Department of Biomedical Engineering, Linköping University, Linköping, Sweden.
Department of Health, Medicine, and Caring Sciences, Division of Diagnostics and Specialist Medicine, Linköping University, Linköping, Sweden.
Microvasc Res. 2022 May;141:104317. doi: 10.1016/j.mvr.2022.104317. Epub 2022 Jan 10.
Chronic limb-threatening ischemia (CLTI) has a major impact on patients' lives and is associated with a heavy health care burden with high morbidity and mortality. Treatment by endovascular intervention is mostly based on macrocirculatory information from angiography and does not consider the microcirculation. Despite successful endovascular intervention according to angiographic criteria, a proportion of patients fail to heal ischemic lesions. This might be due to impaired microvascular perfusion and variations in the supply to different angiosomes. Non-invasive optical techniques for microcirculatory perfusion and oxygen saturation imaging have the potential to provide the interventionist with additional information in real-time, supporting clinical decisions during the intervention. This study presents a novel multimodal imaging system, based on multi-exposure laser speckle contrast imaging and multi-spectral imaging, for continuous use during endovascular intervention. The results during intervention display spatiotemporal changes in the microcirculation compatible with expected physiological reactions during balloon dilation, with initially induced ischemia followed by a restored perfusion, and local administration of a vasodilator inducing hyperemia. We also present perioperative and postoperative follow-up measurements with a pulsatile microcirculation perfusion. Finally, cases of spatial heterogeneity in the oxygen saturation and perfusion are discussed. In conclusion, this technical feasibility study shows the potential of the methodology to characterize changes in microcirculation before, during, and after endovascular intervention.
慢性肢体严重缺血（CLTI）对患者的生活有重大影响，并与高发病率和死亡率相关的沉重医疗负担。血管内介入治疗主要基于血管造影的大循环信息，而不考虑微循环。尽管根据血管造影标准进行了成功的血管内介入治疗，但仍有一部分患者的缺血性病变无法愈合。这可能是由于微血管灌注受损和不同血管分布区的供血变化所致。非侵入性的微循环灌注和氧饱和度成像光学技术有可能实时为介入医生提供额外的信息，在介入过程中支持临床决策。本研究提出了一种新的基于多曝光激光散斑对比成像和多光谱成像的多模态成像系统，可在血管内介入过程中连续使用。介入过程中的结果显示了微循环的时空变化，与球囊扩张过程中的预期生理反应相吻合，最初诱导缺血，随后恢复灌注，局部给予血管扩张剂诱导充血。我们还介绍了脉动微循环灌注的围手术期和术后随访测量。最后，讨论了氧饱和度和灌注的空间异质性的情况。总之，这项技术可行性研究表明，该方法有可能在血管内介入治疗前后和期间描述微循环的变化。
