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Robotic Diagnostic Cerebral Angiography: A Multicenter Experience of 113 Patients. 2023

Charles Beaman, and Ayushi Gautam, and Catherine Peterson, and Naoki Kaneko, and Luciano Ponce, and Hamidreza Saber, and Kasra Khatibi, and Jose Morales, and David Kimball, and Jacob Ridge Lipovac, and Kazim H Narsinh, and Amanda Baker, and M Travis Caton, and Eric R Smith, and May Nour, and Viktor Szeder, and Reza Jahan, and Geoffrey P Colby, and Branden J Cord, and Daniel L Cooke, and Satoshi Tateshima, and Gary Duckwiler, and Ben Waldau, and , and
University of California Stroke Consortium Robotics Workgroup, California, California, USA.

BACKGROUND Neurointerventional robotic systems have potential to reduce occupational radiation, improve procedural precision, and allow for future remote teleoperation. A limited number of single institution case reports and series have been published outlining the safety and feasibility of robot-assisted diagnostic cerebral angiography. METHODS This is a multicenter, retrospective case series of patients undergoing diagnostic cerebral angiography at three separate institutions - University of California, Davis (UCD); University of California, Los Angeles (UCLA); and University of California, San Francisco (UCSF). The equipment used was the CorPath GRX Robotic System (Corindus, Waltham, MA). RESULTS A total of 113 cases were analyzed who underwent robot-assisted diagnostic cerebral angiography from September 28, 2020 to October 27, 2022. There were no significant complications related to use of the robotic system including stroke, arterial dissection, bleeding, or pseudoaneurysm formation at the access site. Using the robotic system, 88 of 113 (77.9%) cases were completed successfully without unplanned manual conversion. The principal causes for unplanned manual conversion included challenging anatomy, technical difficulty with the bedside robotic cassette, and hubbing out of the robotic system due to limited working length. For robotic operation, average fluoroscopy time was 13.2 min (interquartile range (IQR), 9.3 to 16.8 min) and average cumulative air kerma was 975.8 mGY (IQR, 350.8 to 1073.5 mGy). CONCLUSIONS Robotic cerebral angiography with the CorPath GRX Robotic System is safe and easily learned by novice users without much prior manual experience. However, there are technical limitations such as a short working length and an inability to support 0.035" wires which may limit its widespread adoption in clinical practice.

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