Beyond Dexterity: Navigating the Trade‐Offs of Steerable Catheter‐ and Guidewire‐Based Endovascular Robotics for Clinical Applications
Year: 2026
Type: article
Abstract: ABSTRACT Navigating the deep, tortuous pathways of the human body remains a grand challenge for medical robotics. Despite decades of development, current clinical devices face inherent trade‐offs among five core engineering requirements: dexterity, miniaturization, flexibility, force transmission, and stability. This review focuses specifically on steerable endovascular catheters and guidewires and uses these five requirements as a common engineering framework to compare contemporary steering mechanisms and the trade‐offs that constrain their clinical translation. At the mechanism level, precurved concentric‐tube robots and concentric push–pull robots provide compact concentric architectures but remain constrained by elastic coupling, inter‐tube interaction, and mechanical stability. Tendon‐driven systems offer strong force transmission and the greatest degree of clinical maturity, but encounter friction, backlash, and scaling limitations as dexterity increases. Pressure‐driven systems enable compliant distributed bending but face radial expansion and fluidic‐impedance constraints. Thermal and electrical actuation support compact integration, although their performance is limited by response dynamics, actuation strain, or force output. Magnetic systems enable wireless multidirectional steering and substantial miniaturization while shifting the engineering burden toward external field‐generation infrastructure and limiting available distal force. Optical actuation provides an emerging route toward localized and miniaturized control but remains constrained by force generation and response characteristics. For organizational clarity, these mechanisms are discussed within three broad groups, morphological, transmission‐based, and transduction‐based actuation. Overall, this review aims to provide a comprehensive analysis of how existing steering mechanisms address the five core requirements, highlighting their technical foundations, intrinsic trade‐offs, and application boundaries. This analysis culminates in an outline of the key challenges and design considerations that need to be tackled in the future evolution of steerable endovascular robots. We argue that prioritizing omnidirectional active steering at the cost of system simplicity, mechanical stability, and ease of use can hinder clinical adoption. Future endovascular devices may benefit from an application‐specific balance between dexterity and other critical requirements.
Source: SmartBot
DOI: 10.1002/smb2.70075
Authors: Xunzhi Xie, Yumo Wang, Yihao Zheng, Yang Liu
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: diamond
OpenAlex ID: W7225621575