Technical feasibility of 2D-3D coregistration for visualization of self-expandable microstents to facilitate coil embolization of broad-based intracranial aneurysms: an in vitro study.
BACKGROUND
The use of self-expandable microstents for treatment of broad-based intracranial aneurysms is widely spread. However, poor fluoroscopic visibility of the stents remains disadvantageous during the coiling procedure. Flat detector angiographic computed tomography (ACT) provides high resolution imaging of microstents even though integration of this imaging modality in the neurointerventional workflow has not been widely reported.


METHODS
An acrylic glass model was used to simulate the situation of a broad-based sidewall aneurysm. After insertion of a self-expandable microstent, ACT was performed. The resulting 3D dataset of the Microstent was subsequently projected into a conventional 2D fluoroscopic roadmap. This 3D visualization of the stent supported the coil embolization procedure of the in vitro aneurysm.


RESULTS
In vitro 2D-3D coregistration with integration of 3D ACT data of a self-expandable microstent in a conventional 2D roadmap is feasible.


CONCLUSIONS
Unsatisfying stent visibility constrains clinical cases with complex parent vessel anatomy and challenging aneurysm geometry; hence, this technique potentially may be useful in such cases. In our opinion, the clinical feasibility and utility of this new technique should be verified in a clinical aneurysm embolization study series using 2D-3D coregistration.
Richter
Gregor
G
Department of Neuroradiology, University of Erlangen-Nuernberg, Erlangen, Germany. g.richter@kreisklinikum-siegen.de
Pfister
Marcus
M
Struffert
Tobias
T
Engelhorn
Tobias
T
Doelken
Marc
M
Spiegel
Martin
M
Hornegger
Joachim
J
Doerfler
Arnd
A
D000792:Angiography / Q000379:methods*; D001807:Blood Vessel Prosthesis; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015607:Stents; D013382:Subtraction Technique; D025321:Surgery, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*