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Background Telementoring is an emerging approach in surgical education that offers remote supervision and guidance through digital platforms. This study aimed to evaluate the feasibility and non-inferiority of a mobile-based telementoring system for digital subtraction angiography (DSA) and compare it with traditional face-to-face mentoring.Methods This prospective, single-center observational study included 71 patients who underwent DSA between April 2021 and May 2024. Patients were categorized into control (n=48, face-to-face mentoring) and telementoring (n=23) groups. A mobile telementoring system (JOIN, Allm Inc., Tokyo, Japan), which enabled real-time image sharing and voice communication between the examiner and the remote supervisor, was employed. The primary endpoints were contrast volume, procedural time, and radiation dose, with a non-inferiority margin of 20% applied.Results No significant differences were observed between the two groups in contrast volume (88.3±39.6 mL vs 97.1±36.4 mL, p=0.499), procedural time (44.1±17.7 min vs 50.7±19.0 min, p=0.308), or radiation dose (427.9±262.2 mGy vs 506.6±307.1 mGy, p=0.346). Non-inferiority was confirmed across all primary endpoints. No procedural complications occurred. Qualitative feedback indicated high user satisfaction, with the system facilitating effective remote supervision and decision-making.Conclusions This study demonstrates the feasibility and non-inferiority of a mobile telementoring system for DSA, effectively supporting real-time remote guidance and reducing the need for on-site supervision. Its implementation may enhance access to expert mentoring, particularly in regions with limited specialist availability, contributing to equitable and efficient cerebrovascular care.