{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:42:26Z","timestamp":1790840546249,"version":"4.1.0"},"reference-count":23,"publisher":"Korean Society of Interventional Neuroradiology","issue":"2","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["neurointervention.org"],"crossmark-restriction":true},"short-container-title":["Neurointervention"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:p>Purpose: During diagnostic cerebral angiography, catheter navigation requires manual contrast \u201cpuff\u201d injections, while subsequent 2D\/3D runs often use automated power injectors. Using power injectors for navigation puffs has not been described. We present a closed-circuit dual-port injector system (Nemoto Press Duo Elite) that integrates both navigation puff delivery and diagnostic run injection into a single automated platform, eliminating all manual tableside contrast handling. A foot pedal interface enables operator-controlled puff timing, potentially reducing contrast waste and air embolism risk while improving single-operator ergonomics with future remote robotic implications.Materials and Methods: This retrospective comparative cohort study compared 19 consecutive patients undergoing diagnostic cerebral angiography with foot pedal-controlled puff injections (June\u2013July 2023) to 19 historical controls using manual hand injections (May 2021). Both groups used 90% contrast concentration. Fluoroscopy time, radiation dose, contrast utilization, and safety outcomes were compared.Results: Groups were demographically matched (mean age 52.1\u00b114.2 vs. 50.2\u00b112.9 years; 73.7% female). All 38 procedures achieved diagnostic adequacy with no complications. The foot pedal group demonstrated significantly shorter procedure time per vessel (11.5\u00b14.4 vs. 18.9\u00b110.5 min\/vessel, P=0.010) with no significant differences in fluoroscopy time (P=0.171), radiation dose (P=0.690), or contrast delivered (88.7\u00b130.9 vs. 88.2\u00b142.5 mL, P=0.966). A trend toward improved contrast efficiency was observed (23.4\u00b19.4 vs. 27.4\u00b110.4 mL\/vessel, P=0.226). Despite undergoing significantly more 3D rotational runs (1.3\u00b11.0 vs. 0.6\u00b10.7, P=0.030), the foot pedal group maintained comparable safety metrics, strengthening the non-inferiority findings.Conclusion: A closed-circuit dual-port injector system integrating automated navigation puff delivery with diagnostic run injection demonstrates non-inferiority to manual injection for diagnostic cerebral angiography, with shorter procedure time per vessel (39% reduction, P=0.010), though interpretation is limited by differences in indication distribution. By eliminating manual tableside contrast handling, this approach enables precise digital contrast accounting and reduces air embolism risk, establishing a foundation for remote and robotic angiography applications.<\/jats:p>","DOI":"10.5469\/neuroint.2026.00283","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T01:22:01Z","timestamp":1776648121000},"page":"92-102","update-policy":"https:\/\/doi.org\/10.5469\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Closed-Circuit Dual-Port Injector System for Fully Automated Contrast Delivery in Diagnostic Cerebral Angiography"],"prefix":"10.5469","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2924-6957","authenticated-orcid":true,"given":"Mohammad","family":"Rashad","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA"},{"name":"Department of Neurosurgery, University 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Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5795-0866","authenticated-orcid":true,"given":"Nathan","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1528-2779","authenticated-orcid":true,"given":"Warda","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2466-9873","authenticated-orcid":true,"given":"Jaeha","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1479-465X","authenticated-orcid":true,"given":"Giuseppe","family":"Lanzino","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic Neurosurgery, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4891-6582","authenticated-orcid":true,"given":"Linda","family":"Bagley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA"},{"name":"Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8311-2336","authenticated-orcid":true,"given":"Omar","family":"Choudhri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Perelman School of 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