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Updated: Sep 30, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Robotic-Assisted versus Manual Diagnostic Cerebral Angiography: Comparative Outcomes and Learning Curve in a Large
Sarah A Hamimi1, Ahmed Altaf1, Jaeha Kim1
1From the Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Neuroscience, University of Pennsylvania, Philadelphia, PA, USA; Department of Biology, University of Pennsylvania, Philadelphia, PA, USA; School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Royal College of Surgeons in Ireland, Dublin, Ireland; and Section of Neurovascular Surgery, Department of Neurological Surgery, University of Chicago Medicine, Chicago, IL, USA.
Background:
Diagnostic cerebral angiography (DCA) exposes neurointerventionalists to substantial occupational radiation. Robotic-assisted cerebral angiography (RCA) offers operator-dose reduction and a foundation for telerobotic stroke care, but comparisons to manual DCA have only been evaluated in smaller feasibility cohorts.
Methods:
We performed a single-institution retrospective cohort study between September 2021 and May 2023, comparing 214 procedures using the CorPath GRX system against 636 manual DCA controls. Primary outcomes were procedural efficiency (room, procedure, and fluoroscopy time) and patient radiation dose (cumulative air kerma), with per-vessel normalization. Robotic cases were analyzed on an intention-to-treat basis. The operator learning curve was assessed among three neurointerventional primary operators at the attending level, each of whom performed at least 10 cases.
Results:
Robotic and manual angiography did not differ significantly in room time, procedure time, fluoroscopy time, contrast volume administered, or radiation dose. Per-vessel comparisons were similarly null (all p≥0.51). Findings were unchanged after adjustment for age, sex, number of vessels catheterized, access site, and operator. Intraoperative complications were rare (0% vs. 0.8%, p=0.34). Robotic cases required conversion to manual angiography in 18% of cases (39/214), most commonly due to tortuous anatomy, catheter incompatibility, or cassette error. Increasing procedural experience was independently associated with shorter procedural times, and lower contrast administered and patient radiation dose. The learning curve extended across ∼50 cases for outcomes such as room and procedure time.
Conclusions:
RCA showed no statistically significant differences from manual DCA in terms of efficiency, contrast use, and safety, with a learning curve spanning around 50 cases.
