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

Abstract

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 194µm pixel conventional flat-panel detector (FPD) mode and a 76µm 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. 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. 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. 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.