Learning Expert Strategy for Autonomous Robotic Endovascular Intervention via Decoupled Procedural Execution

Yanxi Chen, Tianliang Yao, Shaolong Tang, Jiyuan Zhao, Hengyu Hu, Zhaoxing Li, Antonio J. Sánchez Egea, Peng Qi

Endovascular interventions are high-stakes procedures requiring precise device operation within complex and tortuous vascular anatomies. Autonomous endovascular navigation has the potential to standardize procedural quality and reduce the performance variability inherent in manual operation. Although Reinforcement Learning (RL) approaches have demonstrated promise in enabling autonomy in endovascular intervention, they often struggle with explicit constraint satisfaction and safety guarantees. To address these challenges, a learning-based expert strategy is introduced, enhancing procedural consistency in autonomous endovascular intervention by explicitly decoupling high-level strategic decision-making from low-level procedural execution. The proposed framework replicates the expert clinical decision-making process: a strategic RL policy generates global navigation intents, which are subsequently refined through an expert-informed execution module. This module ensures that robot movements strictly adhere to expert operational norms, real-time kinematic limits, and vessel safety constraints. Experimental evaluation across high-fidelity 3D simulations and a real-world robotic platform demonstrates that the proposed framework not only outperforms baseline policies but also effectively replicates expert-level proficiency. The framework achieves a high navigation success rate (> 96%) and a 29.3% reduction in operational steps, which translates to enhanced operative efficiency and minimized device-vessel interaction. Furthermore, a 13% reduction in trajectory variance indicates superior procedural standardization, aligning autonomous behavior with established clinical norms. These results underscore its potential to enhance the predictability, safety, and consistency of robotic endovascular interventions.