Stereotactic endovascular aortic navigation with a novel ultrasonic-based three-dimensional localization system.
Stereotactic endovascular aortic navigation with a novel ultrasonic-based three-dimensional localization system.
复制标题
采用新型超声三维定位系统进行立体定向血管内主动脉导航。
DOI：
10.1016/j.jvs.2012.09.078
复制
发表时间：
2013
影响因子：
4.3
通讯作者：
Weaver,FredA
中科院分区：
文献类型：
--
作者：
Mung,JayC;Huang,ShihYauGrace;Moos,JohnM;Yen,JesseT;Weaver,FredA
背景血管内主动脉手术已经被开发出来，可以有效地治疗许多主动脉疾病。然而，考虑到分支或有窗内移植物的发展，这些程序也变得越来越复杂。困难的一部分在于当前成像范例的局限性。为了适应血管内技术的未来发展，需要一种更直观的三维(3D)术中成像模式。本文描述了一种新型的血管内导管跟踪装置，它使用超声信号而不是超声成像。该跟踪设备以直观的腔内视图在先前获取的3D计算机断层扫描(CT)图像上显示活体位置的实时信息。该系统在两头猪身上进行了测试，并通过透视和支架移植进行了验证。方法基于超声的定位系统(ULS)提供改进的血管内导管的实时位置信息，并在术前3D CT图像上显示该位置。9F血管内导管的尖端有一个小型超声波发射器，向ULS发出其位置的信号。随后，仅使用ULS对约克郡猪的主动脉中的支架放置位置进行了血管内支架的部署。结果我们成功地沿着注册的CT主动脉图像实时显示了腔内导管尖端的位置，提供了虚拟的腔内跟踪。与血管造影术相比，ULS对腹主动脉导管移动的相对准确性被发现具有小于1 mm的平均误差。ULS坐标98%的时间跟踪在主动脉图像的管腔内，由主动脉图像中心线一个半径距离内的点的比例定义。最后，使用ULS虚拟图像显示技术对三个主动脉支架进行置入，以确定其在主动脉中的目标位置以进行支架置入。目标位置和实际支架位置之间的误差范围为：ULS5.0~+7.9 mm。结论本研究证明了使用−进行虚拟图像引导下的主动脉腔内导航的可行性。这为血管内手术期间术前CT扫描图像的虚拟导航提供了3D平台，有助于支架的部署，并最大限度地减少或消除了程序性电离辐射和碘化对比的需要。未来的工作将集中在将这项技术转化为血管内手术的临床应用所需的小型化和精确度方面。
BACKGROUNDEndovascular aortic procedures have been developed to treat many aortic diseases effectively. However, these procedures are also becoming increasingly complex given the development of branched or fenestrated endografts. Part of the difficulty lies in the limitations of current imaging paradigms. A more intuitive, three-dimensional (3D) mode of intraoperative imaging is desirable to accommodate the future progression of endovascular techniques. This article describes a novel endovascular catheter tracking device that uses ultrasonic signals, not ultrasound imaging. The tracking device displays real-time in vivo location on previously acquired 3D computed tomography (CT) images in an intuitive, endoluminal view. This system was tested in two swine and validated against fluoroscopy and by delivering stent grafts.METHODSThe ultrasonic-based localization system (ULS) provides real-time location information of a modified endovascular catheter and displays this location on preoperative 3D CT images. The 9F endovascular catheter has a small ultrasonic transmitter attached to its tip to signal its location to the ULS. Subsequent endovascular deployment of an aortic stent was carried out using only the ULS to target the stent placement position in the aorta of Yorkshire swine. System accuracy was measured against concurrent angiography as well as to deployed stents in situ.RESULTSWe successfully displayed the endovascular catheter tip location in real time along the registered CT aortic images, providing virtual endoluminal tracking. The relative accuracy of the ULS as compared with angiography for catheter movements in the abdominal aorta was found to have a mean error less than 1 mm. The ULS coordinates tracked within the lumen of the aortic image 98% of the time, as defined by the proportion of points within one radius distance of the aortic image centerline. Finally, three aortic stents were deployed using the ULS virtual image display to locate the target position in the aorta for stent deployment. Errors between target position and actual stent position ranged from −5.0 to +7.9 mm.CONCLUSIONSThis study demonstrates the feasibility of virtual image-guided endovascular aortic navigation using a ULS. This provides a 3D platform for virtual navigation on preoperative CT scan images during endovascular procedures that could assist in stent deployment as well as minimize or eliminate the need for procedural ionizing radiation and iodinated contrast. Future work will focus on miniaturization and refinements in accuracy that will be required to translate this technology into clinical application in endovascular procedures.