Comparison of robotic-assisted carotid stenting and manual carotid stenting through the transradial approach

• Published in: Journal of neurosurgery Vol. 135; no. 1; p. 21
• Main Authors: Weinberg, Joshua H, Sweid, Ahmad, Sajja, Kalyan, Gooch, M Reid, Herial, Nabeel, Tjoumakaris, Stavropoula, Rosenwasser, Robert H, Jabbour, Pascal
• Format: Journal Article
• Language: English
• Published: United States 01.07.2021
• Subjects: robot; stent; interventional neurosurgery; endovascular; robotic-assisted; transradial; carotid artery; vascular disorders; angioplasty
• ISSN: 1933-0693
• DOI: 10.3171/2020.5.JNS201421

The objective of this study was to demonstrate the feasibility and safety of CorPath GRX robotic-assisted (RA) transradial (TR) carotid artery stenting (CAS) compared with manual TR CAS. The authors conducted a retrospective analysis of a prospectively maintained database and identified 13 consecutive patients who underwent TR CAS from June 2019 through February 2020. Patients were divided into 2 groups: RA (6 patients) and manual (7 patients). Among 6 patients in the RA group with a mean age of 70.0 ± 7.2 years, technical success was achieved in all 6 (100%) procedures; there were no technical or access-site complications and no catheter exchanges. Transfemoral conversion was required in 1 (16.7%) case due to a tortuous aortic arch. There were no perioperative complications, including myocardial infarction, stroke, and mortality. The mean procedure duration was significantly longer in the RA group (85.0 ± 14.3 minutes [95% CI 69.9-100.0] vs 61.2 ± 17.5 minutes [95% CI 45.0-77.4], p = 0.0231). There was no significant difference in baseline characteristics, fluoroscopy time, contrast dose, radiation exposure, catheter exchanges, technical success, transfemoral conversion, technical or access-site complications, myocardial infarction, stroke, other complications, or mortality. The authors' results suggest that RA TR CAS is feasible, safe, and effective. Neurovascular-specific engineering and software modifications are needed prior to complete remote control. Remote control has important implications regarding patient access to lifesaving procedures for conditions such as stroke and aneurysm rupture as well as operative precision. Future clinical investigations among larger cohorts are needed to demonstrate reliable performance and patient benefit.