A256 Pushing the frontiers of neurointervention : a systematic comparison of robotic-assisted and manual endovascular techniques

<h3>Introduction</h3> Robotic neurointervention represents a paradigm shift in endovascular care. Yet, its clinical utility across cerebrovascular indications remains incompletely defined. <h3>Aim of study</h3> To evaluate procedural performance, safety, and radiation exposure across robotic-assisted and manual interventional neuroradiology (INR) procedures in a stratified, indication-specific analysis. <h3>Method</h3> A PRISMA-compliant systematic review of PubMed, Embase, Scopus, Cochrane, and Web of Science (through April 2025) was conducted. Comparative studies in humans assessing robotic vs. manual INR were included. Outcomes assessed: technical success, complications, operator radiation exposure, and conversion to manual technique. <h3>Results</h3> Thirteen studies encompassing 738 robotic and 720 manual procedures were analyzed. Carotid artery stenting demonstrated comparable success rates (robotic: 90–94%; manual: 96–100%) with 20–45% reduction in operator radiation exposure. In diagnostic angiography, robotic systems achieved 95–100% success but universally required manual assistance. Aneurysm embolization with robotic support showed 96% success and 7% unplanned conversions. AVM and sinus stenting had a 92% robotic success rate with no major complications. Across indications, complication rates remained low (&lt;2%) in both cohorts. <h3>Conclusion</h3> While robotic-assisted INR is not yet autonomous, it delivers competitive procedural efficacy with significantly reduced operator radiation. Unlike previous reviews, our analysis dissects outcomes by procedural type and highlights underreported system limitations. These insights support targeted adoption and inform future robotic design and randomized evaluation. <h3>Conflict of Interest</h3> No