P-018 MRI-based Endovascular Navigation in a Flow and Cadaveric Model; Feasibility Study
P-018 MRI-based Endovascular Navigation in a Flow and Cadaveric Model; Feasibility Study
复制标题
P-018 血流和尸体模型中基于 MRI 的血管内导航；
DOI：
10.1136/neurintsurg-2014-011343.54
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发表时间：
2014
影响因子：
4.8
通讯作者：
Buciuc R
中科院分区：
文献类型：
--
作者：
Buciuc R
引言/目的目前血管内导航是通过使用荧光透视进行的。这种方式有一些缺点，如辐射，使用对比剂和缺乏“真实的时间”的脑实质的可视化。本研究的目的是测试的可行性导航血管内器械上的流动模型和尸体模型，使用MR-基于fluoroscopy.Materials and MethodsThe研究是在IMRI实验室，英国邓迪大学完成。该流动模型由Elastrat流动模型组成，与具有心率和输出控制的外科心脏泵耦合。对于尸体模型，使用了三具Thiel尸体。在1例病例中，通过直接颈动脉入路或通过胸骨下切口并经左心室进一步导航至升主动脉（方法在单独报告中描述）进入脑血管循环。在1例病例中，还通过右颈静脉直接入路和逆行导航进入上级矢状窦获得静脉通路。使用的导管是一个球囊导管，它进一步连接到心脏泵的抽吸组件，以再现右心功能并避免脑肿胀。通过荧光镜确认导管在右颈内动脉和左颈内动脉以及右椎动脉中的位置。进入颈内动脉后，将流动或尸体模型转移到MRI单元并进行测试。对于血流模型，使用心脏泵以70次/min的速率和4 l/min的流量输送液体。对于尸体模型，选择单次注射15 ml钆作为颅内导航的“路线图”。选择基于MRI的脉冲序列（4脉冲/秒），相当于荧光透视检查。MRI多平面软件以及介入MRI线圈也用于该实验。在介入医生和MRI控制台中的“导航器”之间使用MRI兼容通信设备。对于血管内器械，使用MR兼容Penumbra导管。电线是原型非金属电线，机械回收器是Acandis，一种德国生产的机械回收器。Hydrocoil也被导航到MCA bifurcation. ResultsFlow的可视化以及基于MR的路线图的多平面“实时”渲染是可能的流量和尸体model.For流量模型的人工创建的凝块被部署在M2分支，并成功地检索。对于尸体模型，Penumbra导管可以导航到M1节段水平。对于血流模型，尝试在MCA分叉部动脉瘤中导航微导管。一个水弹簧圈通过微导管导航到M1段的流量model. ConclusionMR为基础的血管内导航在血管内血管系统是可能的。目前，该技术在医疗实践中的应用还存在许多局限性，但其理论上的优势使其在未来的工作中不断努力。布丘克：没有。M.鲁布：没有。B。考克斯：没有。A.梅尔泽：没有。
Introduction/purposeCurrently endovascular navigation is performed by using fluoroscopy. This modality has some disadvantages such as, radiation, use of contrast and lack of visualization of brain parenchyma in “real time”. The purpose of this study was to test the feasibility of navigating endovascular instruments on a flow model and in a cadaveric model using MR- based fluoroscopy.Materials and methodsThe study was completed at the IMRI lab, University of Dundee, UK. The flow model consisted of an Elastrat flow model, coupled with a surgical heart pump with control for heart rate and output. For the cadaveric model three Thiel cadavers were used. The access of the cerebrovascular circulation was either through direct carotid access in one case or through a substernal incision and further navigation into the ascending aorta via the left ventricle (method described in a separate presentation). In one case venous access was also obtained through a direct approach to the right jugular vein and retrograde navigation into the superior sagittal sinus. The catheter used was a balloon catheter which was further connected to a suction component of the heart pump in an effort to reproduce the right heart function and avoid brain swelling.The position of catheters in the right and left internal carotid arteries as well as in the right vertebral artery was confirmed fluoroscopically.After access to the internal carotid artery the flow or cadaveric models were transferred to the MRI unit and testing of navigation was performed.For the flow model the heart pump was used to deliver fluid at a rate of 70 beats/min and a flow of 4 l/min. For the cadaveric model a single injection of Gadolinium 15 ml was elected to serve as the “roadmap” for intracranial navigation. MRI based pule sequences of 4 pulses/sec fluoroscopic equivalent were chosen. MRI multiplanar software as well as interventional MRI coils were also used for this experiment. Communication MRI-compatible equipment between the interventionalist and a “navigator” in the MRI console was used.For endovascular instruments, MR compatible Penumbra catheters were used. The wires were prototype non-metalic wires and the mechanical retriever was Acandis a German produced mechanical retriever. A Hydrocoil was also navigated to MCA bifurcation.ResultsVisualization of flow as well as multiplanar “live” rendering of MR based roadmaps was possible on the flow and cadaveric model.For the flow model an artificially created clot was deployed in an M2 branch and successfully retrieved. For the cadaveric model navigation of Penumbra catheters was possible to the level of M1 segment. For the flow model a microcatheter was attempted to be navigated in an MCA bifurcation aneurysm. A hydrocoil was navigated through the microcatheter into the M1 segment of the flow model.ConclusionMR-based endovascular navigation in the cerebro-vascular system is possible. Currently there are many limitations to the applicability of this technology in medical practice but the theoretical advantages make future efforts worthwhile.DisclosuresR. Buciuc: None. M. Rube: None. B. Cox: None. A. Melzer: None.