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

Weinberg, Joshua; Sweid, Ahmad; Sajja, Kalyan; Gooch, M. Reid; Herial, Nabeel; Tjoumakaris, Stavropoula; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.3171/2020.5.jns201421

Cited by 23 publications

(17 citation statements)

References 33 publications

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“…Some studies have shown that transfemoral carotid artery stenting (TCAR) can reduce the incidence of perioperative embolic complications in CAS, especially in high-risk patients requiring treatment with CAS, and has a low incidence of local complications, neurological events, myocardial complications, and mortality during the early postoperative period, and is considered an acceptable alternative in patients treated with CAS[ 26 - 29 ]. Furthermore, transradial carotid artery stenting has demonstrated feasibility and safety in CAS[ 30 - 32 ]. Recently, robotic-assisted CAS has been shown to be technically feasible; however, further studies are warranted to properly establish the safety and benefits of this technique[ 30 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

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Ileal hemorrhagic infarction after carotid artery stenting: A case report and review of the literature

Shen

et al. 2021

WJCC

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BACKGROUND Ileal hemorrhagic infarction after carotid artery stenting (CAS) is a fatal complication. The prognosis of ileal hemorrhagic infarction after CAS is very poor if not treated in a timely manner. We describe a rare case of ileal hemorrhagic infarction due to acute embolism of the mesenteric artery after CAS. CASE SUMMARY A 67-year-old man with acute ischemic stroke underwent CAS via the right femoral artery approach 21 d after intensive medical treatment. On the first day after surgery, the patient had abdominal distension and abdominal pain. Abdominal enhanced computed tomography revealed intestinal obstruction, severe stenosis of the superior mesenteric artery, and poor distal angiography. An exploratory laparotomy was performed, and pathological examination showed hemorrhagic ileal infarction. It was subsequently found that the patient had intestinal flatulence. With the guidance of an ultrasound scan, the patient underwent abdominal puncture, drainage, and catheterization. After 58 d of treatment, the patient was discharged from hospital with a National Institutes of Health Stroke Scale score of 2 points, and a Modified Rankin Scale score of 1 point. At the 6-mo follow-up, the patient had an excellent functional outcome without stroke or mesenteric ischemia. Furthermore, computed tomography angiography showed that the carotid stent was patent. CONCLUSION Ileal hemorrhagic infarction is a fatal complication after CAS, usually caused by mesenteric artery embolism. Thus, more attention should be paid to the complications of embolism in the vascular system as well as the nervous system after CAS, and the complications should be identified and treated as early as possible.

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, transradial carotid artery stenting has demonstrated feasibility and safety in CAS[ 30 - 32 ]. Recently, robotic-assisted CAS has been shown to be technically feasible; however, further studies are warranted to properly establish the safety and benefits of this technique[ 30 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Ileal hemorrhagic infarction after carotid artery stenting: A case report and review of the literature

Shen

et al. 2021

WJCC

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“…A similar research group conducted a retrospective comparison of transradial robot-assisted carotid stent placement with manual stent placement and found that the mean procedural duration was significantly longer while using the robot (85.0 [SD, 14.3] versus 61.2 [SD, 17.5] minutes), but there was no significant difference in other procedural characteristics such as fluoroscopy time, contrast dose, radiation exposure, catheter exchanges, technical success, transfemoral conversion, and complications. 54 Nogueira et al 55 also recently treated 4 patients with severe symptomatic carotid stenosis and achieved technical and procedural success. All steps of the procedure were completed by the robotic system except for navigation and deployment of the stent, which is currently incompatible.…”

Section: Clinical Applications Of Robotic Neurointerventionmentioning

confidence: 99%

“…One of the major goals of robotic endovascular systems is to increase efficiency and decrease procedural time; yet, early research indicates prolonged procedural time when using the robot. 54 It is unclear whether this issue is entirely due to inherent deficiencies of current robots or more related to limited operator experience. Clearly, a standardized training curriculum is needed to optimize physician interaction with robotic systems.…”

Section: Limitationsmentioning

confidence: 99%

A Review of Robotic Interventional Neuroradiology

Beaman

Kaneko

Meyers

et al. 2021

AJNR Am J Neuroradiol

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Robotic interventional neuroradiology is an emerging field with the potential to enhance patient safety, reduce occupational hazards, and expand systems of care. Endovascular robots allow the operator to precisely control guidewires and catheters from a lead-shielded cockpit located several feet (or potentially hundreds of miles) from the patient. This has opened up the possibility of expanding telestroke networks to patients without access to life-saving procedures such as stroke thrombectomy and cerebral aneurysm occlusion by highly-experienced physicians. The prototype machines, first developed in the early 2000s, have evolved into machines capable of a broad range of techniques, while incorporating newly automated maneuvers and safety algorithms. In recent years, preliminary clinical research has been published demonstrating the safety and feasibility of the technology in cerebral angiography and intracranial intervention. The next step is to conduct larger, multisite, prospective studies to assess generalizability and, ultimately, improve patient outcomes in neurovascular disease.

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“…1,2 Additionally, a great merit of robotic surgeries is the ability to perform them at remote locations, which would essentially provide lifesaving procedures to patients who are unable to present to a cerebrovascular center in a timely fashion. [2][3][4][5][6] Historically, robots were largely designed for other surgical specialties, mainly interventional cardiology; 1 it was more recently that they were engineered to assist in neurosurgical procedures such as depth electrode implantation for epilepsy, and minimally invasive spine surgeries. 7,8 The CorPath GRX (Corindus Inc.) robot-assisted platform is the latest robotic system initially designed for interventional cardiology procedures.…”

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confidence: 99%

Robot-assisted carotid artery stenting: outcomes, safety, and operational learning curve

Abbas

Saiegh

Naamani

et al. 2022

Neurosurgical Focus

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OBJECTIVE Over the past 2 decades, robots have been increasingly used in surgeries to help overcome human limitations and perform precise and accurate tasks. Endovascular robots were pioneered in interventional cardiology, however, the CorPath GRX was recently approved by the FDA for peripheral vascular and extracranial interventions. The authors aimed to evaluate the operational learning curve for robot-assisted carotid artery stenting over a period of 19 months at a single institution. METHODS A retrospective analysis of a prospectively maintained database was conducted, and 14 consecutive patients who underwent robot-assisted carotid artery stenting from December 2019 to June 2021 were identified. The metrics for proficiency were the total fluoroscopy and procedure times, contrast volume used, and radiation dose. To evaluate operator progress, the patients were divided into 3 groups of 5, 4, and 5 patients based on the study period. RESULTS A total of 14 patients were included. All patients received balloon angioplasty and stent placement. The median degree of stenosis was 95%. Ten patients (71%) were treated via the transradial approach and 4 patients (29%) via the transfemoral approach, with no procedural complications. The median contrast volume used was 80 mL, and the median radiation dose was 38,978.5 mGy/cm2. The overall median fluoroscopy and procedure times were 24.6 minutes and 70.5 minutes, respectively. Subgroup analysis showed a significant decrease in these times, from 32 minutes and 86 minutes, respectively, in group 1 to 21.9 minutes and 62 minutes, respectively, in group 3 (p = 0.002 and p = 0.008, respectively). CONCLUSIONS Robot-assisted carotid artery stenting was found to be safe and effective, and the learning curve for robotic procedures was overcome within a short period of time at a high-volume cerebrovascular center.

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

Cited by 23 publications

References 33 publications

Ileal hemorrhagic infarction after carotid artery stenting: A case report and review of the literature

Ileal hemorrhagic infarction after carotid artery stenting: A case report and review of the literature

A Review of Robotic Interventional Neuroradiology

Robot-assisted carotid artery stenting: outcomes, safety, and operational learning curve

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