Purpose: Autonomous systems in mechanical thrombectomy (MT) hold promise for reducing procedure times, minimizing radiation exposure, and enhancing patient safety. However, current reinforcement learning (RL) methods only reach the carotid arteries, are not generalizable to other patient vasculatures, and do not consider safety. We propose a safe dual-device RL algorithm that can navigate beyond the carotid arteries to cerebral vessels.

Methods: We used the Simulation Open Framework Architecture to represent the intricacies of cerebral vessels, and a modified Soft Actor-Critic RL algorithm to learn, for the first time, the navigation of micro-catheters and micro-guidewires. We incorporate patient safety metrics into our reward function by integrating guidewire tip forces. Inverse RL is used with demonstrator data on 12 patient-specific vascular cases.

Results: Our simulation demonstrates successful autonomous navigation within unseen cerebral vessels, achieving a 96% success rate, 7.0 s procedure time, and 0.24 N mean forces, well below the proposed 1.5 N vessel rupture threshold.

Conclusion: To the best of our knowledge, our proposed autonomous system for MT two-device navigation reaches cerebral vessels, considers safety, and is generalizable to unseen patient-specific cases for the first time. We envisage future work will extend the validation to vasculatures of different complexity and on in vitro models. While our contributions pave the way toward deploying agents in clinical settings, safety and trustworthiness will be crucial elements to consider when proposing new methodology.

Keywords: Artificial intelligence; Autonomous navigation; Endovascular intervention; Machine learning; Mechanical thrombectomy; Reinforcement learning.

© 2025. The Author(s).