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New devices and techniques
Case series
Robotic Diagnostic Cerebral Angiography: A Multicenter Experience of 113 Patients
  1. Charles Beaman1,2,
  2. Ayushi Gautam1,3,
  3. Catherine Peterson1,4,
  4. Naoki Kaneko1,2,
  5. Luciano Ponce2,
  6. Hamidreza Saber2,
  7. Kasra Khatibi2,
  8. Jose Morales2,
  9. David Kimball2,
  10. Jacob Ridge Lipovac4,
  11. Kazim H Narsinh1,3,
  12. Amanda Baker3,
  13. M Travis Caton3,
  14. Eric R Smith3,
  15. May Nour2,
  16. Viktor Szeder2,
  17. Reza Jahan2,
  18. Geoffrey P Colby1,2,5,
  19. Branden J Cord1,4,
  20. Daniel L Cooke1,3,
  21. Satoshi Tateshima2,
  22. Gary Duckwiler1,2,
  23. Ben Waldau1,4
  24. Robotics Working Group
    1. 1 University of California Stroke Consortium Robotics Workgroup, California, California, USA
    2. 2 Radiology, University of California Los Angeles, Los Angeles, California, USA
    3. 3 Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
    4. 4 Neurosurgery, University of California Davis, Sacramento, CA, USA
    5. 5 Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
    1. Correspondence to Professor Ben Waldau, Department of Neurological Surgery, University of California Davis, Sacramento, CA 95817, USA; bwaldau{at}ucdavis.edu

    Abstract

    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.

    • angiography
    • device
    • technology
    • technique

    https://doi.org/10.1136/jnis-2023-020448

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      Footnotes

      • X @charlesbeaman, @juadngne, @amandaebaker, @EricRSmithMD

      • CB and AG contributed equally.

      • Collaborators The University of California Stroke Consortium Robotics Workgroup.

      • Contributors CB drafted the manuscript, recorded data, conducted analyses, and critically revised the manuscript. AG helped draft the manuscript, recorded data, created the table, and critically revised the manuscript. CP helped draft the manuscript and recorded data. JRL helped record data. NK, LP, HS, KK, JM, DK, KHN, AB, MTC, ERS, MN, VS, RJ, GPC, BJC, DLC, ST, and GD conducted cases and critically revised the manuscript. BW conducted cases, programmed the REDCap database, recorded data, critically revised the manuscript, and supervised the project.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests ST previously consulted for Corindus Vascular Robotics in 2018 and 2019 but currently has no relationship or stock options with the company. BW was a consultant for Siemens/Corindus in 2020 but currently has no relationship or stock options with the company.

      • Provenance and peer review Not commissioned; externally peer reviewed.