O-024 Robotic-assisted neuroangiography: feasibility and technical note of initial experience

Abstract

<h3>Background</h3> Preliminary experiences of robotic assisted neuroendovascular interventions have been recently reported. We aim to describe the feasibility and our initial experience of robotic-assisted neuroangiography for diagnosis and treatment planning. <h3>Objective</h3> To discuss our initial experience, feasibility and technical note in our early experience with the use of the CorPath GRX robotic-assisted technology for neuroendovascular procedures, including transfemoral, transradial and distal transradial diagnostic neuroangiograms. <h3>Methods</h3> Single-center technical report of the first forty-four consecutive cases of robtic assisted diagnostic neuroangiography using the CorPath GRX Robotic System (Corindus Inc, Waltham, MA) from October 2020 through February 2021. <h3>Results</h3> 43 diagnostic neuroangiographies were planned. In 38 cases, at least 1 vessel was selected and studied using the CorPath GRX robotic-assisted technology, in two cases the neuroangiography was completed by switching to manual, allowing for 36 diagnostic neuroangiograms to be fully completed as planned using the CorPath GRX robotic-assisted technology. In five (11%) cases, the robot was setup but it was either not used due to a change in plans, or inability to select at least one single vessel as planned. In one case, failure was due to defective cassette and in another case due to communication error between joystick and robotic arm. [NK1] The mean of number or vessels successfully selected and studied using robotic assisted neuroangiography was 4.1 (ranging from 1 to 7 for cerebral angiograms, and 22 for one spinal angiogram). No complications were reported as result of the use the CorPath GRX robotic technology to perform neuroangiograms. The mean fluoroscopy time for the 23 cerebral angiograms was 16.5 minutes [8.9 - 27.2 minutes], and the mean radiation exposure to the patients was 63.1 Gy/cm²[30.3 - 105 Gy/cm²]. [NK2] Catheterization failures involved mostly wire slipping and catheter slipping. Simmon-2 shape catheter were did not pose a particular challenge when being formed. Our group quickly learned that the V18 was the microwire of choice as well the 5F Terumo XP version of each catheter tip shape to maximize catheterization success. An additional 0.018’ companion wire was used successfully for additional support when advancing 6F guide sheaths from the aortic arch into the innominate artery and common carotid artery. <h3>Conclusions</h3> We describe our initial experience of the CorPath GRX system (Corindus) to navigate the arch and great vessels, and in 1 case the spinal segmental vessels in patients as clinically indicated. We also demonstrated the feasibility of completing the diagnostic portion of our planned endovascular embolization cases, thus minimizing radiation exposure and the need to wear apron lead to the operators. <h3>Disclosures</h3> <b>L. Ponce Mejia:</b> None.