Russ M, O'Hara R, Setlur Nagesh S V, Mokin M, Jimenez C, Siddiqui A, Bednarek D, Rudin S, Ionita C
Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY.
Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY; University of Antioquia-GIB-Eafit, Medellin, Colombia.
Proc SPIE Int Soc Opt Eng. 2015 Feb 21;9417. doi: 10.1117/12.2081997. Epub 2015 Mar 19.
Minimally invasive endovascular image-guided interventions (EIGIs) are the preferred procedures for treatment of a wide range of vascular disorders. Despite benefits including reduced trauma and recovery time, EIGIs have their own challenges. Remote catheter actuation and challenging anatomical morphology may lead to erroneous endovascular device selections, delays or even complications such as vessel injury. EIGI planning using 3D phantoms would allow interventionists to become familiarized with the patient vessel anatomy by first performing the planned treatment on a phantom under standard operating protocols. In this study the optimal workflow to obtain such phantoms from 3D data for interventionist to practice on prior to an actual procedure was investigated. Patient-specific phantoms and phantoms presenting a wide range of challenging geometries were created. Computed Tomographic Angiography (CTA) data was uploaded into a Vitrea 3D station which allows segmentation and resulting stereo-lithographic files to be exported. The files were uploaded using processing software where preloaded vessel structures were included to create a closed-flow vasculature having structural support. The final file was printed, cleaned, connected to a flow loop and placed in an angiographic room for EIGI practice. Various Circle of Willis and cardiac arterial geometries were used. The phantoms were tested for ischemic stroke treatment, distal catheter navigation, aneurysm stenting and cardiac imaging under angiographic guidance. This method should allow for adjustments to treatment plans to be made before the patient is actually in the procedure room and enabling reduced risk of peri-operative complications or delays.
微创血管内图像引导介入治疗(EIGIs)是治疗多种血管疾病的首选方法。尽管具有创伤小、恢复时间短等优点,但EIGIs也有自身的挑战。远程导管驱动和复杂的解剖形态可能导致血管内器械选择错误、延误甚至出现血管损伤等并发症。使用三维模型进行EIGI规划可以让介入医生通过首先在标准操作流程下在模型上进行计划治疗,从而熟悉患者血管解剖结构。在本研究中,探讨了从三维数据中获取此类模型以供介入医生在实际手术前进行练习的最佳工作流程。创建了患者特异性模型以及呈现各种复杂几何形状的模型。将计算机断层血管造影(CTA)数据上传到Vitrea 3D工作站,该工作站可进行分割并导出生成的立体光刻文件。使用处理软件上传这些文件,其中包含预加载的血管结构以创建具有结构支撑的封闭血流脉管系统。最终文件被打印、清理、连接到血流回路并放置在血管造影室中用于EIGI练习。使用了各种Willis环和心脏动脉几何形状。在血管造影引导下对这些模型进行了缺血性中风治疗、远端导管导航、动脉瘤支架置入和心脏成像测试。这种方法应能在患者实际进入手术室之前对治疗计划进行调整,并降低围手术期并发症或延误的风险。
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