TH‐C‐210A‐03: X‐Ray Based Imaging in Neurovascular Intervention — Requirements and Challenges

Abstract

In the US, 795,000 people are expected to have a new or recurrent stroke in 2009. Ischemic stroke, which accounts for more than 80% of all strokes, carries a severe toll being the 3rd cause of death and the leading cause of disability. The cost of stroke, both direct and indirect, will exceed $60 billion this year alone. Hemorrhagic stroke on the other hand originates from rupture of brain aneurysms, which cause the vast majority of subarachnoid hemorrhage, a devastating medical emergency that affects more than 30,000 Americans each year and causes substantial disability and death.As in the coronary and peripheral vascular system, surgical treatment and medical management is progressively replaced by minimally invasive endovascular treatment. In recent years we have witnessed a rapid advancement in stent and stent‐like technology. Stents do not only serve for a combined intra‐ and extrasaccular treatment of challenging aneurysms, but assist the revascularization in acute and chronic ischemic conditions of the neurovascular system. In the Neuroangiography Suite x‐ray based imaging for guidance of devices and for monitoring brain perfusion during the intervention has experienced a quantum leap. Replacement of Image Intensifiers (II) with Flat Panel Detectors (FD) has enabled to increase the rotational speed of the system and its use as cone beam CT. Today angiography techniques do not only serve to characterize local flow alterations induced by vessel implants, but also study brain perfusion prior and during revascularization maneuvers. Detailed information of vascular structures is provided in conjunction with the surrounding brain tissue and vessel wall. Imaging of temporary or permanent implants is available with high resolution that is vital for a precise placement, treatment efficacy and patient safety.