Tangen Geir Arne, Manstad-Hulaas Frode, Nypan Erik, Brekken Reidar
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim, Norway.
Clin Med Insights Cardiol. 2018 Jan 4;12:1179546817751432. doi: 10.1177/1179546817751432. eCollection 2018.
A prototype steerable catheter was designed for endovascular procedures. This technical pilot study reports the initial experience using the catheter for cannulation of visceral arteries.
The 7F catheter was manually steerable with operator control handle for bending and rotation of the tip. The maximum bending angle was approximately 90° and full 360° rotation of the tip was supported. The study involved 1 pig with 4 designated target arteries: the left and right renal arteries, the superior mesenteric artery, and the celiac trunk. Fluoroscopy with 3-dimensional (3D) overlay showing the ostia from preoperative computed tomography angiography was used for image guidance. The cannulation was considered successful if the guidewire was placed well inside the target artery. In addition to evaluating cannulation success, procedure time and associated radiation doses were recorded. The procedure was performed twice with 2 different operators.
Both operators successfully reached all 4 target arteries, demonstrating the feasibility of the steerable catheter for endovascular cannulation of visceral arteries. No contrast medium was used, and median radiation dose was 4.5 mGy per cannulation. An average of approximately 2 minutes was used per cannulation. This study motivates further testing in a more comprehensive study to evaluate reproducibility in several animals and with inclusion of more operators. Further development by integrating the new catheter tool in a navigation system is also an interesting next step, combining fine control of catheter tip movements and 3D image guidance without ionizing radiation.
设计了一种用于血管内手术的可操纵导管原型。这项技术试点研究报告了使用该导管进行内脏动脉插管的初步经验。
7F导管可通过操作员控制手柄手动操纵，以实现尖端的弯曲和旋转。最大弯曲角度约为90°，并支持尖端360°全旋转。该研究涉及1头猪，有4条指定的目标动脉：左、右肾动脉、肠系膜上动脉和腹腔干。使用术前计算机断层血管造影显示开口的三维（3D）叠加荧光透视进行图像引导。如果导丝放置在目标动脉内，则插管被认为成功。除了评估插管成功率外，还记录了手术时间和相关辐射剂量。该手术由2名不同的操作员进行了两次。
两名操作员均成功到达了所有4条目标动脉，证明了可操纵导管用于内脏动脉血管内插管的可行性。未使用造影剂，每次插管的中位辐射剂量为4.5 mGy。每次插管平均用时约2分钟。这项研究促使在更全面的研究中进行进一步测试，以评估在几只动物中以及纳入更多操作员时的可重复性。将新的导管工具集成到导航系统中进行进一步开发也是有趣的下一步，可结合导管尖端运动的精细控制和无电离辐射的3D图像引导。
