Article Figures & Data
Figures
- FIG 1.
Example of a virtual roadmap of supra-aortic vessels. The vasculature is segmented from the MRA dataset with VesselNavigator software, with landmarks added on the brachiocephalic artery trunk, the right and left common carotid arteries, and the left subclavian artery. During this step, the operator saves projection angles, which can be recalled during catheterization.
- FIG 2.
Detailed workflow of the MRA-fluoroscopy or CTA-fluoroscopy image fusion process for supra-aortic vessel catheterization in neurovascular interventions. Preoperative planning starts with uploading the MRA/CTA dataset on VesselNavigator. A, 3D semiautomatic segmentation of the aortic arch and the supra-aortic vessels and ostium labeling. B, Perioperative 2D–3D coregistration with 2 orthogonal positions of the anterior-posterior C-arm using anatomic landmarks. C, Perioperative augmented guidance.
- FIG 3.
Spatial accuracy assessment of MRA/CTA–fluoroscopy fusion. A 3-category semiquantitative scale was used to measure the maximum offset. A, Example of an accurate fusion at the ostium of the brachiocephalic artery trunk: The catheter projects within the lumen of the vessel in the ROI. B, Example of a mismatch at the ostium of the right common carotid artery: The catheter projects out of the lumen but within a distance inferior to the diameter of the vessel. C, Example of an inaccurate fusion at the ostium of the left common carotid artery: The catheter projects out of the vessel at a distance superior to the diameter.
Tables
- Table 1:
Patient characteristics (demographics, cardiovascular risk, procedure features, and aortic arch type)
Patient Characteristics Age (yr) Median (Interquartile range) 55 (50–68) Sex Female (No.) (%) 20 (61%) Male (No.) (%) 13 (39%) Cardiovascular risk factorsa (No.) (%) 0 12 (34%) 1 6 (16%) ≥2 17 (50%) Procedure type (No.) (%) Diagnostic/follow-up angiography 23 (66%) Intracranial embolization 9 (16%) Mechanical thrombectomy 3 (8%) Anesthesia (No.) (%) Conscious sedation 26 (74%) General anesthesia 9 (26%) Noninvasive imaging for navigation (No.) (%) CTA 12 (34%) MRA 23 (66%) Aortic arch type (No.) (%) I 20 (57%) II 8 (23%) III 7 (20%) Bovine variant 9 (26%) ↵a We considered smoking, high blood pressure, high low-density lipoprotein and low high-density lipoprotein cholesterol levels, age, and obesity.
ROIs of the Virtual Roadmap/Spatial Accuracy No. (%) Brachiocephalic artery trunk Accurate 27 (96.4) Mismatch 1 (3.6) Inaccurate All 28 (100) Right subclavian artery Accurate 8 (100) Mismatch Inaccurate All 8 (100) Right vertebral artery Accurate 5 (100) Mismatch Inaccurate All 5 (100) Right common carotid artery Accurate 16 (69.6) Mismatch 3 (13.0) Inaccurate 4 (17.4) All 23 (100) Right internal carotid artery Accurate 10 (66.7) Mismatch 3 (20.0) Inaccurate 2 (13.3) All 15 (100) Left common carotid artery Accurate 24 (85.7) Mismatch 3 (10.7) Inaccurate 1 (3.6) All 28 (100) Left internal carotid artery Accurate 17 (81.0) Mismatch 3 (14.3) Inaccurate 1 (4.8) All 21 (100) Left subclavian artery Accurate 13 (92.9) Mismatch 1 (7.1) Inaccurate All 14 (100) Left vertebral artery Accurate 8 (88.9) Mismatch 1 (11.1) Inaccurate All 9 (100) Overall Accurate 128 (84.8) Mismatch 15 (9.9) Inaccurate 8 (5.3) All - Table 3:
Comparison of spatial accuracy between aortic arch and cervical level (group 1) and the distal cervical level (group 2)
Spatial Accuracy Group 1 No. (%) Group 2 No. (%) Overall No. (%) Accurate 85 (92.4) 43 (72.9) 128 (84.8) Mismatch/inaccurate 7 (7.6) 16 (27.1) 23 (15.2)
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