A neurovascular high-frequency optical coherence tomography system enables in situ cerebrovascular volumetric microscopy

Intravascular imaging has emerged as a valuable tool for the treatment of coronary and peripheral artery disease; however, no solution is available for safe and reliable use in the tortuous vascular anatomy of the brain. Endovascular treatment of stroke is delivered under image guidance with insufficient resolution to adequately assess underlying arterial pathology and therapeutic devices. High-resolution imaging, enabling surgeons to visualize cerebral arteries\u27 microstructure and micron-level features of neurovascular devices, would have a profound impact in the research, diagnosis, and treatment of cerebrovascular diseases. Here, we present a neurovascular high-frequency optical coherence tomography (HF-OCT) system, including an imaging console and an endoscopic probe designed to rapidly acquire volumetric microscopy data at a resolution approaching 10 microns in tortuous cerebrovascular anatomies. Using a combination of in vitro, ex vivo, and in vivo models, the feasibility of HF-OCT for cerebrovascular imaging was demonstrated

Current Opinions on Optimal Management of Basilar Artery Occlusion: After the BEST of BASICS Survey

Background The best management of basilar artery occlusion (BAO) remains uncertain. The BASICS (Basilar Artery International Cooperation Study) and the BEST (Basilar Artery Occlusion Endovascular Intervention Versus Standard Medical Treatment) trials reported neutral results. We sought to understand physicians’ approaches to BAOs and whether further BAO randomized controlled trials were warranted. Methods We conducted an online international survey from January to March 2022 to stroke neurologists and neurointerventionalists. Survey questions were designed to examine clinical and imaging parameters under which clinicians would offer (or rescind) a patient with BAO to endovascular therapy (EVT) or best medical management versus enrollment into a randomized clinical trial. Results Of >3002 invited participants, 1245 responded (41.4% response rate) from 73 countries, including 54.7% stroke neurologists and 43.6% neurointerventionalists. More than 95% of respondents would offer EVT to patients with BAO, albeit in various clinical circumstances. There were 70.0% of respondents who indicated that the BASICS and BEST trials did not change their practice. Only 22.1% of respondents would perform EVT according to anterior circulation occlusion criteria. The selection of patients for BAO EVT by clinical severity, timing, and imaging modality differed according to geography, specialty, and country income level. Over 80% of respondents agreed that further randomized clinical trials for BAO were warranted. Moreover, 45.6% of respondents indicated they would find it acceptable to enroll all trial‐eligible patients into the medical arm of a BAO trial, whereas 26.3% would not enroll. Conclusion Most stroke physicians continue to believe in the efficacy of EVT in selected patients with BAO in spite of BEST and BASICS. There is no consensus on which selection criteria to use, and few clinicians would use anterior circulation occlusion criteria for BAOs. Further randomized clinical trials for BAO are warranted

Intracranial Aneurysm Classifier Using Phenotypic Factors: An International Pooled Analysis

Intracranial aneurysms (IAs) are usually asymptomatic with a low risk of rupture, but consequences of aneurysmal subarachnoid hemorrhage (aSAH) are severe. Identifying IAs at risk of rupture has important clinical and socio-economic consequences. The goal of this study was to assess the effect of patient and IA characteristics on the likelihood of IA being diagnosed incidentally versus ruptured. Patients were recruited at 21 international centers. Seven phenotypic patient characteristics and three IA characteristics were recorded. The analyzed cohort included 7992 patients. Multivariate analysis demonstrated that: (1) IA location is the strongest factor associated with IA rupture status at diagnosis; (2) Risk factor awareness (hypertension, smoking) increases the likelihood of being diagnosed with unruptured IA; (3) Patients with ruptured IAs in high-risk locations tend to be older, and their IAs are smaller; (4) Smokers with ruptured IAs tend to be younger, and their IAs are larger; (5) Female patients with ruptured IAs tend to be older, and their IAs are smaller; (6) IA size and age at rupture correlate. The assessment of associations regarding patient and IA characteristics with IA rupture allows us to refine IA disease models and provide data to develop risk instruments for clinicians to support personalized decision-making

Applications of multimodal imaging in interventional neuroradiology angiousuites

Les deux piliers de la Neuroradiologie Interventionnelle (NRI) sont depuis la naissance de cette spécialité née dans les années 1960-70 : la technicité des « outils » employés et le guidage par l’image. Grace à des avancées technologiques majeures, nos cathéters nous autorisent désormais à naviguer dans n’importe quelle artère du cerveau. Et l’ensemble des dispositifs de NRI existants nous permet de désobstruer une artère occlue, emboliser une lésion à risque de saignement ou bien reconstruire des vaisseaux pathologiques. En revanche, si la résolution de l’angiographie numérique s’est progressivement améliorée au fil des années, nous ne disposions encore récemment que de peu d’éléments pour planifier et évaluer précisément nos traitements, ceci directement au bloc de NRI.La première partie de ce travail a consisté à démontrer le potentiel d’une technologie largement disponible mais sous-employée. L’imagerie volumique par faisceau conique (Cone Beam CT) est en effet une aide précieuse pour imager les dispositifs faiblement radio-opaques. Dans un deuxième temps, nous exposons au travers de plusieurs modèles précliniques, le potentiel extraordinaire de l’imagerie intra-vasculaire par tomographie en cohérence optique (Optical Coherence Tomography). Non utilisée en pratique clinique NRI jusqu’à ce jour, cette imagerie à très haute résolution a le potentiel de devenir un véritable microscope vasculaire utilisable in vivo. Enfin, après la description des ces modalités morphologiques nous nous sommes efforcés de démontrer la valeur ajoutée des imageries fonctionnelles lors du traitement des pathologies neurovasculaires. Nous illustrons cette progression dans les techniques d’imagerie au travers de deux approches différentes pour le traitement des anévrismes intracrâniens ; l’une endosacculaire (WEB) et l’autre pariétale (stents à diversion de flux).Au total, l’importance de l’imagerie dans notre spécialité est encore en train de se renforcer, en raison de sa diversification. Il ne fait aucun doute que dans un avenir proche, la multiplicité des informations fournies sera disponible, en temps réel, par réalité augmentée, à la manière d’un pilote d’avion. Dans le futur, c’est même par l’imagerie que nous réaliserons nos interventions ; quand les systèmes à résonnance magnétique permettront de guider, à distance les cathéters jusqu’à leur cible.Since the very beginning of Interventional Neuroradiology (INR), the two pillars of this young specialty born in the 1960-70 have been both technological innovation and imaging. Thanks to numerous evolutions, we now can navigate our catheters anywhere in the brain. And all the available devices allow us to open an obstructed artery, occlude an hemorrhagic lesion or reconstruct a pathological vessel. The resolution of digital subtraction angiography has gradually improved over the years but up until recently we did not benefit from diverse options to plan and evaluate our treatments. The first part of this work consisted in demonstrating the clinical potential of a widely available but underused modality, the Cone Beam Computed Tomography. It allows a very good visualization of devices presenting a low radiodensity. In a second part, we exposed through multiple preclinical models, the potential impact of intravascular imaging with optical coherence tomography. Only used in the cardiology field, it could become an in vivo microscope for the analysis of neurovascular diseases and their treatment. Finally, after the description of morphological imaging modalities, we demonstrated the interest of functional imaging for the treatment planning of the cerebrovascular diseases managed by INR. We will illustrate this imaging progression through two very different approaches to treat intracranial aneurysms ; one endosaccular (WEB device) the other parietal (Flow diverter stents). In total, the importance of imaging is continuously growing in our field, because of the diversification of INR imaging. There is no doubt that in few years from now the multiplicity of these data will be provided through advanced reality systems similarly with pilots helmet mounted displays. In the future, it is possible that treatments will even be performed through imaging when magnetic resonance system will allow the remote navigation of catheters up to their pathological targe

Apport de l’imagerie multimodale avancée au bloc de neuroradiologie interventionnelle

Since the very beginning of Interventional Neuroradiology (INR), the two pillars of this young specialty born in the 1960-70 have been both technological innovation and imaging. Thanks to numerous evolutions, we now can navigate our catheters anywhere in the brain. And all the available devices allow us to open an obstructed artery, occlude an hemorrhagic lesion or reconstruct a pathological vessel. The resolution of digital subtraction angiography has gradually improved over the years but up until recently we did not benefit from diverse options to plan and evaluate our treatments. The first part of this work consisted in demonstrating the clinical potential of a widely available but underused modality, the Cone Beam Computed Tomography. It allows a very good visualization of devices presenting a low radiodensity. In a second part, we exposed through multiple preclinical models, the potential impact of intravascular imaging with optical coherence tomography. Only used in the cardiology field, it could become an in vivo microscope for the analysis of neurovascular diseases and their treatment. Finally, after the description of morphological imaging modalities, we demonstrated the interest of functional imaging for the treatment planning of the cerebrovascular diseases managed by INR. We will illustrate this imaging progression through two very different approaches to treat intracranial aneurysms ; one endosaccular (WEB device) the other parietal (Flow diverter stents). In total, the importance of imaging is continuously growing in our field, because of the diversification of INR imaging. There is no doubt that in few years from now the multiplicity of these data will be provided through advanced reality systems similarly with pilots helmet mounted displays. In the future, it is possible that treatments will even be performed through imaging when magnetic resonance system will allow the remote navigation of catheters up to their pathological targetLes deux piliers de la Neuroradiologie Interventionnelle (NRI) sont depuis la naissance de cette spécialité née dans les années 1960-70 : la technicité des « outils » employés et le guidage par l’image. Grace à des avancées technologiques majeures, nos cathéters nous autorisent désormais à naviguer dans n’importe quelle artère du cerveau. Et l’ensemble des dispositifs de NRI existants nous permet de désobstruer une artère occlue, emboliser une lésion à risque de saignement ou bien reconstruire des vaisseaux pathologiques. En revanche, si la résolution de l’angiographie numérique s’est progressivement améliorée au fil des années, nous ne disposions encore récemment que de peu d’éléments pour planifier et évaluer précisément nos traitements, ceci directement au bloc de NRI.La première partie de ce travail a consisté à démontrer le potentiel d’une technologie largement disponible mais sous-employée. L’imagerie volumique par faisceau conique (Cone Beam CT) est en effet une aide précieuse pour imager les dispositifs faiblement radio-opaques. Dans un deuxième temps, nous exposons au travers de plusieurs modèles précliniques, le potentiel extraordinaire de l’imagerie intra-vasculaire par tomographie en cohérence optique (Optical Coherence Tomography). Non utilisée en pratique clinique NRI jusqu’à ce jour, cette imagerie à très haute résolution a le potentiel de devenir un véritable microscope vasculaire utilisable in vivo. Enfin, après la description des ces modalités morphologiques nous nous sommes efforcés de démontrer la valeur ajoutée des imageries fonctionnelles lors du traitement des pathologies neurovasculaires. Nous illustrons cette progression dans les techniques d’imagerie au travers de deux approches différentes pour le traitement des anévrismes intracrâniens ; l’une endosacculaire (WEB) et l’autre pariétale (stents à diversion de flux).Au total, l’importance de l’imagerie dans notre spécialité est encore en train de se renforcer, en raison de sa diversification. Il ne fait aucun doute que dans un avenir proche, la multiplicité des informations fournies sera disponible, en temps réel, par réalité augmentée, à la manière d’un pilote d’avion. Dans le futur, c’est même par l’imagerie que nous réaliserons nos interventions ; quand les systèmes à résonnance magnétique permettront de guider, à distance les cathéters jusqu’à leur cible

Comparaison de la qualité d'image et des doses d'irradiation délivrées en TDM cardiaque avec synchronisationà l'ECG en mode prospectif vs rétrospectif (utilisation de paramètres ajustés à l'IMC des patients)

ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Comparing magnetic resonance angiography (MRA) and computed tomography angiography (CTA) with conventional angiography in the detection of distal territory cerebral mycotic and oncotic aneurysms

International audienc

How a decade of aneurysms embolization with the Woven EndoBridge has changed our understanding and practices?

Background: Safety and efficacy of the WEB (Woven EndoBridge) device have been extensively evaluated in several good clinical practice studies. Nonetheless, the WEB had several structural evolutions overtime up to the fifth generation WEB device (WEB17). Here, we tried to understand how this may have modified our practices and enlarged our indications for its use. Methods: We retrospectively analyzed data from all patients with aneurysms treated (or intended to be treated) with a WEB at our institution between July 2012 and February 2022. The time frame was split in two periods: before and after the arrival of the WEB17 in our center (February 2017). Results: 252 patients with 276 wide-necked aneurysms were included; 78 aneurysms (28.2%) were ruptured. Successful embolization with a WEB device was achieved in 263/276 aneurysms (95.3%). With the availability of WEB17, treated aneurysms were significantly smaller (8.2 mm versus 5.9 mm, p<0.001) and off-label location significantly increased (4.4% versus 17.3%, p = 0.02) with an increase of sidewall aneurysm (4.4% versus 11.6%, p = 0.06). Also, WEB were more significantly oversized (1.05 versus 1.11, p<0.01). Adequate and complete occlusion rates increased constantly during the two periods (54.8% versus 67.5%, p = 0.08 and 74.2% versus 83.7%, p = 0.10, respectively). The proportion of ruptured aneurysms slightly increased between the two periods (24.6% versus 29.5%, p = 0.44). Conclusions: Over the first decade of its availability, the WEB device usage shifted towards smaller aneurysms and broader indications, including ruptured aneurysms. The oversizing strategy also became the standard of practice for WEB deployment in our institution