High-resolution angioscopic imaging during endovascular neurosurgery.
BACKGROUND
Endoluminal optical imaging, or angioscopy, has not seen widespread application during neurointerventional procedures, largely as a result of the poor imaging resolution of existing angioscopes. Scanning fiber endoscopes (SFEs) are a novel endoscopic platform that allows high-resolution video imaging in an ultraminiature form factor that is compatible with currently used distal access endoluminal catheters.


OBJECTIVE
To test the feasibility and potential utility of high-resolution angioscopy with an SFE during common endovascular neurosurgical procedures.


METHODS
A 3.7-French SFE was used in a porcine model system to image endothelial disruption, ischemic stroke and mechanical thrombectomy, aneurysm coiling, and flow-diverting stent placement.


RESULTS
High-resolution, video-rate imaging was shown to be possible during all of the common procedures tested and provided information that was complementary to standard fluoroscopic imaging. SFE angioscopy was able to assess novel factors such as aneurysm base coverage fraction and side branch patency, which have previously not been possible to determine with conventional angiography.


CONCLUSIONS
Endovascular imaging with an SFE provides important information on factors that cannot be assessed fluoroscopically and is a novel platform on which future neurointerventional techniques may be based because it allows for periprocedural inspection of the integrity of the vascular system and the deployed devices. In addition, it may be of diagnostic use for inspecting the vascular wall and postprocedure device evaluation.
*Department of Medical Biophysics, University of Toronto; ‡Department of Medical Imaging, Toronto Western Hospital, University Health Network; §Radiation Medicine Program, Princess Margaret Cancer Centre; ¶Techna Institute, University Health Network, Toronto, Ontario, Canada; ‖Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; #Department of Mechanical Engineering, University of Washington, Seattle, Washington; **Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
Patrick Z
PZ
McVeigh
Raphael
R
Sacho
Robert A
RA
Weersink
Vitor M
VM
Pereira
Walter
W
Kucharczyk
Eric J
EJ
Seibel
Brian C
BC
Wilson
Timo
T
Krings
D017546:Angioscopy / Q000295:instrumentation*; D000818:Animals; D004195:Disease Models, Animal; D004724:Endoscopy; D005240:Feasibility Studies; D019635:Neurosurgical Procedures / Q000379:methods; D020521:Stroke / Q000175:diagnosis* / Q000601:surgery*; D013552:Swine