High-Definition Zoom Mode: A High Resolution X-ray Microscope for Neurointerventional Treatment Procedures

J Neuroimaging. 2019 Sep;29(5):565-572. doi: 10.1111/jon.12652. Epub 2019 Jul 24.

Abstract

Background and purpose: Visualization of structural details of treatment devices during neurointerventional procedures can be challenging. A new true two-resolution imaging X-ray detector system features a 194 µm pixel conventional flat-panel detector (FPD) mode and a 76 µm pixel high-resolution high-definition (Hi-Def) zoom mode in one detector panel. The Hi-Def zoom mode was developed for use in interventional procedures requiring superior image quality over a small field of view (FOV). We report successful use of this imaging system during intracranial aneurysm treatment in 1 patient with a Pipeline-embolization device and 1 patient with a low-profile visualized intramural support (LVIS Blue) device plus adjunctive coiling.

Methods: A guide catheter was advanced from the femoral artery insertion site to the proximity of each lesion using standard FPD mode. Under magnified small FOV Hi-Def imaging mode, an intermediate catheter and microcatheters were guided to the treatment site, and the PED and LVIS Blue plus coils were deployed. Radiation doses were tracked intraprocedurally.

Results: Critical details, including structural changes in the PED and LVIS Blue and position and movement of the microcatheter tip within the coil mass, were more readily apparent in Hi-Def mode. Skin-dose mapping indicated that Hi-Def mode limited radiation exposure to the smaller FOV of the treatment area.

Conclusions: Visualization of device structures was much improved in the high-resolution Hi-Def mode, leading to easier, more controlled deployment of stents and coils than conventional FPD mode.

Keywords: aneurysms; coils; flat-panel mode; flow-diversion devices; high-definition mode.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Blood Vessel Prosthesis*
  • Embolization, Therapeutic / methods
  • Endovascular Procedures / methods
  • Female
  • Humans
  • Intracranial Aneurysm / therapy*
  • Male
  • Middle Aged
  • Neurosurgical Procedures
  • Stents*
  • Treatment Outcome
  • X-Rays