Endovascular image-guided interventions (EIGI) involve navigation of a catheter through the vasculature followed by application of treatment at the site of anomaly using live 2D projection images for guidance. 3D images acquired prior to EIGI are used to quantify the vascular anomaly and plan the intervention. If fused with the information of live 2D images they can also facilitate navigation and treatment. For this purpose 3D-2D image registration is required. Although several 3D-2D registration methods for EIGI achieve registration accuracy below 1 mm, their clinical application is still limited by insufficient robustness or reliability. In this paper, we propose a 3D-2D registration method based on matching a 3D vasculature model to intensity gradients of live 2D images. To objectively validate 3D-2D registration methods, we acquired a clinical image database of 10 patients undergoing cerebral EIGI and established "gold standard" registrations by aligning fiducial markers in 3D and 2D images. The proposed method had mean registration accuracy below 0.65 mm, which was comparable to tested state-of-the-art methods, and execution time below 1s. With the highest rate of successful registrations and the highest capture range the proposed method was the most robust and thus a good candidate for application in EIGI.
COBISS.SI-ID: 9795156
Endovascular mechanical revascularization (thrombectomy) is an increasingly used method for intracranial large vessel recanalization in acute stroke. The purpose of the study was to analyze the recanalization rate, clinical outcome, and complication rate in our stroke patients treated with mechanical revascularization. Methods A total of 57 patients with large vessel stroke (within 3 h for anterior and 12 h for posterior circulation) were treated with mechanical revascularization at a single center during 24 months. The primary goal of endovascular treatment using different mechanical devices was recanalization of the occluded vessel. Recanalization rate (reported as thrombolysis in cerebral infarction [TICI] score), clinical outcome (reported as National Institutes of Health Stroke Scale [NIHSS] score and modified Rankin scale [mRS] score), as well as periprocedural complications were analyzed. Results The mean age of the patients was 63.1 12.9 years, with baseline median NIHSS score of 14 (interquartile range, 9.519). Successful recanalization (TICI 2b or 3) was achieved in 41 (72 %) patients. Twenty patients (35 %) presented with favorable outcome (mRS 2) 30 days after stroke. Overall, significant neurological improvement (4 NIHSS point reduction) occurred in 36 (63 %) patients. A clinically significant procedure-related adverse events (vessel disruption, peri/postprocedural intracranial bleeding) defined with decline in NIHSS of 4 or death occurred in three (5 %) patients. Conclusions The study showed a high recanalization rate with improved clinical outcome and a low rate of periprocedural complications in our stroke patients treated with mechanical revascularization. Therefore, we could conclude that endovascular revascularization (primary or in combination with a bridging thrombolysis) was an effective and safe procedure for intracranial large vessel recanalization in acute stroke.
COBISS.SI-ID: 31021529
Endovascular image guided interventions involve catheter navigation through the vasculature to the treatment site under guidance of live 2D projection images. During treatment materials are delivered through the catheter that requires information about the blood flow direction, obtained by injecting contrast agent and observing its propagation on the live 2D images. To facilitate navigation and treatment the information from the live 2D images can be superimposed on a 3D vessel tree model, extracted from pre-interventional 3D images. However, the 3D and live 2D images first need to be spatially corresponded by a 3D-2D registration. In this paper, we propose a novel 3D-2D registration method based on matching orientations of 3D vessels’ centerlines to the edges of live 2D images. Results indicate that the proposed 3D-2D registration is highly robust and feasible for real-time execution ((1 s). Example of 3D contrast flow visualization also demonstrates the potential for real clinical application.
COBISS.SI-ID: 9774164