A novel three-dimensional navigation technology for ultrasound-guided transcarotid artery revascularization
Objective: Transcarotid artery revascularization is a rapidly growing therapy for carotid stenosis. Compared with carotid endarterectomy, transcarotid artery revascularization involves significant radiation exposure to both patient and surgeons. In this study, an innovative fluoroscopy-sparing techn...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-01-01
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| Series: | JVS-Vascular Insights |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949912725000777 |
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| Summary: | Objective: Transcarotid artery revascularization is a rapidly growing therapy for carotid stenosis. Compared with carotid endarterectomy, transcarotid artery revascularization involves significant radiation exposure to both patient and surgeons. In this study, an innovative fluoroscopy-sparing technique was evaluated to guide stent placement precisely in the carotid artery using real-time navigated ultrasound (US) fused with preoperative computed tomography (CT) imaging. Methods: The endovascular navigation approach combined a clinical US unit and optical tracking system to visualize and localize two-dimensional ultrasound images in three-dimensional (3D) space. Testing with an ultrasound imaging phantom in an operating room environment to evaluate feasibility and accuracy of the method was performed. Preoperative CT scans of the phantom were acquired along with tracked, in-procedure US sweeps to create 3D artery models from each of the two image volumes. The CT and US models were aligned automatically through multi-step registration that enabled real-time visualization of the US image feed overlaid on the 3D CT artery model. In-procedure stents and guidewires were identified on two-dimensional US, and their 3D locations were overlaid on the 3D artery model along with the US image. This real-time, navigation interface guided surgeon placement of a 40-mm stent across an artificial 20-mm lesion in the carotid artery phantom. After stent placement, a postoperative CT was acquired to quantify accuracy of stent positioning, measured as distance from stent center point to lesion center point. Technical success was assessed in terms of lesion coverage by the stent placed using the coregistered (to pre-procedure CT) US image guidance. Results: Six procedures were performed with 100% technical success rate. Average stent positioning accuracy was 1.3 ± 1.1 mm. Registration accuracy between CT and US model alignment was 1.0 ± 0.4 mm on average. Total time for image registration, including image acquisition and processing, was 91 ± 6 seconds on average. Conclusions: A fluoroscopy-sparing US-based endovascular navigation approach is both accurate and efficient for endovascular stent placement. The method provided intuitive, real-time 3D navigation of instruments relative to arterial anatomy and did not rely on expertise with US imaging. The technique leveraged existing technologies and workflows while obviating the need for fluoroscopy and shows promise for being evaluated in clinical studies in the future. : Clinical Relevance: Image fusion techniques, which merge intraoperative and pre-procedure imaging, are emerging to reduce the amount of intraoperative angiography. A navigation approach that combines an optically tracked clinical ultrasound with pre-procedure computed tomography is described for transcarotid artery revascularization. This fluoroscopy-sparing approach provides localization of in-procedure two-dimensional ultrasound fused to pre-procedure three-dimensional carotid images. The study demonstrates the approach is accurate and efficient in a preclinical phantom setting by providing intuitive, real-time three-dimensional navigation of instruments relative to arterial anatomy. If similarly successful when used in clinical procedures, the technique would reduce the need for intraoperative angiography. |
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| ISSN: | 2949-9127 |