Background Endovascular technological advances have revolutionized the field of neurovascular surgery and have become the mainstay of treatment for many cerebrovascular pathologies. Digital subtraction angiography (DSA) is the ’gold standard' for visualization of the vasculature and deployment of endovascular devices. Nonetheless, with recent technological advances in optics, angioscopy has emerged as a potentially important adjunct to DSA. Angioscopy can offer direct visualization of the intracranial vasculature, and direct observation and inspection of device deployment. However, previous iterations of this technology have not been sufficiently miniaturized or practical for modern neurointerventional practice.
Objective To describe the evolution, development, and design of a microangioscope that offers both high-quality direct visualization and the miniaturization necessary to navigate in the small intracranial vessels and provide examples of its potential applications in the diagnosis and treatment of cerebrovascular pathologies using an in vivo porcine model.
Methods In this proof-of-concept study we introduce a novel microangioscope, designed from coherent fiber bundle technology. The microangioscope is smaller than any previously described angioscope, at 1.7 F, while maintaining high-resolution images. A porcine model is used to demonstrate the resolution of the images in vivo.
Results Video recordings of the microangioscope show the versatility of the camera mounted on different microcatheters and its ability to navigate external carotid artery branches. The microangioscope is also shown to be able to resolve the subtle differences between red and white thrombi in a porcine model.
Conclusion A new microangioscope, based on miniaturized fiber optic technology, offers a potentially revolutionary way to visualize the intracranial vascular space.
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Contributors Conception and design: VMS, PK. Acquisition of data: TL, VMS, PC, MP, RG, SRC, JJ, DEC, PK. Analysis and interpretation of data: TL, VMS, PC, MP, RG, SRC, JJ, DEC, PK. Drafting the article: TL, VMS, PC, MP, DEC, PK. Critically revising the article: all authors. Reviewed the submitted version of the manuscript: all authors. Study supervision: PK. Guarantor: TL.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests PC and MP are employees of VenaMed, the company that developed the technology and main device discussed in this work. PK owns common stock in VenaMed.
Ethics approval Institutional Animal Care and Use Committee at Baylor College of Medicine.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Not required.