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Zhu L, Zhong Y, Yan M, Ni S, Zhao X, Wu S, Wang G, Zhang K, Chi Q, Qin X, Li C, Huang X, Wu W. Macrophage Membrane-Encapsulated Dopamine-Modified Poly Cyclodextrin Multifunctional Biomimetic Nanoparticles for Atherosclerosis Therapy. ACS APPLIED MATERIALS & INTERFACES 2024; 16:32027-32044. [PMID: 38867426 DOI: 10.1021/acsami.4c04431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Atherosclerotic plaques exhibit high cholesterol deposition and oxidative stress resulting from high reactive oxygen species (ROS). These are the major components in plaques and the main pro-inflammatory factor. Therefore, it is crucial to develop an effective therapeutic strategy that can simultaneously address the multiple pro-inflammatory factors via removing cholesterol and inhibiting the overaccumulated ROS. In this study, we constructed macrophage membrane-encapsulated biomimetic nanoparticles (MM@DA-pCD@MTX), which not only alleviate cholesterol deposition at the plaque lesion via reverse cholesterol transport but also scavenge the overaccumulated ROS. β-Cyclodextrin (β-CD) and the loaded methotrexate (MTX) act synergistically to induce cholesterol efflux for inhibiting the formation of foam cells. Among them, MTX up-regulated the expression of ABCA1, CYP27A1, and SR-B1. β-CD increased the solubility of cholesterol crystals. In addition, the ROS scavenging property of dopamine (DA) was perfectly preserved in MM@DA-pCD@MTX, which could scavenge the overaccumulated ROS to alleviate the oxidative stress at the plaque lesion. Last but not least, MM-functionalized "homing" targeting of atherosclerotic plaques not only enables the targeted drug delivery but also prolongs in vivo circulation time and drug half-life. In summary, MM@DA-pCD@MTX emerges as a potent, multifunctional therapeutic platform for AS treatment, offering a high degree of biosafety and efficacy in addressing the complex pathophysiology of atherosclerosis.
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Affiliation(s)
- Li Zhu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
| | - Yuan Zhong
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
| | - Meng Yan
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
| | - Sheng Ni
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
| | - Xiong Zhao
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
| | - Shuai Wu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
- Jin Feng Laboratory, Chongqing 401329, China
| | - Kun Zhang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
- Chongqing University Three Gorges Hospital, Chongqing 404000, China
| | - Qingjia Chi
- Department of Engineering Structure and Mechanics, School of Science, Wuhan University of Technology, Wuhan 430070, China
| | - Xian Qin
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
- Chongqing University Three Gorges Hospital, Chongqing 404000, China
| | - Chuanwei Li
- Department of Cardiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing University, Chongqing 400042, China
| | - Xiaobei Huang
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing 400714, China
| | - Wei Wu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, China
- Jin Feng Laboratory, Chongqing 401329, China
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Gao Z. Strategies for enhanced gene delivery to the central nervous system. NANOSCALE ADVANCES 2024; 6:3009-3028. [PMID: 38868835 PMCID: PMC11166101 DOI: 10.1039/d3na01125a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/12/2024] [Indexed: 06/14/2024]
Abstract
The delivery of genes to the central nervous system (CNS) has been a persistent challenge due to various biological barriers. The blood-brain barrier (BBB), in particular, hampers the access of systemically injected drugs to parenchymal cells, allowing only a minimal percentage (<1%) to pass through. Recent scientific insights highlight the crucial role of the extracellular space (ECS) in governing drug diffusion. Taking into account advancements in vectors, techniques, and knowledge, the discussion will center on the most notable vectors utilized for gene delivery to the CNS. This review will explore the influence of the ECS - a dynamically regulated barrier-on drug diffusion. Furthermore, we will underscore the significance of employing remote-control technologies to facilitate BBB traversal and modulate the ECS. Given the rapid progress in gene editing, our discussion will also encompass the latest advances focused on delivering therapeutic editing in vivo to the CNS tissue. In the end, a brief summary on the impact of Artificial Intelligence (AI)/Machine Learning (ML), ultrasmall, soft endovascular robots, and high-resolution endovascular cameras on improving the gene delivery to the CNS will be provided.
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Affiliation(s)
- Zhenghong Gao
- Mechanical Engineering, The University of Texas at Dallas USA
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3
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Faisal S, Barbour M, Seibel EJ, Aliseda A. Hemodynamics of Saline Flushing in Endoscopic Imaging of Partially Occluded Coronary Arteries. Cardiovasc Eng Technol 2024; 15:211-223. [PMID: 38191806 DOI: 10.1007/s13239-023-00708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Intravascular endoscopy can aid in the diagnosis of coronary atherosclerosis by providing direct color images of coronary plaques. The procedure requires a blood-free optical path between the catheter and plaque, and achieving clearance safely remains an engineering challenge. In this study, we investigate the hemodynamics of saline flushing in partially occluded coronary arteries to advance the development of intravascular forward-imaging catheters that do not require balloon occlusion. METHODS In-vitro experiments and CFD simulations are used to quantify the influence of plaque size, catheter stand-off distance, saline injection flowrate, and injection orientation on the time required to achieve blood clearance. RESULTS Experiments and simulation of saline injection from a dual-lumen catheter demonstrated that flushing times increase both as injection flow rate (Reynolds number) decreases and as the catheter moves distally away from the plaque. CFD simulations demonstrated that successful flushing was achieved regardless of lumen axial orientation in a 95% occluded artery. Flushing time was also found to increase as plaque size decreases for a set injection flowrate, and a lower limit for injection flowrate was found to exist for each plaques size, below which clearance was not achieved. For the three occlusion sizes investigated (90, 95, 97% by area), successful occlusion was achieved in less than 1.2 s. Investigation of the pressure fields developed during injection, highlight that rapid clearance can be achieved while keeping the arterial overpressure to < 1 mmHg. CONCLUSIONS A dual lumen saline injection catheter was shown to produce clearance safely and effectively in models of partially occluded coronary arteries. Clearance was achieved across a range of engineering and clinical parameters without the use of a balloon occlusion, providing development guideposts for a fluid injection system in forward-imaging coronary endoscopes.
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Affiliation(s)
- Syed Faisal
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA
| | - Michael Barbour
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA.
| | - Eric J Seibel
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA
| | - Alberto Aliseda
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA
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Bae H, Rodewald M, Meyer-Zedler T, Bocklitz TW, Matz G, Messerschmidt B, Press AT, Bauer M, Guntinas-Lichius O, Stallmach A, Schmitt M, Popp J. Feasibility studies of multimodal nonlinear endoscopy using multicore fiber bundles for remote scanning from tissue sections to bulk organs. Sci Rep 2023; 13:13779. [PMID: 37612362 PMCID: PMC10447453 DOI: 10.1038/s41598-023-40944-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/18/2023] [Indexed: 08/25/2023] Open
Abstract
Here, we report on the development and application of a compact multi-core fiber optical probe for multimodal non-linear imaging, combining the label-free modalities of Coherent Anti-Stokes Raman Scattering, Second Harmonic Generation, and Two-Photon Excited Fluorescence. Probes of this multi-core fiber design avoid moving and voltage-carrying parts at the distal end, thus providing promising improved compatibility with clinical requirements over competing implementations. The performance characteristics of the probe are established using thin cryo-sections and artificial targets before the applicability to clinically relevant samples is evaluated using ex vivo bulk human and porcine intestine tissues. After image reconstruction to counteract the data's inherently pixelated nature, the recorded images show high image quality and morpho-chemical conformity on the tissue level compared to multimodal non-linear images obtained with a laser-scanning microscope using a standard microscope objective. Furthermore, a simple yet effective reconstruction procedure is presented and demonstrated to yield satisfactory results. Finally, a clear pathway for further developments to facilitate a translation of the multimodal fiber probe into real-world clinical evaluation and application is outlined.
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Affiliation(s)
- Hyeonsoo Bae
- Leibniz Institute of Photonic Technology (Leibniz IPHT), Member of Leibniz Health Technologies, Member of the Leibniz Centre for Photonics in Infection Research (LPI), PO Box 100239, 07702, Jena, Germany
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich-Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany
| | - Marko Rodewald
- Leibniz Institute of Photonic Technology (Leibniz IPHT), Member of Leibniz Health Technologies, Member of the Leibniz Centre for Photonics in Infection Research (LPI), PO Box 100239, 07702, Jena, Germany
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich-Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany
| | - Tobias Meyer-Zedler
- Leibniz Institute of Photonic Technology (Leibniz IPHT), Member of Leibniz Health Technologies, Member of the Leibniz Centre for Photonics in Infection Research (LPI), PO Box 100239, 07702, Jena, Germany
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich-Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany
| | - Thomas W Bocklitz
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich-Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany
| | - Gregor Matz
- GRINTECH GmbH, Schillerstraße 1, 07745, Jena, Germany
| | | | - Adrian T Press
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Medical Faculty, Friedrich-Schiller University Jena, Kastanienstr. 1, 07747, Jena, Germany
| | - Michael Bauer
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Michael Schmitt
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich-Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany
| | - Juergen Popp
- Leibniz Institute of Photonic Technology (Leibniz IPHT), Member of Leibniz Health Technologies, Member of the Leibniz Centre for Photonics in Infection Research (LPI), PO Box 100239, 07702, Jena, Germany.
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich-Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany.
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5
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Zhang K, Xu H, Li K. Molecular Imaging for Early-Stage Disease Diagnosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1199:39-58. [PMID: 37460726 DOI: 10.1007/978-981-32-9902-3_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
With the development of cellular biology, molecular biology, and other subjects, targeted molecular probe was combined with medical imaging technologies to launch a new scientific discipline of molecular imaging that is a research discipline to visualize, characterize, and analyze biological process at the cellular and molecular levels for real-time tracking and precision therapy, also termed as the medical imaging in the twenty-first century. An array of imaging techniques has been developed to image specific targets of living cells or tissues by molecular probes, including optical molecular imaging (OI), magnetic resonance molecular imaging, ultrasound (US) molecular imaging, nuclear medicine molecular imaging, X-ray molecular imaging, and multi-mode molecular imaging. These imaging techniques make the early diagnosis of various diseases possible by means of visualization of gene expression, interactions between proteins, signal transduction, cell metabolism, cell traces, and other physiological or pathological processes in the living system, which bridge the gap between molecular biology and clinical medicine. This chapter will lay the emphasis on the early-stage diagnosis of fatal diseases, such as malignant tumors, cardio- or cerebrovascular diseases, digestive system disease, central nervous system disease, and other diseases employing molecular imaging in a real-time visualized manner.
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Affiliation(s)
- Kuo Zhang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.
| | - Haiyan Xu
- School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
| | - Kai Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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6
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Liang X, Li H, Li X, Tian X, Zhang A, Luo Q, Duan J, Chen Y, Pang L, Li C, Liang XJ, Zeng Y, Yang J. Highly sensitive H 2O 2-scavenging nano-bionic system for precise treatment of atherosclerosis. Acta Pharm Sin B 2023; 13:372-389. [PMID: 36815039 PMCID: PMC9939301 DOI: 10.1016/j.apsb.2022.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
In atherosclerosis, chronic inflammatory processes in local diseased areas may lead to the accumulation of reactive oxygen species (ROS). In this study, we devised a highly sensitive H2O2-scavenging nano-bionic system loaded with probucol (RPP-PU), to treat atherosclerosis more effectively. The RPP material had high sensitivity to H2O2, and the response sensitivity could be reduced from 40 to 10 μmol/L which was close to the lowest concentration of H2O2 levels of the pathological environment. RPP-PU delayed the release and prolonged the duration of PU in vivo. In Apolipoprotein E deficient (ApoE‒/‒) mice, RPP-PU effectively eliminated pathological ROS, reduced the level of lipids and related metabolic enzymes, and significantly decreased the area of vascular plaques and fibers. Our study demonstrated that the H2O2-scavenging nano-bionic system could scavenge the abundant ROS in the atherosclerosis lesion, thereby reducing the oxidative stress for treating atherosclerosis and thus achieve the therapeutic goals with atherosclerosis more desirably.
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Affiliation(s)
- Xiaoyu Liang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300192, China
| | - Huiyang Li
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300192, China
| | - Xuanling Li
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300192, China,Medical College of Qinghai University, Xining 810016, China
| | - Xinxin Tian
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300192, China
| | - Aiai Zhang
- The First Affiliated Hospital of Hebei North University, Zhangjiakou 075061, China
| | - Qingzhi Luo
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
| | - Jianwei Duan
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300192, China
| | - Youlu Chen
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300192, China
| | - Liyun Pang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300192, China
| | - Chen Li
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300192, China
| | - Xing-Jie Liang
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, China
| | - Yong Zeng
- Beijing Anzhen Hospital of Capital Medical University, Beijing 100029, China,Corresponding authors.
| | - Jing Yang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin 300192, China,Corresponding authors.
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7
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Liu Y, Brinjikji W, Abbasi M, Dai D, Arturo Larco JL, Madhani SI, Shahid AH, Mereuta OM, Nogueira RG, Kvamme P, Layton KF, Delgado Almandoz JE, Hanel RA, Mendes Pereira V, Almekhlafi MA, Yoo AJ, Jahromi BS, Gounis MJ, Patel B, Fitzgerald S, Doyle K, Haussen DC, Al-Bayati AR, Mohammaden M, Pisani L, Rodrigues GM, Thacker IC, Kayan Y, Copelan A, Aghaebrahim A, Sauvageau E, Demchuk AM, Bhuva P, Soomro J, Nazari P, Cantrell DR, Puri AS, Entwistle J, Kadirvel R, Cloft HJ, Kallmes DF, Savastano L. Quantification of clot spatial heterogeneity and its impact on thrombectomy. J Neurointerv Surg 2022; 14:1248-1252. [PMID: 34911736 PMCID: PMC11178127 DOI: 10.1136/neurintsurg-2021-018183] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/29/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Compositional and structural features of retrieved clots by thrombectomy can provide insight into improving the endovascular treatment of ischemic stroke. Currently, histological analysis is limited to quantification of compositions and qualitative description of the clot structure. We hypothesized that heterogeneous clots would be prone to poorer recanalization rates and performed a quantitative analysis to test this hypothesis. METHODS We collected and did histology on clots retrieved by mechanical thrombectomy from 157 stroke cases (107 achieved first-pass effect (FPE) and 50 did not). Using an in-house algorithm, the scanned images were divided into grids (with sizes of 0.2, 0.3, 0.4, 0.5, and 0.6 mm) and the extent of non-uniformity of RBC distribution was computed using the proposed spatial heterogeneity index (SHI). Finally, we validated the clinical significance of clot heterogeneity using the Mann-Whitney test and an artificial neural network (ANN) model. RESULTS For cases with FPE, SHI values were smaller (0.033 vs 0.039 for grid size of 0.4 mm, P=0.028) compared with those without. In comparison, the clot composition was not statistically different between those two groups. From the ANN model, clot heterogeneity was the most important factor, followed by fibrin content, thrombectomy techniques, red blood cell content, clot area, platelet content, etiology, and admission of intravenous tissue plasminogen activator (IV-tPA). No statistical difference of clot heterogeneity was found for different etiologies, thrombectomy techniques, and IV-tPA administration. CONCLUSIONS Clot heterogeneity can affect the clot response to thrombectomy devices and is associated with lower FPE. SHI can be a useful metric to quantify clot heterogeneity.
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Affiliation(s)
- Yang Liu
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mehdi Abbasi
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | - Raul G Nogueira
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter Kvamme
- Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Kennith F Layton
- NeuroInterventional Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | | | - Ricardo A Hanel
- Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mohammed A Almekhlafi
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Albert J Yoo
- Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Babak S Jahromi
- Radiology and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J Gounis
- Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Biraj Patel
- Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Seán Fitzgerald
- Department of Physiology and CURAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Karen Doyle
- Department of Physiology and CURAM-SFI Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Diogo C Haussen
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Leonardo Pisani
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Ike C Thacker
- NeuroInterventional Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Yasha Kayan
- NeuroInterventional Radiology, Abbot Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Alexander Copelan
- NeuroInterventional Radiology, Abbot Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Amin Aghaebrahim
- Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Andrew M Demchuk
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Parita Bhuva
- Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Jazba Soomro
- Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Pouya Nazari
- Radiology and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donald Robert Cantrell
- Radiology and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ajit S Puri
- Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - John Entwistle
- Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | | | - Harry J Cloft
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Luis Savastano
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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8
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Savastano L, Mousavi H, Liu Y, Khalsa SSS, Zheng Y, Davis E, Reddy A, Brinjikji W, Bhambri A, Cockrum J, Pandey AS, Thompson BG, Gordon D, Seibel EJ, Yonas H. Unifying theory of carotid plaque disruption based on structural phenotypes and forces expressed at the lumen/wall interface. Stroke Vasc Neurol 2022; 7:465-475. [PMID: 35649687 PMCID: PMC9811551 DOI: 10.1136/svn-2021-001451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/08/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To integrate morphological, haemodynamic and mechanical analysis of carotid atheroma driving plaque disruption. MATERIALS AND METHODS First, we analysed the phenotypes of carotid endarterectomy specimens in a photographic dataset A, and matched them with the likelihood of preoperative stroke. Second, laser angioscopy was used to further define the phenotypes in intact specimens (dataset B) and benchmark with histology. Third, representative vascular geometries for each structural phenotype were analysed with Computational Fluid Dynamics (CFD), and the mechanical strength of the complicated atheroma to resist penetrating forces was quantified (n=14). RESULTS In dataset A (n=345), ulceration (fibrous cap disruption) was observed in 82% of all plaques, intraplaque haemorrhage in 68% (93% subjacent to an ulcer) and false luminal formation in 48%. At least one of these 'rupture' phenotypes was found in 97% of symptomatic patients (n=69) compared with 61% in asymptomatic patients. In dataset B (n=30), laser angioscopy redemonstrated the structural phenotypes with near-perfect agreement with histology. In CFD, haemodynamic stress showed a large pulse magnitude, highest upstream to the point of maximal stenosis and on ulceration the inflow stream excavates the necrotic core cranially and then recirculates into the true lumen. Based on mechanical testing (n=14), the necrotic core is mechanically weak and penetrated by the blood on fibrous cap disruption. CONCLUSIONS Fibrous cap ulceration, plaque haemorrhage and excavation are sequential phenotypes of plaque disruption resulting from the chiselling effect of haemodynamic forces over unmatched mechanical tissue strength. This chain of events may result in thromboembolic events independently of the degree of stenosis.
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Affiliation(s)
| | - Hossein Mousavi
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Yang Liu
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Siri Sahib S Khalsa
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Yihao Zheng
- Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Evan Davis
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Adithya Reddy
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Ankur Bhambri
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Joshua Cockrum
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Aditya S Pandey
- Neurosurgery, Michigan Medicine, Ann Arbor, Michigan, USA,Radiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - B Gregory Thompson
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - David Gordon
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric J Seibel
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Howard Yonas
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Saba L, Antignani PL, Gupta A, Cau R, Paraskevas KI, Poredos P, Wasserman B, Kamel H, Avgerinos ED, Salgado R, Caobelli F, Aluigi L, Savastano L, Brown M, Hatsukami T, Hussein E, Suri JS, Mansilha A, Wintermark M, Staub D, Montequin JF, Rodriguez RTT, Balu N, Pitha J, Kooi ME, Lal BK, Spence JD, Lanzino G, Marcus HS, Mancini M, Chaturvedi S, Blinc A. International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: From basic strategies to advanced approaches. Atherosclerosis 2022; 354:23-40. [DOI: 10.1016/j.atherosclerosis.2022.06.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022]
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Nardi V, Benson JC, Larson AS, Brinjikji W, Saba L, Meyer FB, Lanzino G, Lerman A, Savastano LE. Carotid artery endarterectomy in patients with symptomatic non-stenotic carotid artery disease. Stroke Vasc Neurol 2022; 7:251-257. [PMID: 35241631 PMCID: PMC9240461 DOI: 10.1136/svn-2021-000939] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/08/2021] [Indexed: 11/09/2022] Open
Abstract
Object We sought to determine the safety and efficacy in secondary stroke prevention of carotid endarterectomy (CEA) in patients with symptomatic non-stenotic carotid artery disease (SyNC). Methods This was a single-centre retrospective case series. All patients who underwent CEA for unilateral anterior circulation cerebrovascular events with ipsilateral <50% carotid stenosis from 2002 to 2020 were included. Imaging hallmarks including the degree of luminal stenosis and the presence of various vulnerable plaque characteristics (eg, intraplaque haemorrhage (IPH) on MR angiography, ulceration or low-density plaque on CT angiography) were assessed. The presence of vulnerable plaque characteristics was compared between arteries ipsilateral to the ischaemic event and contralateral arteries. The prevalence of perioperative/intraoperative complications, as well as recurrent ischaemic events at follow-up was determined. Results Thirty-two patients were included in the analysis, of which 25.0% were female. Carotid arteries ipsilateral to an ischaemic event had a significantly higher prevalence of IPH when compared with contralateral arteries (80.0% vs 0.0%; p<0.001). There were no intraoperative complications. One patient (3.1%) developed symptoms of transient ipsilateral ischaemia 1 day following CEA which resolved without treatment. In a median follow-up of 18.0 months (IQR 5.0–36.0), only one patient (3.1%) experienced a transient neurologic deficit with complete resolution (annualised rate of recurrent stroke after CEA of 1.5% for a total follow-up of 788 patient-months following CEA). All other patients (31/32, 96.9%) were free of recurrent ischaemic events. Conclusion CEA appears to be safe and well-tolerated in patients with SyNC. Additional studies with larger cohorts and longer follow-up intervals are needed in order to determine the role of CEA in this patient population.
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Affiliation(s)
- Valentina Nardi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Luca Saba
- Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy
| | | | | | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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11
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Larson A, Nardi V, Brinjikji W, Benson JC, Lanzino G, Savastano L. Endarterectomy for symptomatic non-stenotic carotids: a systematic review and descriptive analysis. Stroke Vasc Neurol 2022; 7:6-12. [PMID: 34244446 PMCID: PMC8899633 DOI: 10.1136/svn-2021-001122] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/22/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To systematically analyse prior reports of carotid endarterectomy (CEA) performed in cases of ≤50% carotid stenosis in order to understand patient tolerance and potential benefit. METHODS A systematic review and descriptive analysis was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An English-language search was performed of online databases using librarian-selected search terms. Abstracts were reviewed for relevance which included mention of carotid endarterectomy and stenosis. Prospective or retrospective observational cohort studies that reported series of patients who underwent endarterectomy for minimal (≤50%) luminal stenosis with reported outcomes were included. RESULTS Six studies (which included our institutional series) with a total of 143 patients met the inclusion criteria. The weighted mean age at the time of CEA was 72.3 years; 113 (79.0%) were male. 55.8% of patients with available data had recurrent ipsilateral ischaemic events despite medical therapy. Two patients out of 129 with available perioperative data (1.6%) had perioperative MRI findings of acute ischaemic stroke, both within the hemisphere contralateral to the side of CEA. Of the 138 patients with available follow-up (mean, 36 months), none had recurrent ipsilateral ischaemic events. CONCLUSIONS Endarterectomy for symptomatic carotid disease causing ≤50% stenosis may be a potentially beneficial strategy to prevent stroke recurrence. Studies with robust methodology are needed to draw more definitive conclusions in terms of the safety and efficacy of endarterectomy for minimal stenosis with vulnerable features relative to intensive medical therapy.
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Affiliation(s)
- Anthony Larson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Valentina Nardi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John C Benson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Jiao Y, Yuan J, Sodimu OM, Qiang Y, Ding Y. Deep Neural Network-Aided Histopathological Analysis of Myocardial Injury. Front Cardiovasc Med 2022; 8:724183. [PMID: 35083295 PMCID: PMC8784602 DOI: 10.3389/fcvm.2021.724183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Deep neural networks have become the mainstream approach for analyzing and interpreting histology images. In this study, we established and validated an interpretable DNN model to assess endomyocardial biopsy (EMB) data of patients with myocardial injury. Deep learning models were used to extract features and classify EMB histopathological images of heart failure cases diagnosed with either ischemic cardiomyopathy or idiopathic dilated cardiomyopathy and non-failing cases (organ donors without a history of heart failure). We utilized the gradient-weighted class activation mapping (Grad-CAM) technique to emphasize injured regions, providing an entry point to assess the dominant morphology in the process of a comprehensive evaluation. To visualize clustered regions of interest (ROI), we utilized uniform manifold approximation and projection (UMAP) embedding for dimension reduction. We further implemented a multi-model ensemble mechanism to improve the quantitative metric (area under the receiver operating characteristic curve, AUC) to 0.985 and 0.992 on ROI-level and case-level, respectively, outperforming the achievement of 0.971 ± 0.017 and 0.981 ± 0.020 based on the sub-models. Collectively, this new methodology provides a robust and interpretive framework to explore local histopathological patterns, facilitating the automatic and high-throughput quantification of cardiac EMB analysis.
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13
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Faisal S, Seibel EJ, Aliseda A. Optimization Study of the Hemodynamics of Saline Flushing in Endoscopic Imaging of Chronic Total Occlusions (CTOs). Cardiovasc Eng Technol 2021; 12:541-555. [PMID: 34131832 DOI: 10.1007/s13239-021-00550-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE In this study, in vitro experiments and computational fluid dynamic (CFD) simulations are used to expand the understand of the physics of saline flushing of a blocked artery to enable optical imaging. This process involves saline injection, mixing with blood, and advection of the mixture away from the region of interest to provide a clear optical path for imaging. METHODS CFD simulations are used as a rapid turn-around tool for the evolutionary design process of an endovascular catheter that combines imaging forward-viewing element with saline flushing lumens. RESULTS A novel design and control technique is developed that provides the method to regulate the pressure in a blocked artery during saline flushing, so only small deviations from physiological pressure values are exerted on the damaged artery wall at any time, minimizing risk of rupture. In vitro experiments demonstrate the optical clearing process in phantoms simulating chronic total occlusions (CTOs) in coronary arteries with an opaque blood surrogate being removed by saline flushing. With the CFD compared by the experiments, parametric analyses of artery diameter and curvature, and flushing lumen diameter size were conducted to understand their impact on flushing times and pressures. Different plaque morphologies were studied to explore the feasibility of saline flushing in different CTO conditions. CONCLUSIONS A new catheter design is demonstrated to safely and effectively produce saline flushing, leading to a clear optical imaging field, and an improved technique is outlined that overcomes some practical challenges and limitations commonly encountered in angioscopy.
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Affiliation(s)
- Syed Faisal
- Mechanical Engineering Department, University of Washington, Seattle, USA
| | - Eric J Seibel
- Mechanical Engineering Department, University of Washington, Seattle, USA
| | - Alberto Aliseda
- Mechanical Engineering Department, University of Washington, Seattle, USA.
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14
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Chen J, Jiang Y, Chang TS, Joshi B, Zhou J, Rubenstein JH, Wamsteker EJ, Kwon RS, Appelman H, Beer DG, Turgeon DK, Seibel EJ, Wang TD. Multiplexed endoscopic imaging of Barrett's neoplasia using targeted fluorescent heptapeptides in a phase 1 proof-of-concept study. Gut 2021; 70:1010-1013. [PMID: 33028666 PMCID: PMC8108279 DOI: 10.1136/gutjnl-2020-322945] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Jing Chen
- Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Yang Jiang
- Biomedical Engineering, University of Washington, Seattle, WA, USA
| | - Tse-Shao Chang
- Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Bishnu Joshi
- Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Juan Zhou
- Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Erik J Wamsteker
- Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard S Kwon
- Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Henry Appelman
- Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - David G Beer
- Thoracic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Eric J Seibel
- Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Thomas D Wang
- Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA .,Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA.,Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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15
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Ding Y, Gudapati V, Lin R, Fei Y, Sevag Packard RR, Song S, Chang CC, Baek KI, Wang Z, Roustaei M, Kuang D, Jay Kuo CC, Hsiai TK. Saak Transform-Based Machine Learning for Light-Sheet Imaging of Cardiac Trabeculation. IEEE Trans Biomed Eng 2021; 68:225-235. [PMID: 32365015 PMCID: PMC7606319 DOI: 10.1109/tbme.2020.2991754] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Recent advances in light-sheet fluorescence microscopy (LSFM) enable 3-dimensional (3-D) imaging of cardiac architecture and mechanics in toto. However, segmentation of the cardiac trabecular network to quantify cardiac injury remains a challenge. METHODS We hereby employed "subspace approximation with augmented kernels (Saak) transform" for accurate and efficient quantification of the light-sheet image stacks following chemotherapy-treatment. We established a machine learning framework with augmented kernels based on the Karhunen-Loeve Transform (KLT) to preserve linearity and reversibility of rectification. RESULTS The Saak transform-based machine learning enhances computational efficiency and obviates iterative optimization of cost function needed for neural networks, minimizing the number of training datasets for segmentation in our scenario. The integration of forward and inverse Saak transforms can also serve as a light-weight module to filter adversarial perturbations and reconstruct estimated images, salvaging robustness of existing classification methods. The accuracy and robustness of the Saak transform are evident following the tests of dice similarity coefficients and various adversary perturbation algorithms, respectively. The addition of edge detection further allows for quantifying the surface area to volume ratio (SVR) of the myocardium in response to chemotherapy-induced cardiac remodeling. CONCLUSION The combination of Saak transform, random forest, and edge detection augments segmentation efficiency by 20-fold as compared to manual processing. SIGNIFICANCE This new methodology establishes a robust framework for post light-sheet imaging processing, and creating a data-driven machine learning for automated quantification of cardiac ultra-structure.
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Affiliation(s)
- Yichen Ding
- Henry Samueli School of Engineering and David Geffen School of Medicine, University of California, Los Angeles, CA 90095 USA
| | - Varun Gudapati
- Henry Samueli School of Engineering and David Geffen School of Medicine, University of California, Los Angeles, CA 90095 USA
| | - Ruiyuan Lin
- Ming-Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, CA 90089 USA
| | - Yanan Fei
- Ming-Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, CA 90089 USA
| | - René R Sevag Packard
- Henry Samueli School of Engineering and David Geffen School of Medicine, University of California, Los Angeles, CA 90095 USA
| | - Sibo Song
- Ming-Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, CA 90089 USA
| | - Chih-Chiang Chang
- Henry Samueli School of Engineering and David Geffen School of Medicine, University of California, Los Angeles, CA 90095 USA
| | - Kyung In Baek
- Henry Samueli School of Engineering and David Geffen School of Medicine, University of California, Los Angeles, CA 90095 USA
| | - Zhaoqiang Wang
- Henry Samueli School of Engineering and David Geffen School of Medicine, University of California, Los Angeles, CA 90095 USA
| | - Mehrdad Roustaei
- Henry Samueli School of Engineering and David Geffen School of Medicine, University of California, Los Angeles, CA 90095 USA
| | - Dengfeng Kuang
- Tianjin Key Laboratory of Optoelectronic Sensor and Sensing Network Technology, and Institute of Modern Optics, Nankai University, Tianjin 300350, China
| | - C.-C. Jay Kuo
- Ming-Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, CA 90089 USA
| | - Tzung K. Hsiai
- Henry Samueli School of Engineering and David Geffen School of Medicine, University of California, Los Angeles, CA 90095 USA
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Srinivasan VM, Lazaro TT, Srivatsan A, Cooper P, Phillips M, Garcia R, Chen SR, Johnson JN, Burkhardt JK, Collins DE, Kan P. Applications of a Novel Microangioscope for Neuroendovascular Intervention. AJNR Am J Neuroradiol 2020; 42:347-353. [PMID: 33361372 DOI: 10.3174/ajnr.a6900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Visualization in neuroendovascular intervention currently relies on biplanar fluoroscopy and contrast administration. With the advent of endoscopy, direct visualization of the intracranial intravascular space has become possible with microangioscopes. We analyzed the efficacy of our novel microangioscope to enable direct observation and inspection of the cerebrovasculature, complementary to a standard fluoroscopic technique. MATERIALS AND METHODS Iterations of microangioscopes were systematically evaluated for use in neurodiagnostics and neurointerventions in both live animal and human cadaveric models. Imaging quality, trackability, and navigability were assessed. Diagnostic procedures assessed included clot identification and differentiation, plaque identification, inspection for vessel wall injury, and assessment of stent apposition. Interventions performed included angioscope-assisted stent-retriever thrombectomy, clot aspiration, and coil embolization. RESULTS The microangioscope was found helpful in both diagnosis and interventions by independent evaluators. Mean ratings of the imaging quality on a 5-point scale ranged from 3.0 (clot identification) to 4.7 (Pipeline follow-up). Mean ratings for clinical utility ranged from 3.0 (aspiration thrombectomy) to 4.7 (aneurysm treatment by coil embolization and WEB device). CONCLUSIONS This fiber optic microangioscope can safely navigate and visualize the intravascular space in human cadaveric and in vivo animal models with satisfactory resolution. It has potential value in diagnostic and neurointerventional applications.
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Affiliation(s)
- V M Srinivasan
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - T T Lazaro
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - A Srivatsan
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - P Cooper
- Vena Medical (P.C., M.P.), Kitchener, Ontario, Canada
| | - M Phillips
- Vena Medical (P.C., M.P.), Kitchener, Ontario, Canada
| | - R Garcia
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - S R Chen
- Department of Interventional Radiology (S.R.C.), The MD Anderson Cancer Center, Houston, Texas
| | - J N Johnson
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - J-K Burkhardt
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
| | - D E Collins
- Center for Comparative Medicine (D.E.C.) Baylor College of Medicine, Houston, Texas
| | - P Kan
- From the Department of Neurosurgery (V.M.S., T.T.L., A.S., R.G., J.N.J., J.-K.B., P.K.)
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Xu W, Lin J, Gao M, Chen Y, Cao J, Pu J, Huang L, Zhao J, Qian K. Rapid Computer-Aided Diagnosis of Stroke by Serum Metabolic Fingerprint Based Multi-Modal Recognition. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2020; 7:2002021. [PMID: 33173737 PMCID: PMC7610260 DOI: 10.1002/advs.202002021] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/30/2020] [Indexed: 05/07/2023]
Abstract
Stroke is a leading cause of mortality and disability worldwide, expected to result in 61 million disability-adjusted life-years in 2020. Rapid diagnostics is the core of stroke management for early prevention and medical treatment. Serum metabolic fingerprints (SMFs) reflect underlying disease progression, predictive of patient phenotypes. Deep learning (DL) encoding SMFs with clinical indexes outperforms single biomarkers, while posing challenges with poor prediction to interpret by feature selection. Herein, rapid computer-aided diagnosis of stroke is performed using SMF based multi-modal recognition by DL, to combine adaptive machine learning with a novel feature selection approach. SMFs are extracted by nano-assisted laser desorption/ionization mass spectrometry (LDI MS), consuming 100 nL of serum in seconds. A multi-modal recognition is constructed by integrating SMFs and clinical indexes with an enhanced area under curve (AUC) up to 0.845 for stroke screening, compared to single-modal diagnosis by only SMFs or clinical indexes. The prediction of DL is addressed by selecting 20 key metabolite features with differential regulation through a saliency map approach, shedding light on the molecular mechanisms in stroke. The approach highlights the emerging role of DL in precision medicine and suggests an expanding utility for computational analysis of SMFs in stroke screening.
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Affiliation(s)
- Wei Xu
- State Key Laboratory for Oncogenes and Related GenesDivision of CardiologyRenji HospitalSchool of MedicineShanghai Jiao Tong University160 Pujian RoadShanghai200127P. R. China
- State Key Laboratory for Oncogenes and Related GenesSchool of Biomedical EngineeringShanghai Jiao Tong UniversityShanghai200030P. R. China
| | - Jixian Lin
- Department of NeurologyMinhang HospitalFudan University170 Xinsong RoadShanghai201199P. R. China
| | - Ming Gao
- School of Management Science and EngineeringDongbei University of Finance and EconomicsDalian116025P. R. China
- Center for Post‐doctoral Studies of Computer ScienceNortheastern UniversityShenyang110819P. R. China
| | - Yuhan Chen
- School of Management Science and EngineeringDongbei University of Finance and EconomicsDalian116025P. R. China
- Center for Post‐doctoral Studies of Computer ScienceNortheastern UniversityShenyang110819P. R. China
| | - Jing Cao
- State Key Laboratory for Oncogenes and Related GenesDivision of CardiologyRenji HospitalSchool of MedicineShanghai Jiao Tong University160 Pujian RoadShanghai200127P. R. China
- State Key Laboratory for Oncogenes and Related GenesSchool of Biomedical EngineeringShanghai Jiao Tong UniversityShanghai200030P. R. China
| | - Jun Pu
- State Key Laboratory for Oncogenes and Related GenesDivision of CardiologyRenji HospitalSchool of MedicineShanghai Jiao Tong University160 Pujian RoadShanghai200127P. R. China
- State Key Laboratory for Oncogenes and Related GenesSchool of Biomedical EngineeringShanghai Jiao Tong UniversityShanghai200030P. R. China
| | - Lin Huang
- Stem Cell Research CenterRenji HospitalSchool of MedicineShanghai Jiao Tong University160 Pujian RoadShanghai200127P. R. China
| | - Jing Zhao
- Department of NeurologyMinhang HospitalFudan University170 Xinsong RoadShanghai201199P. R. China
| | - Kun Qian
- State Key Laboratory for Oncogenes and Related GenesDivision of CardiologyRenji HospitalSchool of MedicineShanghai Jiao Tong University160 Pujian RoadShanghai200127P. R. China
- State Key Laboratory for Oncogenes and Related GenesSchool of Biomedical EngineeringShanghai Jiao Tong UniversityShanghai200030P. R. China
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Scharf E, Dremel J, Kuschmierz R, Czarske J. Video-rate lensless endoscope with self-calibration using wavefront shaping. OPTICS LETTERS 2020; 45:3629-3632. [PMID: 32630916 DOI: 10.1364/ol.394873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Lensless fiber endoscopes are of great importance for keyhole imaging. Coherent fiber bundles (CFB) can be used in endoscopes as remote phased arrays to capture images. One challenge is to image at high speed while correcting aberrations induced by the CFB. We propose the combination of digital optical phase conjugation, using a spatial light modulator, with fast scanning, for which a 2D galvo scanner and an adaptive lens are employed. We achieve the transmission of laser and image scanning through the CFB. Video-rate imaging at 20 Hz in 2D with subcellular resolution is demonstrated in 3D with 1 Hz. The sub-millimeter-diameter scanning endoscope has a great potential in biomedicine, for manipulation, e.g., in optogenetics, as well as in imaging.
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Zhou G, Lim ZH, Qi Y, Zhou G. Single-Pixel MEMS Imaging Systems. MICROMACHINES 2020; 11:E219. [PMID: 32093324 PMCID: PMC7074650 DOI: 10.3390/mi11020219] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/16/2022]
Abstract
Single-pixel imaging technology is an attractive technology considering the increasing demand of imagers that can operate in wavelengths where traditional cameras have limited efficiency. Meanwhile, the miniaturization of imaging systems is also desired to build affordable and portable devices for field applications. Therefore, single-pixel imaging systems based on microelectromechanical systems (MEMS) is an effective solution to develop truly miniaturized imagers, owing to their ability to integrate multiple functionalities within a small device. MEMS-based single-pixel imaging systems have mainly been explored in two research directions, namely the encoding-based approach and the scanning-based approach. The scanning method utilizes a variety of MEMS scanners to scan the target scenery and has potential applications in the biological imaging field. The encoding-based system typically employs MEMS modulators and a single-pixel detector to encode the light intensities of the scenery, and the images are constructed by harvesting the power of computational technology. This has the capability to capture non-visible images and 3D images. Thus, this review discusses the two approaches in detail, and their applications are also reviewed to evaluate the efficiency and advantages in various fields.
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Affiliation(s)
- Guangcan Zhou
- Micro and Nano Systems Initiative, Department of Mechanical Engineering, National University of Singapore, Singapore 117575, Singapore; (G.Z.); (Z.H.L.); (Y.Q.)
| | - Zi Heng Lim
- Micro and Nano Systems Initiative, Department of Mechanical Engineering, National University of Singapore, Singapore 117575, Singapore; (G.Z.); (Z.H.L.); (Y.Q.)
| | - Yi Qi
- Micro and Nano Systems Initiative, Department of Mechanical Engineering, National University of Singapore, Singapore 117575, Singapore; (G.Z.); (Z.H.L.); (Y.Q.)
| | - Guangya Zhou
- Micro and Nano Systems Initiative, Department of Mechanical Engineering, National University of Singapore, Singapore 117575, Singapore; (G.Z.); (Z.H.L.); (Y.Q.)
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Franchi F, Olthoff M, Krier J, Noble C, Al-Hijji M, Ramaswamy V, Witt T, Burke M, Benscoter M, Lerman A, Sandhu GS, Rodriguez-Porcel M. A Metabolic Intravascular Platform to Study FDG Uptake in Vascular Injury. Cardiovasc Eng Technol 2020; 11:328-336. [PMID: 32002814 DOI: 10.1007/s13239-020-00457-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Metabolic alterations underlie many pathophysiological conditions, and their understanding is critical for the development of novel therapies. Although the assessment of metabolic changes in vivo has been historically challenging, recent developments in molecular imaging have allowed us to study novel metabolic research concepts directly in the living subject, bringing us closer to patients. However, in many instances, there is need for sensors that are in close proximity to the organ under investigation, for example to study vascular metabolism. METHODS In this study, we developed and validated a metabolic detection platform directly in the living subject under an inflammatory condition. The signal collected by a scintillating fiber is amplified using a photomultiplier tube and decodified by an in-house tunable analysis platform. For in vivo testing, we based our experiments on the metabolic characteristics of macrophages, cells closely linked to inflammation and avid for glucose and its analog 18F-fluorodeoxyglucose (18F-FDG). The sensor was validated in New Zealand rabbits, in which inflammation was induced by either a) high cholesterol (HC) diet for 16 weeks or b) vascular balloon endothelial denudation followed by HC diet. RESULTS There was no difference in weight, hemodynamics, blood pressure, or heart rate between the groups. Vascular inflammation was detected by the metabolic sensor (Inflammation: 0.60 ± 0.03 AU vs. control: 0.48 ± 0.03 AU, p = 0.01), even though no significant inflammation/atherosclerosis was detected by intravascular ultrasound, underscoring the high sensitivity of the system. These findings were confirmed by the presence of macrophages on ex vivo aortic tissue staining. CONCLUSION In this study, we validated a tunable very sensitive metabolic sensor platform that can be used for the detection of vascular metabolism, such as inflammation. This sensor can be used not only for the detection of macrophage activity but, with alternative probes, it could allow the detection of other pathophysiological processes.
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Affiliation(s)
- F Franchi
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA.
| | - M Olthoff
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - J Krier
- Department of Physiology and Biomedical Engineering, Mayo Clinic School of Medicine Rochester, Rochester, MN, 55902, USA
| | - C Noble
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - M Al-Hijji
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - V Ramaswamy
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - T Witt
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - M Burke
- Division of Engineering, Mayo Clinic School of Medicine Rochester, Rochester, MN, 55902, USA
| | - M Benscoter
- Division of Engineering, Mayo Clinic School of Medicine Rochester, Rochester, MN, 55902, USA
| | - A Lerman
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - G S Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - M Rodriguez-Porcel
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic School of Medicine Rochester, Rochester, MN, 55902, USA
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Ye W, Chen Y, Tang W, Zhang N, Li Z, Liu Z, Yu B, Xu FJ. Reduction-Responsive Nucleic Acid Delivery Systems To Prevent In-Stent Restenosis in Rabbits. ACS APPLIED MATERIALS & INTERFACES 2019; 11:28307-28316. [PMID: 31356048 DOI: 10.1021/acsami.9b08544] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cardiovascular and cerebrovascular ischemic diseases seriously affect human health. Endovascular stent placement is an effective treatment but always leads to in-stent restenosis (ISR). Gene-eluting stent, which combines gene therapy with stent implantation, is a potential method to prevent ISR. In this study, an efficient gene-eluting stent was designed on the basis of one new nucleic acid delivery system to decrease the possibility of ISR. The reduction-responsive branched nucleic acid vector (SKP) with low cytotoxicity was first synthesized via ring-opening reaction. The impressive in vitro transfection performances of SKP were proved using luciferase reporter, enhanced green fluorescent protein plasmid, and vascular endothelial growth factor plasmid (pVEGF). Subsequently, SKP/pVEGF complexes were coated on the surfaces of pretreated clinical stents to construct gene-eluting stents (S-SKP/pVEGF). Antirestenosis performance of S-SKP/pVEGF was evaluated via implanting stents into rabbit aortas. S-SKP/pVEGF could lead to the localized upregulation of VEGF proteins, improve the progress of re-endothelialization, and inhibit the development of ISR in vivo. Such efficient pVEGF-eluting stent with responsive nucleic acid delivery systems is very promising to prevent in-stent restenosis of cerebrovascular diseases.
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Affiliation(s)
- Weijie Ye
- Department of Neurology , China-Japan Friendship Hospital , Beijing 100029 , China
| | - Yiming Chen
- Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Ministry of Education, Beijing Laboratory of Biomedical Materials , Beijing University of Chemical Technology , Beijing 100029 , China
| | - Wenxiong Tang
- Department of Neurology , China-Japan Friendship Hospital , Beijing 100029 , China
| | - Na Zhang
- Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Ministry of Education, Beijing Laboratory of Biomedical Materials , Beijing University of Chemical Technology , Beijing 100029 , China
| | - Zhonghao Li
- Department of Neurology , China-Japan Friendship Hospital , Beijing 100029 , China
| | - Zunjing Liu
- Department of Neurology , China-Japan Friendship Hospital , Beijing 100029 , China
| | - Bingran Yu
- Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Ministry of Education, Beijing Laboratory of Biomedical Materials , Beijing University of Chemical Technology , Beijing 100029 , China
| | - Fu-Jian Xu
- Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Ministry of Education, Beijing Laboratory of Biomedical Materials , Beijing University of Chemical Technology , Beijing 100029 , China
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22
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Lazaro T, Srinivasan VM, Cooper P, Phillips M, Garcia R, Chen SR, Johnson J, Collins DE, Kan P. A new set of eyes: development of a novel microangioscope for neurointerventional surgery. J Neurointerv Surg 2019; 11:1036-1039. [PMID: 30878951 DOI: 10.1136/neurintsurg-2018-014610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endovascular technological advances have revolutionized the field of neurovascular surgery and have become the mainstay of treatment for many cerebrovascular pathologies. Digital subtraction angiography (DSA) is the 'gold standard' for visualization of the vasculature and deployment of endovascular devices. Nonetheless, with recent technological advances in optics, angioscopy has emerged as a potentially important adjunct to DSA. Angioscopy can offer direct visualization of the intracranial vasculature, and direct observation and inspection of device deployment. However, previous iterations of this technology have not been sufficiently miniaturized or practical for modern neurointerventional practice. OBJECTIVE To describe the evolution, development, and design of a microangioscope that offers both high-quality direct visualization and the miniaturization necessary to navigate in the small intracranial vessels and provide examples of its potential applications in the diagnosis and treatment of cerebrovascular pathologies using an in vivo porcine model. METHODS In this proof-of-concept study we introduce a novel microangioscope, designed from coherent fiber bundle technology. The microangioscope is smaller than any previously described angioscope, at 1.7 F, while maintaining high-resolution images. A porcine model is used to demonstrate the resolution of the images in vivo. RESULTS Video recordings of the microangioscope show the versatility of the camera mounted on different microcatheters and its ability to navigate external carotid artery branches. The microangioscope is also shown to be able to resolve the subtle differences between red and white thrombi in a porcine model. CONCLUSION A new microangioscope, based on miniaturized fiber optic technology, offers a potentially revolutionary way to visualize the intracranial vascular space.
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Affiliation(s)
- Tyler Lazaro
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | | | | | - Robert Garcia
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Stephen R Chen
- Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Dalis E Collins
- Center for Comparative Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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23
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Pasarikovski CR, Cardinell J, Yang VXD. Perspective review on applications of optics in cerebral endovascular neurosurgery. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-7. [PMID: 30915784 PMCID: PMC6975230 DOI: 10.1117/1.jbo.24.3.030601] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/19/2019] [Indexed: 05/20/2023]
Abstract
Cerebral endovascular neurosurgery has transformed the way we manage cerebrovascular disease. Several landmark trials have demonstrated the effectiveness of endovascular techniques leading to continued technological development and applications for various diseases. The utilization of optical technologies and devices is already underway in the field of endovascular neurosurgery. We discuss the contemporary paradigms, challenges, and current optical applications for the most common cerebrovascular diseases: carotid atherosclerotic disease, cerebral aneurysms, intracranial atherosclerosis, and dural arteriovenous fistulas. We also describe needs-based opportunities for future optical applications, with the goal of providing researchers a sense of where we feel optical technologies could impact the way we manage cerebral disease.
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Affiliation(s)
- Christopher R. Pasarikovski
- University of Toronto, Division of Neurosurgery, Department of Surgery, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, NeuroVascular Clinic, Toronto, Ontario, Canada
| | - Jillian Cardinell
- Ryerson University, Bioengineering and Biophotonics Laboratory, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Division of Neurosurgery, Toronto, Ontario, Canada
| | - Victor X. D. Yang
- University of Toronto, Division of Neurosurgery, Department of Surgery, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, NeuroVascular Clinic, Toronto, Ontario, Canada
- Ryerson University, Bioengineering and Biophotonics Laboratory, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Division of Neurosurgery, Toronto, Ontario, Canada
- Address all correspondence to Victor X. D. Yang, E-mail:
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24
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An Electro-Thermal Actuation Method for Resonance Vibration of a Miniaturized Optical-Fiber Scanner for Future Scanning Fiber Endoscope Design. ACTUATORS 2019. [DOI: 10.3390/act8010021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Medical professionals increasingly rely on endoscopes to carry out many minimally invasive procedures on patients to safely examine, diagnose, and treat a large variety of conditions. However, their insertion tube diameter dictates which passages of the body they can be inserted into and, consequently, what organs they can access. For inaccessible areas and organs, patients often undergo invasive and risky procedures—diagnostic confirmation of peripheral lung nodules via transthoracic needle biopsy is one example from oncology. Hence, this work sets out to present an optical-fiber scanner for a scanning fiber endoscope design that has an insertion tube diameter of about 0.5 mm, small enough to be inserted into the smallest airways of the lung. To attain this goal, a novel approach based on resonance thermal excitation of a single-mode 0.01-mm-diameter fiber-optic cantilever oscillating at 2–4 kHz is proposed. The small size of the electro-thermal actuator enables miniaturization of the insertion tube. Lateral free-end deflection of the cantilever is used as a benchmark for evaluating performance. Experimental results show that the cantilever can achieve over 0.2 mm of displacement at its free end. The experimental results also support finite element simulation models which can be used for future design iterations of the endoscope.
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25
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MEMS Actuators for Optical Microendoscopy. MICROMACHINES 2019; 10:mi10020085. [PMID: 30682852 PMCID: PMC6412441 DOI: 10.3390/mi10020085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 01/21/2023]
Abstract
Growing demands for affordable, portable, and reliable optical microendoscopic imaging devices are attracting research institutes and industries to find new manufacturing methods. However, the integration of microscopic components into these subsystems is one of today's challenges in manufacturing and packaging. Together with this kind of miniaturization more and more functional parts have to be accommodated in ever smaller spaces. Therefore, solving this challenge with the use of microelectromechanical systems (MEMS) fabrication technology has opened the promising opportunities in enabling a wide variety of novel optical microendoscopy to be miniaturized. MEMS fabrication technology enables abilities to apply batch fabrication methods with high-precision and to include a wide variety of optical functionalities to the optical components. As a result, MEMS technology has enabled greater accessibility to advance optical microendoscopy technology to provide high-resolution and high-performance imaging matching with traditional table-top microscopy. In this review the latest advancements of MEMS actuators for optical microendoscopy will be discussed in detail.
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26
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García-Vázquez V, von Haxthausen F, Jäckle S, Schumann C, Kuhlemann I, Bouchagiar J, Höfer AC, Matysiak F, Hüttmann G, Goltz JP, Kleemann M, Ernst F, Horn M. Navigation and visualisation with HoloLens in endovascular aortic repair. Innov Surg Sci 2018; 3:167-177. [PMID: 31579781 PMCID: PMC6604581 DOI: 10.1515/iss-2018-2001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/29/2018] [Indexed: 01/30/2023] Open
Abstract
Introduction Endovascular aortic repair (EVAR) is a minimal-invasive technique that prevents life-threatening rupture in patients with aortic pathologies by implantation of an endoluminal stent graft. During the endovascular procedure, device navigation is currently performed by fluoroscopy in combination with digital subtraction angiography. This study presents the current iterative process of biomedical engineering within the disruptive interdisciplinary project Nav EVAR, which includes advanced navigation, image techniques and augmented reality with the aim of reducing side effects (namely radiation exposure and contrast agent administration) and optimising visualisation during EVAR procedures. This article describes the current prototype developed in this project and the experiments conducted to evaluate it. Methods The current approach of the Nav EVAR project is guiding EVAR interventions in real-time with an electromagnetic tracking system after attaching a sensor on the catheter tip and displaying this information on Microsoft HoloLens glasses. This augmented reality technology enables the visualisation of virtual objects superimposed on the real environment. These virtual objects include three-dimensional (3D) objects (namely 3D models of the skin and vascular structures) and two-dimensional (2D) objects [namely orthogonal views of computed tomography (CT) angiograms, 2D images of 3D vascular models, and 2D images of a new virtual angioscopy whose appearance of the vessel wall follows that shown in ex vivo and in vivo angioscopies]. Specific external markers were designed to be used as landmarks in the registration process to map the tracking data and radiological data into a common space. In addition, the use of real-time 3D ultrasound (US) is also under evaluation in the Nav EVAR project for guiding endovascular tools and updating navigation with intraoperative imaging. US volumes are streamed from the US system to HoloLens and visualised at a certain distance from the probe by tracking augmented reality markers. A human model torso that includes a 3D printed patient-specific aortic model was built to provide a realistic test environment for evaluation of technical components in the Nav EVAR project. The solutions presented in this study were tested by using an US training model and the aortic-aneurysm phantom. Results During the navigation of the catheter tip in the US training model, the 3D models of the phantom surface and vessels were visualised on HoloLens. In addition, a virtual angioscopy was also built from a CT scan of the aortic-aneurysm phantom. The external markers designed for this study were visible in the CT scan and the electromagnetically tracked pointer fitted in each marker hole. US volumes of the US training model were sent from the US system to HoloLens in order to display them, showing a latency of 259±86 ms (mean±standard deviation). Conclusion The Nav EVAR project tackles the problem of radiation exposure and contrast agent administration during EVAR interventions by using a multidisciplinary approach to guide the endovascular tools. Its current state presents several limitations such as the rigid alignment between preoperative data and the simulated patient. Nevertheless, the techniques shown in this study in combination with fibre Bragg gratings and optical coherence tomography are a promising approach to overcome the problems of EVAR interventions.
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Affiliation(s)
- Verónica García-Vázquez
- Institute for Robotics and Cognitive Systems, University of Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
| | - Felix von Haxthausen
- Institute for Robotics and Cognitive Systems, University of Lübeck, Lübeck, Germany
| | - Sonja Jäckle
- Fraunhofer MEVIS - Institute for Medical Image Computing, Lübeck, Germany
| | - Christian Schumann
- Fraunhofer MEVIS - Institute for Medical Image Computing, Bremen, Germany
| | - Ivo Kuhlemann
- Institute for Robotics and Cognitive Systems, University of Lübeck, Lübeck, Germany
| | - Juljan Bouchagiar
- Division of Vascular- and Endovascular Surgery, Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Anna-Catharina Höfer
- Division of Vascular- and Endovascular Surgery, Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Florian Matysiak
- Division of Vascular- and Endovascular Surgery, Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Gereon Hüttmann
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Jan Peter Goltz
- Division of Interventional Radiology, Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Markus Kleemann
- Division of Vascular- and Endovascular Surgery, Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Floris Ernst
- Institute for Robotics and Cognitive Systems, University of Lübeck, Lübeck, Germany
| | - Marco Horn
- Division of Vascular- and Endovascular Surgery, Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.,Vascular Unit, Department of Surgery, Prince of Wales Hospital, Sydney, Australia
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27
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Rajiv A, Zhou Y, Ridge J, Reinhall PG, Seibel EJ. Electromechanical Model-Based Design and Testing of Fiber Scanners for Endoscopy. J Med Device 2018. [DOI: 10.1115/1.4040271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Forward-viewing catheters and scopes for diagnosing disease and guiding interventions in small ducts (less than 3 mm diameter) require wide-field high-quality imaging since scope tip bending is difficult and ineffective. A high-fidelity electromechanically coupled finite element (FE) model of a piezoelectric actuated resonant fiber scanner is presented, which enables improvement on the general design of fiber-optic scanner geometry to increase scan frequency and field of view (FOV). Using the proposed model, parametric sweeps on the specific design variables achieved by acid etching of glass fiber are analyzed to identify their effect on scanner performance and to choose improved designs. The resulting complex fiber scanner design requires development of unique microfabrication techniques. Comparison of three model simulations and their experimental testing show that our proposed coupled model has prediction error of ≤12% with respect to experimental data, while other uncoupled models have up to 39% error. The model and microfabrication techniques presented in this paper have significance for fiber scanning-based systems in that they demonstrate reliability for model-driven design and also flexibility for fiber scanner design of complex geometries, allowing for improvement on medical imaging performance.
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Affiliation(s)
- Abhijith Rajiv
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA 98195 e-mail:
| | - Yaxuan Zhou
- Human Photonics Laboratory, Department of Electrical Engineering, University of Washington, Seattle, WA 98195 e-mail:
| | - Jeremy Ridge
- Human Photonics Laboratory, Department of Electrical Engineering, University of Washington, Seattle, WA 98195
| | - Per G. Reinhall
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195
| | - Eric J. Seibel
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA 98195 e-mail:
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28
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McVeigh PZ, Moloney T, Wilson BC, Wheatcroft M. High-Resolution Scanning Fiber Angioscopy as an Adjuvant to Fluoroscopy During Endovascular Interventions. J Endovasc Ther 2018; 25:617-623. [PMID: 30122139 DOI: 10.1177/1526602818794663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To demonstrate the feasibility and potential utility of high-resolution angioscopy during common endovascular interventions. METHODS A 3.7-F scanning fiber angioscope was used in 6 Yorkshire pigs to image branch vessel selection, subintimal dissection, wire snaring, and stent placement. The angioscope was introduced in a coaxial fashion within a standard 6-F guide catheter. A clear field of view was provided using continuous heparinized saline flush through the outer guide catheter. The flush flow rate was manually adjusted to provide clear imaging depending on the diameter of the vessel and local blood flow conditions. RESULTS The scanning fiber angioscope was compatible with off-the-shelf catheters and devices commonly used in peripheral and aortic interventions. Video-rate, high-resolution images were obtained during all the interventions tested and provided information that was complementary to simultaneously acquired fluoroscopy. The scanning fiber angioscope was able to detect subintimal dissection and branch vessel stent coverage with higher resolution than fluoroscopy alone. CONCLUSION Endoluminal imaging with the scanning fiber angioscope is feasible with current endovascular devices and provides additional relevant information that cannot be assessed fluoroscopically. The scanning fiber angioscope represents a novel optical platform on which new endovascular techniques may be developed that will minimize radiation and contrast doses for patients.
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Affiliation(s)
- Patrick Z McVeigh
- 1 Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,2 Department of Physics, Ryerson University, Toronto, Ontario, Canada.,3 Division of Vascular Surgery, St Michael's Hospital/University of Toronto, Toronto, Ontario, Canada
| | | | - Brian C Wilson
- 1 Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,5 Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Mark Wheatcroft
- 3 Division of Vascular Surgery, St Michael's Hospital/University of Toronto, Toronto, Ontario, Canada
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29
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Krstajić N, Mills B, Murray I, Marshall A, Norberg D, Craven TH, Emanuel P, Choudhary TR, Williams GOS, Scholefield E, Akram AR, Davie A, Hirani N, Bruce A, Moore A, Bradley M, Dhaliwal K. Low-cost high sensitivity pulsed endomicroscopy to visualize tricolor optical signatures. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-12. [PMID: 29992799 DOI: 10.1117/1.jbo.23.7.076005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/16/2018] [Indexed: 05/20/2023]
Abstract
A highly sensitive, modular three-color fluorescence endomicroscopy imaging platform spanning the visible to near-infrared (NIR) range is demonstrated. Light-emitting diodes (LEDs) were sequentially pulsed along with the camera acquisition to provide up to 20 frames per second (fps) three-color imaging performance or 60 fps single color imaging. The system was characterized for bacterial and cellular molecular imaging in ex vivo human lung tissue and for bacterial and indocyanine green imaging in ex vivo perfused sheep lungs. A practical method to reduce background tissue autofluorescence is also proposed. The platform was clinically translated into six patients with pulmonary disease to delineate healthy, cancerous, and fibrotic tissue autofluorescent structures. The instrument is the most broadband clinical endomicroscopy system developed to date (covering visible to the NIR, 500 to 900 nm) and demonstrates significant potential for future clinical utility due to its low cost and modular capability to suit a wide variety of molecular imaging applications.
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Affiliation(s)
- Nikola Krstajić
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
- University of Edinburgh, Institute for Integrated Micro and Nano Systems, School of Engineering, Edi, United Kingdom
- University of Dundee, School of Science and Engineering, Dundee, United Kingdom
| | - Bethany Mills
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
| | - Ian Murray
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
| | - Adam Marshall
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
| | - Dominic Norberg
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
| | - Thomas H Craven
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
| | - Philip Emanuel
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
| | - Tushar R Choudhary
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
- Heriot-Watt University, Institute of Biological Chemistry, Biophysics and Bioengineering, Edinburgh, United Kingdom
| | - Gareth O S Williams
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
| | - Emma Scholefield
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
| | - Ahsan R Akram
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
| | - Andrew Davie
- Royal Infirmary of Edinburgh, NHS Lothian, Department of Medical Physics, Edinburgh, United Kingdom
| | - Nik Hirani
- University of Edinburgh, Department of Respiratory Medicine, Edinburgh, United Kingdom
| | - Annya Bruce
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
| | - Anne Moore
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
| | - Mark Bradley
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
- University of Edinburgh, School of Chemistry, EaStChem, Edinburgh, United Kingdom
| | - Kevin Dhaliwal
- University of Edinburgh, Queen's Medical Research Institute, EPSRC IRC Hub in Optical Molecular Sens, United Kingdom
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30
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Molony C, McIntyre J, Maguire A, Hakimjavadi R, Burtenshaw D, Casey G, Di Luca M, Hennelly B, Byrne HJ, Cahill PA. Label-free discrimination analysis of de-differentiated vascular smooth muscle cells, mesenchymal stem cells and their vascular and osteogenic progeny using vibrational spectroscopy. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2018; 1865:343-353. [DOI: 10.1016/j.bbamcr.2017.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/13/2017] [Accepted: 11/10/2017] [Indexed: 01/09/2023]
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31
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Savastano LE, Seibel EJ. Scanning Fiber Angioscopy: A Multimodal Intravascular Imaging Platform for Carotid Atherosclerosis. Neurosurgery 2017; 64:188-198. [PMID: 28899060 DOI: 10.1093/neuros/nyx322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 08/01/2017] [Indexed: 01/28/2023] Open
Affiliation(s)
- Luis E Savastano
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Eric J Seibel
- Department of Mechanical Engineering, University of Washington, Seattle, Washington
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32
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Garcia-Garcia HM, Azizi V, Kajita AH. Cardiovascular devices: Potent angioscopy for weak plaques. Nat Biomed Eng 2017. [DOI: 10.1038/s41551-017-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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