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Ughi GJ, Marosfoi MG, King RM, Caroff J, Peterson LM, Duncan BH, Langan ET, Collins A, Leporati A, Rousselle S, Lopes DK, Gounis MJ, Puri AS. A neurovascular high-frequency optical coherence tomography system enables in situ cerebrovascular volumetric microscopy. Nat Commun 2020; 11:3851. [PMID: 32737314 PMCID: PMC7395105 DOI: 10.1038/s41467-020-17702-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 07/09/2020] [Indexed: 01/11/2023] Open
Abstract
Intravascular imaging has emerged as a valuable tool for the treatment of coronary and peripheral artery disease; however, no solution is available for safe and reliable use in the tortuous vascular anatomy of the brain. Endovascular treatment of stroke is delivered under image guidance with insufficient resolution to adequately assess underlying arterial pathology and therapeutic devices. High-resolution imaging, enabling surgeons to visualize cerebral arteries' microstructure and micron-level features of neurovascular devices, would have a profound impact in the research, diagnosis, and treatment of cerebrovascular diseases. Here, we present a neurovascular high-frequency optical coherence tomography (HF-OCT) system, including an imaging console and an endoscopic probe designed to rapidly acquire volumetric microscopy data at a resolution approaching 10 microns in tortuous cerebrovascular anatomies. Using a combination of in vitro, ex vivo, and in vivo models, the feasibility of HF-OCT for cerebrovascular imaging was demonstrated.
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Affiliation(s)
- Giovanni J Ughi
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
- Gentuity LLC, Sudbury, MA, USA
| | - Miklos G Marosfoi
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Neurointerventional Radiology, Beth Israel Lahey Clinic, Burlington, MA, USA
| | - Robert M King
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Jildaz Caroff
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Interventional Neuroradiology, NEURI Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | | | | | - Erin T Langan
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Amanda Collins
- Division of Translational Anatomy, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anita Leporati
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Ajit S Puri
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
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Optical Coherence Tomography for Intracranial Aneurysms: A New Method for Assessing the Aneurysm Structure. World Neurosurg 2018; 123:e194-e201. [PMID: 30476668 DOI: 10.1016/j.wneu.2018.11.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is a lack of precise methods for predicting the risk of aneurysm rupture. Therefore, prophylactic treatment is used, which leads to unnecessary potential complications. A new modality enabling a more accurate risk assessment is needed. Optical coherence tomography (OCT) is a new-generation imaging technology that has astonishing resolution for vascular imaging. In this study, OCT was used for the evaluation of intracranial aneurysms. METHODS In vivo OCT imaging was performed for aneurysms induced in 6 rabbits and in 9 intracranial aneurysm patients. Catheters were cut short to prevent any extra length from damaging aneurysms and tissues. Images of both the parent artery and the aneurysm at multiple viewing angles were obtained using rotational OCT scanning. RESULTS The OCT images of rabbits correlated well with histologic sections. The 3-layered architecture of the parent arteries was explicitly shown. Ruptured intracranial aneurysms manifested complete breakdown of the wall structure; however, this was not observed in any unruptured aneurysms. The OCT images of unruptured intracranial aneurysms demonstrated a trend of degradation by showing the gradual disappearance of the demarcation between the layers or incomplete apoptosis in layer structures. CONCLUSION OCT is the most precise imaging modality because it provides detailed information regarding the aneurysm structures, thus enabling more distinct insight into the vascular construction of intracranial aneurysms.
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Optical Coherence Tomography. Stroke 2018; 49:1044-1050. [DOI: 10.1161/strokeaha.117.019818] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 12/22/2017] [Accepted: 01/09/2018] [Indexed: 11/16/2022]
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Richards CN, Schneider PA. Will mesh-covered stents help reduce stroke associated with carotid stent angioplasty? Semin Vasc Surg 2017; 30:25-30. [DOI: 10.1053/j.semvascsurg.2017.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Griessenauer CJ, Gupta R, Shi S, Alturki A, Motiei-Langroudi R, Adeeb N, Ogilvy CS, Thomas AJ. Collar Sign in Incompletely Occluded Aneurysms after Pipeline Embolization: Evaluation with Angiography and Optical Coherence Tomography. AJNR Am J Neuroradiol 2017; 38:323-326. [PMID: 28056454 DOI: 10.3174/ajnr.a5010] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/15/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow diversion with the Pipeline Embolization Device has emerged as an attractive treatment for cerebral aneurysms. Processes involved in aneurysm occlusion include changes in intra-aneurysmal hemodynamics and endothelialization of the device. Here, we call attention to a radiographic sign not previously reported that is detected in incompletely occluded aneurysms after treatment with the Pipeline Embolization Device at angiographic follow-up and referred to as the "collar sign." MATERIALS AND METHODS A retrospective review of all patients who underwent placement of a Pipeline Embolization Device for cerebral aneurysms between January 2014 and May 2016 was performed. All aneurysms found to show the collar sign at follow-up were included. Optical coherence tomography was performed in 1 case. RESULTS One hundred thirty-five aneurysms were treated in 115 patients. At angiographic follow-up, 17 (10.7%) aneurysms were found to be incompletely occluded. Ten (58.8%) of these aneurysms (average diameter, 7.9 ± 5.0 mm) were found to have the collar sign at angiographic follow-up (average, 5.5 ± 1.0 months). Four (40.0%) of the aneurysms underwent a second angiographic follow-up (average, 11.0 ± 0.9 months) after treatment, and again were incompletely occluded and showing the collar sign. Two patients underwent retreatment with a second Pipeline Embolization Device. Optical coherence tomography showed great variability of endothelialization at the proximal end of the Pipeline Embolization Device. CONCLUSIONS The collar sign appears to be indicative of endothelialization, but continued blood flow into the aneurysm. This is unusual given the processes involved in aneurysm occlusion after placement of the Pipeline Embolization Device and has not been previously reported.
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Affiliation(s)
- C J Griessenauer
- From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - R Gupta
- From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - S Shi
- From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - A Alturki
- From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - R Motiei-Langroudi
- From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - N Adeeb
- From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - C S Ogilvy
- From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - A J Thomas
- From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Griessenauer CJ, Foreman PM, Deveikis JP, Harrigan MR. Optical coherence tomography of traumatic aneurysms of the internal carotid artery: report of 2 cases. J Neurosurg 2015; 124:305-9. [PMID: 26252460 DOI: 10.3171/2015.1.jns142840] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The pathophysiology of extracranial traumatic aneurysm formation has not been fully elucidated. Intraarterial optical coherence tomography (OCT), an imaging modality capable of micrometer cross-sectional resolution, was used to evaluate patients presenting with saccular traumatic aneurysms of the internal carotid artery (ICA). Two consecutive trauma patients diagnosed with saccular traumatic aneurysms of the cervical ICA, per the institutional screening protocol for traumatic cerebrovascular injury, underwent digital subtraction angiography (DSA) with OCT. Optical coherence tomography demonstrated disruption of the intima with preservation and stretching of the more peripheral layers. In 1 patient the traumatic aneurysm was associated with thrombus formation and a separate, more proximal dissection not visible on CT angiography (CTA) or DSA. Imaging with OCT indicates that saccular traumatic aneurysms may develop from disruption of the intima with at least partial preservation of the media and adventitia. This provides in vivo evidence that saccular traumatic aneurysms result from a partial arterial wall tear rather than complete disruption. Interestingly, OCT was also able to detect arterial injury and thrombi not visible on CTA or DSA.
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Affiliation(s)
| | - Paul M Foreman
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - John P Deveikis
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Mark R Harrigan
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
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Given CA, Ramsey CN, Attizzani GF, Jones MR, Brooks WH, Bezerra HG, Costa MA. Optical coherence tomography of the intracranial vasculature and Wingspan stent in a patient. J Neurointerv Surg 2014; 7:e22. [DOI: 10.1136/neurintsurg-2014-011114.rep] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2014] [Indexed: 12/21/2022]
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Given CA, Ramsey CN, Attizzani GF, Jones MR, Brooks WH, Bezerra HG, Costa MA. Optical coherence tomography of the intracranial vasculature and Wingspan stent in a patient. BMJ Case Rep 2014; 2014:bcr-2014-011114. [PMID: 24835808 DOI: 10.1136/bcr-2014-011114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 67-year-old man with medically refractory vertebrobasilar insufficiency and short segment occlusions of the intracranial vertebral arteries was treated with angioplasty and stent placement. Fifteen hours after the procedure the patient developed symptoms of posterior fossa ischemia and repeat angiography showed thrombus formation within the stent which was treated with thrombolytic and aggressive antiplatelet therapy. Angiography revealed lysis of the clot, but concerns regarding the mechanism of the thrombotic phenomenon prompted frequency-domain optical coherence tomography (FDOCT) assessment. FDOCT provided excellent visualization of the stent and vessel wall interactions, as well as excluding residual flow-limiting stenosis, obviating the need for further intervention. The potential utility of FDOCT in the evaluation of intracranial atherosclerotic disease and additional intracranial applications are discussed.
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Affiliation(s)
- Curtis Alden Given
- Neurosurgical Associates, Baptist Health Lexington, Lexington, Kentucky, USA
| | - Christian Norman Ramsey
- Neurosurgical Associates, Baptist Health Lexington, Lexington, Kentucky, USA Department of Neurosurgery, Baptist Health Lexington, Lexington, Kentucky, USS
| | | | - Michael R Jones
- Department of Cardiology, Baptist Health Lexington, Lexington, Kentucky, USA
| | - William H Brooks
- Neurosurgical Associates, Baptist Health Lexington, Lexington, Kentucky, USA Department of Neurosurgery, Baptist Health Lexington, Lexington, Kentucky, USS
| | - Hiram G Bezerra
- Department of Cardiology, Case Western University, Cleveland, Ohio, USA
| | - Marco A Costa
- Department of Cardiology, Case Western University, Cleveland, Ohio, USA
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Abstract
Symptomatic carotid artery stenosis is an important cause of stroke with significant morbidity and mortality. Revascularization with carotid endarterectomy reduces the recurrence of stroke and until recently was considered the gold standard of therapy. Carotid artery stenting has emerged as an alternative method of revascularization in both high-risk and standard-risk patients. This review appraises the role of surgery versus stenting for patients with symptomatic carotid stenosis.
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Affiliation(s)
- Jun Li
- Department of Medicine, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA; Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Rahul Sakhuja
- Department of Medicine, Division of Cardiology, Wellmont CVA Heart Institute, 2050 Meadowview Pkwy, Kingsport, TN 37660, USA
| | - Sahil A Parikh
- Department of Medicine, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA; Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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