Citations

Objective Preclinical studies suggest that robotic carotid artery stenting (CAS) could be superior to manual CAS. However, very limited comparative data exists comparing robotic and manual CAS patients. In addition, no data exists comparing the costs of manual and robotic CAS. Methods All robotic CAS cases at 2 academic neurosurgery centers were retrospectively reviewed and 1:1 propensity matched with manual CAS cases. Personnel costs, supply costs, and total procedure costs were collected in collaboration with hospital administration using time‐driven activity‐based cost‐analysis (TDABC). Results 24 robotic CAS cases were performed between 2019 and 2023. Co‐morbidities and baseline procedural characteristics were well‐matched between robotic and manual cases. Unplanned manual conversion was observed in only one robotic case (4.2%). Robotic CAS complications and outcomes were comparable to manual. Robotic CAS was associated with a significantly increased fluoroscopy time (29.0 vs. 19.2 min.; p<0.001). Robotic procedure time (88.9±18.2 min.) was significantly (p=0.003) higher than manual (68.72±22.4 min.). Health professional costs ($1,589.71±176.92, $1,375.99±233.39, p<0.005), supply cost ($3,918.25±421.20, $2,152.74±1,030.26, p<0.001) and total procedure costs ($5,306.11±608.95, $3,437.56±1,165.67, p<0.001) were greater for robotic CAS. Conclusions With a low rate of technical failure and post‐operative complications, we show robotic carotid artery stenting is safe and feasible in the first multi‐center and largest sample to date. In addition, robotic CAS achieves comparable clinical outcomes. Robotic CAS was associated with increased fluoroscopy time, but fluoroscopy time decreased as operators gained familiarity with the CorPath GRX. Robotic CAS was associated with a greater procedural cost, which was driven by greater personnel and supply costs. Our findings highlight the need for further studies to optimize robotic CAS and reduce its associated costs.

Background Ischemic stroke remains a leading cause of morbidity and mortality worldwide. Understanding stroke etiology is critical in future stroke prevention. A cardioembolic etiology of stroke makes up a significant proportion of all ischemic stroke. Part of the evaluation for a cardioembolic etiology requires a structural evaluation of the heart to evaluate for sources of thrombus. Traditionally, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have been utilized for this purpose, although both have limitations. Cardiac computed tomography (CCT) has emerged as a potential alternative, offering non‐invasive imaging with high sensitivity and specificity for detecting intracardiac thrombi. This study aimed to evaluate the diagnostic yield of CCT compared to TTE and TEE in detecting high‐risk cardioaortic sources of embolism, including left ventricular (LV) thrombus, left atrial (LA) thrombus, valvular sources of thrombus, and ulcerated aortic plaques, in patients with ischemic stroke. Methods We conducted a retrospective, single‐center cohort study at Mayo Clinic, Rochester, MN, on patients who underwent CCT within 30 days of stroke onset between March 2019 and June 2023. We compared the diagnostic yields of CCT, TTE, and TEE in detecting structural cardiac sources of embolism. Results 426 patients were included in our study. 87 patients underwent both CCT and TEE, 257 underwent CCT and TTE, and 82 only underwent CCT. The overall diagnostic yield of CCT for detecting high‐risk cardioaortic sources was 15.5%. Specifically, CCT identified LV thrombus in 2.3% of patients, LA thrombus in 4.0%, valvular thrombus in 2.8%, and ulcerated aortic plaques in 7.0%. In comparative analysis, CCT demonstrated a higher yield than TTE (16.0% vs. 3.5%) and a comparable or higher yield than TEE (25.3% vs. 20.7%) in detecting these sources. Conclusions CCT proved to be a viable and potentially superior alternative to traditional echocardiography for identifying some high‐risk structural sources of cardioembolism in ischemic stroke patients. Its non‐invasive nature, coupled with the ability to perform imaging soon after stroke onset, underscores its clinical utility. However, further prospective and blinded studies are required to validate these findings and fully establish the efficacy of CCT in this context.

Background Diagnostic Cerebral Angiography (CA) is a relatively common procedure that provides detailed evaluation of the brain's blood vessels. With the growing preference for Transradial artery (TRA) access over Transfemoral artery (TFA) access, our review aims to compare clinical outcomes and complications associated with these two approaches. Methods We carried out a systematic review using PubMed, Embase, Web of Science, Scopus databases, following the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines. Inclusion was limited to studies that exclusively compared TRA versus TFA approaches for cerebral diagnostic purposes. Results Our study included 27 studies encompassing a total of 12,806 patients. The TRA arm comprised 6,284 patients with a median age of 57.9 years (range: 13.6‐78.2), and 46.4% were male (range: 27.8%‐82%). The TFA arm included 6,522 patients with a median age of 59.0 years (range: 13.0‐79.3), and 44.8% were male (range: 20.7%‐78.4%). Our analysis revealed that the TFA group had a higher successful Cerebral Angiography (CA) rate (OR= 0.62, CI [0.40; 0.95], p=0.03), and lower crossover rate (OR: 2.85, CI [1.39; 5.84], p<0.01) compared to the TRA group. However, the TRA group demonstrated a significantly lower rate of total complications (OR: 0.52, CI [0.33; 0.82], p<0.01, I 2 =59%, p< 0.001) and shorter hospital length of stay (LOS) in hours ([MD]: ‐33.25, CI [‐51.40; ‐15.11], p< 0.001) compared to the TFA group. There were no significant differences between groups in terms of puncture time, procedural time, mean contrast dose, radiation exposure, and radiation dose. Conclusion The choice of access site for cerebral angiography depends on various factors, including facility protocol, provider preference, vascular anatomy, and patient preferences. Our review highlighted the superiority of the transfemoral artery approach in terms of success rates and lower crossover rates. However, transradial artery access may be preferred due to its association with lower complication rates and shorter hospital stays, aligning with patient‐centered outcomes.

Accurate identification of surgical instruments is crucial for efficient workflows and patient safety within the operating room, particularly in preventing complications such as retained surgical instruments. Artificial Intelligence (AI) models have shown the potential to automate this process. This study evaluates the accuracy of publicly available Large Language Models (LLMs)—ChatGPT-4, ChatGPT-4o, and Gemini—and a specialized commercial mobile application, Surgical-Instrument Directory (SID 2.0), in identifying surgical instruments from images. The study utilized a dataset of 92 high-resolution images of 25 surgical instruments (retractors, forceps, scissors, and trocars) photographed from multiple angles. Model performance was evaluated using accuracy, weighted precision, recall, and F1 score. ChatGPT-4o exhibited the highest accuracy (89.1%) in categorizing instruments (e.g., scissors, forceps). SID 2.0 (77.2%) and ChatGPT-4 (76.1%) achieved comparable accuracy, while Gemini (44.6%) demonstrated lower accuracy in this task. For precise subtype identification of instrument names (like “Mayo scissors” or “Kelly forceps”), all models had low accuracy, with SID 2.0 having an accuracy of 39.1%, followed by ChatGPT-4o (33.69%). Subgroup analysis revealed ChatGPT-4 and 4o recognized trocars in all instances. Similarly, Gemini identified surgical scissors in all instances. In conclusion, publicly available LLMs can reliably identify surgical instruments at the category level, with ChatGPT-4o demonstrating an overall edge. However, precise subtype identification remains a challenge for all models. These findings highlight the potential of AI-driven solutions to enhance surgical-instrument management and underscore the need for further refinements to improve accuracy and support patient safety.