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Zhou JJ, Alawneh Y, Sewani A, Keshavarz M, Tahmasebi M, Roy T, Kayssi A, Dueck A, Wright GA, Tavallaei MA. The CathPilot: Performance Validation and Preclinical Safety and Feasibility Assessment. IEEE Trans Biomed Eng 2023; 70:3116-3125. [PMID: 37195835 DOI: 10.1109/tbme.2023.3276199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVES Peripheral endovascular revascularization procedures often fail due to technical limitations of guidewire support, steering, and visualization. The novel CathPilot catheter aims to address these challenges. This study assesses the safety and feasibility of the CathPilot and compares its performance to conventional catheters for peripheral vascular interventions. METHODS The study compared the CathPilot to non-steerable and steerable catheters. The success rates and access times for a relevant target inside a tortuous vessel phantom model were assessed. The reachable workspace within the vessel and the guidewire's force delivery capabilities were also evaluated. To validate the technology, chronic total occlusion tissue samples were used ex vivo to compare crossing success rates with conventional catheters. Finally, in vivo experiments in a porcine aorta were conducted to evaluate safety and feasibility. RESULTS The success rates for reaching the set targets were 31%, 69%, and 100% with the non-steerable catheter, the steerable catheter, and the CathPilot, respectively. CathPilot had a significantly larger reachable workspace, and allowed for up to four times higher force delivery and pushability. In crossing of chronic total occlusion samples, the CathPilot achieved a success rate of 83% and 100%, for fresh and fixed lesions respectively, which was also significantly higher than conventional catheters. The device was fully functional in the in vivo study, and there were no signs of coagulation or damage to the vessel wall. CONCLUSION This study shows the safety and feasibility of the CathPilot system and its potential to reduce failure and complication rates in peripheral vascular interventions. The novel catheter outperformed conventional catheters in all defined metrics. This technology can potentially improve the success rate and outcome of peripheral endovascular revascularization procedures.
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Alawneh Y, Zhou JJ, Sewani A, Tahmasebi M, Roy TL, Kayssi A, Dueck AD, Wright GA, Tavallaei MA. Experimental Protocol and Phantom Design and Development for Performance Characterization of Conventional Devices for Peripheral Vascular Interventions. Ann Biomed Eng 2023:10.1007/s10439-023-03160-x. [PMID: 36808383 DOI: 10.1007/s10439-023-03160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023]
Abstract
Conventional catheter-based interventions for treating peripheral artery disease suffer high failure and complication rates. The mechanical interactions with the anatomy constrain catheter controllability, while their length and flexibility limit their pushability. Also, the 2D X-ray fluoroscopy guiding these procedures fails to provide sufficient feedback about the device location relative to the anatomy. Our study aims to quantify the performance of conventional non-steerable (NS) and steerable (S) catheters in phantom and ex vivo experiments. In a 10 mm diameter, 30 cm long artery phantom model, with four operators, we evaluated the success rate and crossing time in accessing 1.25 mm target channels, the accessible workspace, and the force delivered through each catheter. For clinical relevance, we evaluated the success rate and crossing time in crossing ex vivo chronic total occlusions. For the S and NS catheters, respectively, users successfully accessed 69 and 31% of the targets, 68 and 45% of the cross-sectional area, and could deliver 14.2 and 10.2 g of mean force. Using a NS catheter, users crossed 0.0 and 9.5% of the fixed and fresh lesions, respectively. Overall, we quantified the limitations of conventional catheters (navigation, reachable workspace, and pushability) for peripheral interventions; this can serve as a basis for comparison with other devices.
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Affiliation(s)
- Yara Alawneh
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - James J Zhou
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - Alykhan Sewani
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - Mohammadmahdi Tahmasebi
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada
| | - Trisha L Roy
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | - Ahmed Kayssi
- Department of Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Andrew D Dueck
- Department of Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Graham A Wright
- University of Toronto, Toronto, ON, Canada
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - M Ali Tavallaei
- Faculty of Engineering and Architectural Science, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON, Canada.
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.
- Department of ECBE, Toronto Metropolitan University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
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Beasley RE, Martin J. A commentary on “Factors contributing to efficient recanalization procedures for chronic total occlusion of the superficial femoral artery”. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 37:50-51. [DOI: 10.1016/j.carrev.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/03/2022]
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Tavallaei MA, Zhou JJ, Roy TL, Wright GA. Performance Assessment of a Radiofrequency Powered Guidewire for Crossing Peripheral Arterial Occlusions Based on Lesion Morphology. Ann Biomed Eng 2018; 46:940-946. [PMID: 29616386 DOI: 10.1007/s10439-018-2021-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
Abstract
Endovascular wires and devices for peripheral arterial disease therapy have evolved greatly, yet failure rates of these procedures remain high. Information on lesion composition may inform device selection to improve the success rates of these procedures. This paper, presents an approach for informed guidewire selection. The objective of this study is to quantitatively assess the performance of a radiofrequency powered guidewire in the crossing of various morphology types of peripheral chronic total occlusions. Samples taken from amputated patient limbs are characterized by magnetic resonance imaging. Using a customized catheter test station, the performance of a radiofrequency powered guidewire in puncturing these lesions is compared to a conventional guidewire, and to itself when not powered. The analysis includes quantitative and statistical comparisons of the puncture forces experienced by the different guidewires in "hard" vs. "soft" lesions as well as qualitative assessment of deflections, buckling and puncture success of the wires. Results indicate that the use of radiofrequency ablation significantly reduces the required puncture force, reduced events of buckling and deflection, and resulted in a significantly higher puncture success rate.
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Affiliation(s)
- Mohammad A Tavallaei
- Department of Medical Biophysics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. .,Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room M7 508, Toronto, ON, M4N 3M5, Canada.
| | - James J Zhou
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,University of Waterloo, Waterloo, ON, Canada
| | - Trisha L Roy
- Division of Vascular Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Graham A Wright
- Department of Medical Biophysics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Roy TL, Forbes TL, Dueck AD, Wright GA. MRI for peripheral artery disease: Introductory physics for vascular physicians. Vasc Med 2018. [DOI: 10.1177/1358863x18759826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Magnetic resonance imaging (MRI) has advanced significantly in the past decade and provides a safe and non-invasive method of evaluating peripheral artery disease (PAD), with and without using exogenous contrast agents. MRI offers a promising alternative for imaging patients but the complexity of MRI can make it less accessible for physicians to understand or use. This article provides a brief introduction to the technical principles of MRI for physicians who manage PAD patients. We discuss the basic principles of how MRI works and tailor the discussion to how MRI can evaluate anatomic characteristics of peripheral arterial lesions.
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Affiliation(s)
- Trisha L Roy
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andrew D Dueck
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Graham A Wright
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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Saab F, Jaff MR, Diaz-Sandoval LJ, Engen GD, McGoff TN, Adams G, Al-Dadah A, Goodney PP, Khawaja F, Mustapha JA. Chronic Total Occlusion Crossing Approach Based on Plaque Cap Morphology: The CTOP Classification. J Endovasc Ther 2018; 25:284-291. [DOI: 10.1177/1526602818759333] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: To present the chronic total occlusion (CTO) crossing approach based on plaque cap morphology (CTOP) classification system and assess its ability to predict successful lesion crossing. Methods: A retrospective analysis was conducted of imaging and procedure data from 114 consecutive symptomatic patients (mean age 69±11 years; 84 men) with claudication (Rutherford category 3) or critical limb ischemia (Rutherford category 4–6) who underwent endovascular interventions for 142 CTOs. CTO cap morphology was determined from a review of angiography and duplex ultrasonography and classified into 4 types (I, II, III, or IV) based on the concave or convex shape of the proximal and distal caps. Results: Statistically significant differences among groups were found in patients with rest pain, lesion length, and severe calcification. CTOP type II CTOs were most common and type III lesions the least common. Type I CTOs were most likely to be crossed antegrade and had a lower incidence of severe calcification. Type IV lesions were more likely to be crossed retrograde from a tibiopedal approach. CTOP type IV was least likely to be crossed in an antegrade fashion. Access conversion, or need for an alternate access, was commonly seen in types II, III, and IV lesions. Distinctive predictors of access conversion were CTO types II and III, lesion length, and severe calcification. Conclusion: CTOP type I lesions were easiest to cross in antegrade fashion and type IV the most difficult. Lesion length >10 cm, severe calcification, and CTO types II, III, and IV benefited from the addition of retrograde tibiopedal access.
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Affiliation(s)
- Fadi Saab
- Metro Health–University of Michigan Health, Wyoming, MI, USA
| | | | | | | | | | - George Adams
- University of North Carolina–Rex Healthcare, Raleigh, NC, USA
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