, a magnet, a magnetoresistive element, an encoder, a potentiometer, a Hall effect sensor, or a combination thereof.

[0297] While the above describes an exemplary operation of controller 2202h, it will be understood by those skilled in the art that any of controllers 2204h, 2206h, and 2208h can be operated in a similar manner. In certain embodiments, each of controllers 2202h, 2204h, 2206h, and 2208h can control axial and rotational movement of a corresponding interventional device. In other embodiments, one or more of controllers 2202h, 2204h, 2206h, and 2208h can control only axial or only rotational movement of a corresponding interventional device.

[0298] FIG. 27 illustrates another example of a control mechanism for manipulating an interventional device driven by (or otherwise associated with) a respective hub. The control mechanism 2200i shown in FIG. 27 is an alternative embodiment of the control mechanism shown in FIGS. 26A-26C. The control mechanism 2200i can include a first control 2202i and a second control 2204i for controlling at least two corresponding hubs and / or interventional devices. More or fewer controls can be provided depending on the intended interventional device configuration. Each control can include a spinning wheel 2270i and a knob 2272i. Manipulating the spinning wheel 2270i and / or knob 2272i can move the corresponding hub and / or interventional device, for example, as described with respect to FIGS. 26A-26C.

[0299] 28A and 28B illustrate another exemplary control mechanism 2200j for manipulating an interventional device driven by (or otherwise associated with) a respective hub. The control mechanism of FIGS. 28A-28B can include any of the same or similar features and / or functionality as any of the other control mechanisms described herein. In some embodiments, the control mechanism can include a controller having one or more buttons, joysticks, and / or directional pads (d-pads). In some embodiments, each hub can be manipulated and / or otherwise moved using one or more of the buttons, joysticks, and / or d-pads. Each of the one or more joysticks can have a starting position. The control mechanism can be configured such that each of the one or more joysticks returns to its starting position when it is not being manipulated by a user. In some embodiments, each of the buttons, joysticks, and / or d-pads can be adapted to move a particular hub and associated interventional device during an interventional procedure.

[0300] The control mechanism 2200j can include a control unit 2210j having one or more buttons, joysticks, and / or d-pads. More or fewer buttons, joysticks, and / or d-pads can be provided depending on the intended interventional device configuration. For example, and as shown in FIGS. 28A and 28B , the control unit 2210j can include multiple buttons 2221j, 2222j, 2223j, 2224j, a first joystick 2231j, a second joystick 2232j, a d-pad 2240j, a first shoulder button or bumper button 2251j, a second shoulder button or bumper button 2252j, a first trigger 2261j, and / or a second trigger 2262j. Each of the buttons, joysticks, and / or d-pads can be operated by a user. For example, a joystick can be moved along one or more axes, and one or more of the joystick, button, and d-pad can be pressed. Manipulation of one or more of the buttons, joystick, and / or d-pad can trigger responsive movement in a corresponding hub and / or interventional device. In certain embodiments, movement of at least some of the buttons, joystick, and / or d-pad can trigger responsive movement in a corresponding carriage on the support table, which can drive movement of the corresponding hub. The control mechanism 2200j 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 2200j can be positioned remotely from the support table, such as behind a radiation shield or in a different room or different geographic location, for example, in a telemedicine implementation.

[0301] One or more of the buttons, joystick, and / or d-pad of the control unit 2210j can correspond to and drive movement of the hub and / or interventional device. In certain embodiments, one or more of the buttons, joystick, and / or d-pad can be operated to link or assign control of the hub (e.g., control of axial and / or rotational movement) to another of the buttons, joystick, and / or d-pad of the control unit 2210j. For example, in certain embodiments, one of the buttons, joystick, and / or d-pad can be selected to assign control of a particular hub to the joystick 2231j, and another of the buttons, joystick, and / or d-pad can be selected to assign control of a different particular hub to the joystick 2231j.

[0302] In some embodiments, button 2224j and first joystick 2231j can be configured to move (e.g., axially and / or rotationally) an interventional device, such as a 0.088 inch guide catheter (e.g., guide catheter 31 or guide catheter 2906), by driving a hub (e.g., hub 30 or hub 2914) associated with the interventional device. For example, a user can press button 2224j to enable translation and / or rotation of the corresponding drive hub (e.g., hub 30 or hub 2914) or interventional device (e.g., guide catheter 31 or guide catheter 2906). When translation and / or rotation of the corresponding hub and / or interventional device is enabled, a user can manipulate first joystick 2231j to control the corresponding drive hub and / or interventional device. Similarly, button 2222j and first joystick 2231j can be configured to move (e.g., axially and / or rotationally) an interventional device, such as a 0.071 inch treatment catheter (e.g., catheter 29, catheter 120, or catheter 2904), by actuating a hub (e.g., hub 28, hub 122, or hub 2912) associated with the interventional device. For example, a user can press button 2222j to enable translation and / or rotation of the corresponding hub (e.g., hub 28, hub 122, or hub 2912) and / or interventional device (e.g., catheter 29, catheter 120, or catheter 2904). When translation and / or rotation of the corresponding hub and / or interventional device is enabled, a user can manipulate first joystick 2231j to control the corresponding hub and / or interventional device.The button 2223j and the first joystick 2231j can be configured to move (e.g., axially and / or rotationally) an interventional device, such as a steerable access catheter (e.g., catheter 124 or catheter 2902), by, for example, actuating a hub (e.g., hub 126 or hub 2910) associated with the interventional device. For example, a user can press a button 2223j to enable translation and / or rotation of the corresponding hub (e.g., hub 126 or hub 2910) and / or interventional device (e.g., catheter 124 or catheter 2902). When translation and / or rotation of the corresponding hub and / or interventional device is enabled, a user can manipulate the first joystick 2231j to control the corresponding hub and / or interventional device. The button 2221j and the first joystick 2231j can be configured to actuate two or more hubs simultaneously and / or two or more interventional devices simultaneously. For example, a user can press button 2221j to enable translation and / or rotation of multiple hubs (e.g., hubs 2910, 2912, and 2914) of multiple interventional devices (e.g., catheters 2902, 2904, and 2906). When translation and / or rotation of multiple hubs and / or interventional devices is enabled, a user can operate first joystick 2231j to simultaneously control each of the multiple hubs and / or interventional devices.

[0303] In some cases, the second joystick 2232j can be configured to move (e.g., axially and / or rotationally) an interventional device, such as a guidewire (e.g., guidewire 27 or guidewire 2907), for example, by actuating a hub (e.g., hub 26 or hub 2909) associated with the interventional device. In some embodiments, for example, as described with respect to joystick 2231j, one of the multiple buttons, joystick, and / or d-pad can be selected to assign control of a particular hub to joystick 2232j, and another of the multiple buttons, joystick, and / or d-pad can be selected to assign control of a different particular hub to joystick 2232j.

[0304] The control unit 2210j can be configured to allow the clinician to adjust the functionality of each or at least some of the buttons, joysticks, and / or d-pads, i.e., each of the multiple buttons, joysticks, and / or d-pads can be configured to perform different functions and / or allow control of different hubs by the clinician.

[0305] In operation, when a user enables control of the drive hub by pressing button 2222j and moves the first joystick 2231j in a direction along arrow X' (i.e., about axis 2219j), the corresponding coupled hub and / or interventional device can responsively move in a corresponding axial direction at a predefined linear velocity. The corresponding coupled hub and / or interventional device can continue to move in the same direction at the predefined linear velocity until the user releases (e.g., stops manipulating) the first joystick 2231j or further moves the first joystick 2231j. When the user stops manipulating the first joystick 2231j, the first joystick 2231j can return to its starting position. When the user moves the first joystick 2231j in a direction along arrow Y' (i.e., about axis 2217j), the corresponding coupled hub can rotationally drive the corresponding interventional device in a corresponding direction at a predefined angular velocity. When the user stops manipulating the first joystick 2231j, the first joystick 2231j may return to its starting position. In some cases, if the user moves the first joystick 2231j in a direction having both an X' component and a Y' component (e.g., diagonally along arrow Z'), the corresponding coupled interventional device may responsively move rotationally at a predefined angular velocity and axially at a predefined linear velocity. The corresponding coupled interventional device may continue to move rotationally at a predefined angular velocity and axially at a predefined linear velocity until the user releases (e.g., stops manipulating) the first joystick 2231j or further moves the first joystick 2231j. When the user stops manipulating the first joystick 2231j, the first joystick 2231j may return to its starting position.The clinician can control different hubs and / or interventional devices, or two or more hubs and / or interventional devices simultaneously, by pressing one of the second, third, or fourth buttons 2221j, 2223j, 2224j (which can enable control of one or more of the hubs and / or interventional devices) and by operating the first and / or second joysticks 2231j, 2232j.

[0306] In some embodiments, when a user moves the second joystick 2232j in a direction along arrow Y'', the corresponding coupled interventional device can responsively move rotationally at a predefined angular velocity. The corresponding coupled interventional device can continue to move rotationally at the predefined angular velocity until the user releases (e.g., stops manipulating) the second joystick 2232j or further moves the second joystick 2232j. When the user stops manipulating the second joystick 2232j, the second joystick 2232j can return to its starting position. When a user moves the second joystick 2232j in a direction along arrow X'', the corresponding coupled interventional device can responsively move axially at a predefined velocity. The corresponding coupled interventional device can continue to move axially at the predefined velocity until the user releases (e.g., stops manipulating) the second joystick 2232j or further moves the second joystick 2232j. When the user stops manipulating the second joystick 2232j, the second joystick 2232j can return to its starting position.

[0307] In some embodiments, the first and second triggers 2261j, 2262j can be used to articulate and / or relax an interventional device, such as an access catheter. For example, pressing the first trigger 2261j can relax the access catheter. In some cases, the access catheter will remain relaxed until the user releases the first trigger 2261j. The access catheter can remain in a relaxed position even when the first trigger 2261j is released. The user can articulate the access catheter by pressing the second trigger 2262j. In some cases, the access catheter will continue to articulate until the user releases the second trigger 2262j.

[0308] Other axes and degrees of freedom can be defined to enable the control 2210j to perform movements that can be translated into movements of the hub and / or interventional device. For example, the control mechanism 2200j can be provided with one or more deflection controls configured to initiate lateral deflection within a deflection zone on a corresponding interventional device.

[0309] Movement of the first and / or second joystick 2231j, 2232j along arrows X', Y', Z', Y'' can be configured to move the coupled hub on a 1:1 basis or on a non-1:1 scaled basis. For example, if a user rotates the first joystick 2231j along arrow X' (i.e., about axis 2219j) approximately 5 degrees, the corresponding hub can move in the same direction in response at a predefined linear velocity of 5 mm / sec.

[0310] Movement of the first and / or second joystick 2231j, 2232j along arrows X', Y', Z', Y'' can be configured to rotate the coupled hub on a 1:1 basis or on a non-1:1 scaled basis. For example, if a user rotates the first joystick 2231j along arrow Y' (i.e., about axis 2217j) approximately 5 degrees, the corresponding hub can move at a predefined angular velocity of 5 degrees / second in response.

[0311] 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 axial 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.

[0312] 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.

[0313] One or more rotational sensors can be used to measure the rotational movement of each joystick 2231j, 2232j about axis 2217j and / or axis 2219j relative to a starting position of the respective control, as shown in FIG. 28C. For example, one or more rotational sensors can be configured to measure the rotational movement (e.g., 5 degrees) of the control from its starting position. The linear velocity and / or predefined angular velocity at which the corresponding interventional device will move can depend on measurements by the one or more rotational sensors. The one or more rotational sensors can include, for example, an encoder, a potentiometer, a Hall effect sensor, or a combination thereof. In some cases, the control mechanism 2200j can include one or more rotational sensors for each joystick 2231j, 2232j.

[0314] The control mechanism 2200j can be configured to allow the clinician to adjust the scale factor for different parts of the procedure. For example, distal advancement of the procedure catheter and access catheter through the guide catheter and to the selected ostium can desirably be achieved in a "fast" mode. More distal travel into the neurovasculature can desirably be achieved in a slower mode by actuation of the speed control. For example, for a stage of the procedure that the clinician wishes to proceed in a "fast" mode, the clinician can adjust the predefined linear speed to 10 mm / sec when the control moves 5 degrees along arrow X' (i.e., about axis 2219j). For a stage of the procedure that the clinician wishes to proceed in a slower mode, the clinician can adjust the predefined linear speed to 2 mm / sec when the control moves 5 degrees along arrow X'.

[0315] Any of the control mechanisms disclosed herein (including, but not limited to, control mechanisms 2200, 2200a, 2200b, 2200c, 2200d, 2200e, 2200f, 2200g, 2200h, 2200i, and 2200j) can be configured to allow a user to simultaneously manipulate two or more hubs and / or interventional devices. For example, a control mechanism can be configured to fix the relative positions (e.g., axial and / or rotational positions) of two or more hubs and / or interventional devices with respect to one another. When the relative positions of two or more hubs and / or interventional devices are fixed, operation of the control as described herein can move the two or more hubs and / or interventional devices axially and / or rotationally together as described herein. In other embodiments, two or more hubs and / or interventional devices can be configured to move at different rates / distances when a user operates a single control. For example, moving the control by 2 mm may move the first hub and / or interventional device by 2 mm and the second hub and / or interventional device by 1 mm.

[0316] In some embodiments, moving a hub near an adjacent second hub can cause the second hub to start moving (e.g., to prevent a collision). For example, moving the controller 2202a so that the first hub moves toward the second hub controlled by the controller 2204a can cause the second hub to be controlled to move (thereby moving an associated interventional device) if the first hub comes within a predefined distance of the second hub. The predefined distance can be, for example, about 1 mm, about 2 mm, about 3 mm, about 4 mm, about 5 mm, etc. In some embodiments, moving a first hub near an adjacent second hub can cause the first hub to stop moving. For example, if a user moves control unit 2202a to move a first hub within a predefined distance of a second hub controlled by control unit 2204a, the user can be prevented from using control unit 2202a to advance the first hub further toward the second hub until control unit 2204a is moved to move the second hub away from the first hub.

[0317] 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 more 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.

[0318] Any of the control mechanisms disclosed herein (including, but not limited to, control mechanisms 2200, 2200a, 2200b, 2200c, 2200d, 2200e, 2200f, 2200g, 2200h, 2200i, and 2200j) can be configured to allow a user to control the movement (e.g., axial movement) of the telescoping drive table. For example, at least one control of the control mechanism can be configured to cause axial movement of the telescoping drive table to cause axial movement of a hub coupled to the telescoping drive table. For example, any of the control mechanisms disclosed herein (including, but not limited to, control mechanisms 2200, 2200a, 2200b, 2200c, 2200d, 2200e, 2200f, 2200g, 2200h, 2200i, and 2200j) can be used to control the movement of an embodiment of a telescoping drive table and / or one or more hubs coupled thereto, as described in U.S. patent application Ser. No. 63 / 385,761, entitled "TELESCOPING DRIVE TABLE," filed December 1, 2022, the entire contents of which are incorporated herein by reference.

[0319] Any of the control mechanisms disclosed herein (including, but not limited to, control mechanisms 2200, 2200a, 2200b, 2200c, 2200d, 2200e, 2200f, 2200g, 2200h, 2200i, and 2200j) may be further provided with one or more fluidics controls (e.g., buttons, joysticks, and / or any of the other control embodiments described herein) for controlling components of the fluidics system, for example, to initiate and / or terminate the introduction of fluid (e.g., saline, contrast, etc.) into the catheter and / or to initiate and / or terminate the aspiration of fluid from the catheter.

[0320] 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.

[0321] In some implementations, other control operations besides translational and rotational movements can be performed using any of the controls described herein. For example, the control can be configured to drive shape and / or stiffness changes of a corresponding interventional device. The control can be switched between different operating modes. For example, the control can be switched between movement driven by acceleration and velocity and movement reflecting actual linear displacement or rotation.

[0322] In some implementations, the control mechanism 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.

[0323] In some implementations, the control mechanism can include a haptic component for providing tactile 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 being 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, which may precede a sharp rotation, or the accumulation of large axial forces, which may be a precursor to catheter buckling. Alternatively or additionally, feedback can be provided by one or more visual indicators (e.g., a warning light), audible indicators, etc.

[0324] 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.

[0325] 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.

[0326] 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.

[0327] 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.

[0328] 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, support, and navigation to a specific 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. In some embodiments, any of the control mechanisms described herein can include at least one control for opening and closing a hemostasis valve.

[0329] One or more of the interventional device and hub combinations can further include fluidic connections for coupling to a fluid supply and / or a vacuum source. For example, the insertion or access catheter 2902, the treatment catheter 2904, and the guide catheter 2906 can each be in fluid communication with a saline supply, a contrast supply, and / or a vacuum source. In some embodiments, any of the control mechanisms described herein can include at least one control for initiating and / or terminating the introduction of fluid into and / or the aspiration of fluid from one or more of the catheters. For example, any of the control mechanisms described herein can include at least one control for opening and / or closing one or more valves to initiate the introduction of fluid into and / or the aspiration of fluid from one or more of the catheters. For example, any of the control mechanisms described herein can be used to control various components (e.g., manifold valves, pumps, hemostasis valves, hubs, and / or catheters) of a fluidics system such as that described in U.S. patent application Ser. No. 17 / 879,614, entitled "Multi Catheter System With Integrated Fluidics Management," filed August 2, 2022, the entire contents of which are incorporated herein by reference.

[0330] In some embodiments, the control mechanisms described herein can allow a user to simultaneously control the movement of the catheter (e.g., axial and / or rotational movement) and the fluidics system (e.g., for introducing and / or aspirating fluid).

[0331] 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.).

[0332] 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.

[0333] 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.

[0334] 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.

[0335] 17, guide catheter 2906, treatment catheter 2904, access catheter 2902, and guidewire 2907 can be concentrically arranged. In certain embodiments, guide catheter 2906 can be a "large bore" guide or access catheter having a diameter of at least about 0.075 inches 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.

[0336] 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.

[0337] 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.

[0338] 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.

[0339] 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 290...

Claims

1. 1. A method for robotically controlling an interventional device, comprising: providing an interventional device assembly including a plurality of interventional devices; advancing a first subset of the plurality of interventional devices into the ostium of the descending aorta in a first mode of operation in response to movement of a control unit of a controller, the first subset of the plurality of interventional devices being linked to the control unit in the first mode of operation; switching from the first operational mode to a second operational mode in response to a user input using the controller, wherein switching from the first operational mode to the second operational mode links a second subset of the interventional devices to the control section of the controller, the second subset of the interventional devices being different from the first subset of the interventional devices; advancing the second subset of the plurality of interventional devices to a treatment site in the second mode of operation in response to movement of the control portion of the controller; A method comprising:

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

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

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

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

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

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

8. 7. The method of claim 6, further comprising the step of linking one of the guide catheter, the treatment catheter, and the access catheter to the second controller in response to a user input, wherein movement of the second controller causes the movement of one of the guide catheter, the treatment catheter, and the access catheter.

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

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

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

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

13. 1. A method for robotically controlling an interventional device, comprising: providing a multi-catheter assembly including an access catheter, a guide catheter, and a treatment catheter; actuating the multi-catheter assembly to provide supra-aortic access in response to movement of a control portion of a controller; driving a subset of the multi-catheter assembly to a neurovascular site in response to movement of the control portion of the controller, the subset including the guide catheter and the treatment catheter; performing a neurovascular procedure using the treatment catheter in response to user input on the controller; A method comprising:

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

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

16. 14. The method of claim 13, wherein the control includes a first control, and the method includes driving a guidewire to achieve supra-aortic access in response to movement of a second control of the controller.

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

18. 17. The method of claim 16, further comprising the step of linking one of the access catheter, the guide catheter, and the treatment catheter to the second controller in response to a user input, wherein movement of the second controller causes the movement of one of the guide catheter, the treatment catheter, and the access catheter.

19. The method of claim 13 , wherein the neurovascular procedure includes aspirating a blood clot.

20. 1. A method for robotically controlling an interventional device, comprising: Actuating a first interventional device of the interventional device assembly in response to movement of a joystick of a controller, the first interventional device being linked to the joystick such that movement of the joystick causes responsive movement of the first interventional device; receiving a user input; in response to receiving the user input, linking a second interventional device of the interventional device assembly to the joystick such that movement of the joystick causes responsive movement of the second interventional device; A method comprising:

21. 21. The method of claim 20, further comprising linking the second interventional device to the joystick and then using the joystick to drive the second interventional device.

22. 21. The method of claim 20, wherein linking the second interventional device to the joystick comprises linking the second interventional device to the joystick such that movement of the joystick causes simultaneous responsive movement of both the first interventional device and the second interventional device.

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

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

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

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

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

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

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

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

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

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

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

34. a controller in communication with a plurality of hubs, each of the plurality of hubs coupled to one of a plurality of interventional devices, the controller including a control unit and an operational mode actuator; the controller is configured to transition between a first operational mode and a second operational mode in response to actuation of the operational mode actuator; In the first mode of operation, the controller is linked to a first subset of the plurality of hubs such that movement of the controller causes responsive movement of the first subset of the plurality of hubs; In the second mode of operation, the controller is linked to a second subset of the hubs such that movement of the controller causes responsive movement of the second subset of the hubs, the second subset of the hubs being different from the first subset of the hubs.

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

36. 36. The robotic device control system of claim 35, wherein when the controller is linked to the first subset of the hubs, movement of the controller is configured to simultaneously move each of the guide catheter hub, the treatment catheter hub, and the access catheter hub.

37. 36. The robotic device control system of claim 35, wherein when the controller is linked to the first subset of the hubs, movement of the controller is configured to sequentially move each of the guide catheter hub, the treatment catheter hub, and the access catheter hub the same distance.

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

39. 39. The robotic device control system of claim 38, wherein movement of the controller is configured to simultaneously move each of the guide catheter hubs and the treatment catheter hubs when the controller is linked to the second subset of the hubs.

40. 39. The robotic device control system of claim 38, wherein when the controller is linked to the second subset of the hubs, movement of the controller is configured to sequentially move each of the guide catheter hubs and the treatment catheter hubs the same distance.

41. 35. The robotic device control system of claim 34, wherein the controller includes a first controller and the system includes a second controller linked to a third subset of the plurality of hubs in the first mode of operation.

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

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

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

45. a controller in communication with a plurality of interventional devices, the controller including a control unit and an operational mode actuator; the controller is configured to transition between a first operational mode and a second operational mode in response to actuation of the operational mode actuator; In the first mode of operation, the controller is linked to a first subset of the plurality of interventional devices such that movement of the controller causes responsive movement of the first subset of the plurality of interventional devices; In the second operating mode, the controller is linked to a second subset of the interventional devices such that movement of the controller causes responsive movement of the second subset of the interventional devices, the second subset of the interventional devices being different from the first subset of the interventional devices.

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

47. 47. The robotic device control system of claim 46, wherein movement of the controller is configured to simultaneously move each of the guide catheter, the treatment catheter, and the access catheter when the controller is linked to the first subset of multiple interventional devices.

48. 47. The robotic device control system of claim 46, wherein when the controller is linked to the first subset of multiple interventional devices, movement of the controller is configured to sequentially move each of the guide catheter, the treatment catheter, and the access catheter over the same distance.

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

50. 50. The robotic device control system of claim 49, wherein movement of the control unit is configured to simultaneously move each of the guide catheter and the treatment catheter when the control unit is linked to the second subset of multiple interventional devices.

51. 50. The robotic device control system of claim 49, wherein movement of the control unit is configured to sequentially move each of the guide catheter and the treatment catheter over the same distance when the control unit is linked to the second subset of multiple interventional devices.

52. 46. ​​The robotic device control system of claim 45, wherein the controller includes a first controller and the system includes a second controller linked to a third subset of the plurality of interventional devices in the first mode of operation.

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

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

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

56. a controller in communication with a plurality of hubs, each of the plurality of hubs coupled to one of a plurality of intervention devices; Including, The controller Joystick and; a plurality of hub actuators; Including, a joystick actuator for controlling a robotic device, the joystick being movable relative to the one of the hubs; a joystick actuator for controlling a robotic device, the joystick actuator being movable relative to the one of the hubs;

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

58. 57. The robotic device control system of claim 56, further comprising a velocity actuator, actuation of the velocity actuator varying a range of axial velocities at which the responsive movement of one of the hubs linked to the joystick occurs in response to movement of the joystick.

59. 57. The robotic device control system of claim 56, wherein the system further includes a second joystick linked to at least one of the plurality of hubs, whereby movement of the second joystick causes the responsive movement of at least one of the plurality of hubs linked to the second joystick.

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

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

62. A controller communicating with multiple intervening devices Including, The controller Joystick and; a plurality of interventional device actuators; Including, and wherein actuation of each of a plurality of the interventional device actuators links the joystick with one of a plurality of the interventional devices, such that movement of the joystick causes the corresponding responsive movement of one of the plurality of the interventional devices.

63. 63. The robotic device control system of claim 62, wherein simultaneous actuation of a first intervention device actuator of the plurality of intervention device actuators and a second intervention device actuator of the plurality of intervention device actuators links the joystick with a first intervention device associated with the first intervention device actuator and a second intervention device associated with the second intervention device actuator, such that movement of the joystick causes corresponding responsive movement of the first intervention device and the second intervention device.

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

65. 63. The robotic device control system of claim 62, wherein the system further includes a second joystick linked to at least one of the plurality of interventional devices, whereby movement of the second joystick causes the responsive movement of at least one of the plurality of interventional devices linked to the second joystick.

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

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

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