Use of the Microangiographic Fluoroscope for Coiling of Intracranial Aneurysms

Abstract

BACKGROUND Neurointervention is an ever-evolving specialty with tools including microcatheters, microwires, and coils that allow treatment of pathological conditions in increasingly smaller intracranial arteries, requiring increasing accuracy. As endovascular tools evolve, so too should the imaging. OBJECTIVE To detail the use of microangiography performed with a novel fluoroscope during coiling of intracranial aneurysms in 2 separate patients and discuss the benefits and potential limitations of the technology. METHODS The microangiographic fluoroscope (MAF) is an ultra high-resolution x-ray detector with superior resolution over a small field of view. The MAF can be incorporated into a standard angiographic C-arm system for use during endovascular procedures. RESULTS The MAF was useful for improved visualization during endovascular coiling of 2 unruptured intracranial aneurysms, without adding significant time to the procedure. No significant residual aneurysm filling was identified post-coiling, and no complications occurred. CONCLUSION The MAF is a high-resolution detector developed for use in neurointerventional cases in which superior image quality over a small field of view is required. It has been used with success for coiling of 2 unruptured aneurysms at our institution. It shows promise as an important tool in improving the accuracy with which neurointerventionists can perform certain intracranial procedures.

Endovascular coil embolization of a very small ruptured aneurysm using a novel microangiographic technique: technical note

“…Microangiography represents one of the newest tools in our imaging armamentarium. Compared with a standard fluoroscope, the MAF provides a much higher image resolution in a small field, enabling superior road map navigation, and is ideal for aneurysm catheterization and coiling 7. In the case presented here, the resolution achieved allowed us to see the coils and the microcatheter tip in extreme detail, allowing a much better appreciation of microcatheter and coil behavior in and around the aneurysm for safe deployment of coils in a very small space.…”

General Considerations for Neurointerventional Procedures

“…This technique has pixels sizes of 35 m m and is capable of imaging up to 30 frames per second, compared to traditional fl at panel detectors, which have pixel sizes of 194 m m or larger. 111,112 Magnetically guided angiography, currently available at some centers, uses extracranial magnets to help catheter and wire navigation. 113,114 This technology offers the potential to permit more precise intravascular navigation while shortening fl uoroscopy and procedure times.…”

Evaluation of the microangiographic fluoroscope (MAF) using generalized system performance metrics

“…During initial clinical tests, the MAF has demonstrated the potential to fulfill a need in neurovascular imaging for substantially higher resolution. 12,13 It is therefore, important to evaluate and objectively compare both detectors as part of a total imaging system to determine quantitatively how much image quality improvement might be realized with the MAF as well as what compromises might be required.…”