Purpose:A prototype steerable catheter was designed for endovascular procedures. This technical pilot study reports the initial experience using the catheter for cannulation of visceral arteries.Technique:The 7F catheter was manually steerable with operator control handle for bending and rotation of the tip. The maximum bending angle was approximately 90° and full 360° rotation of the tip was supported. The study involved 1 pig with 4 designated target arteries: the left and right renal arteries, the superior mesenteric artery, and the celiac trunk. Fluoroscopy with 3-dimensional (3D) overlay showing the ostia from preoperative computed tomography angiography was used for image guidance. The cannulation was considered successful if the guidewire was placed well inside the target artery. In addition to evaluating cannulation success, procedure time and associated radiation doses were recorded. The procedure was performed twice with 2 different operators.Conclusions:Both operators successfully reached all 4 target arteries, demonstrating the feasibility of the steerable catheter for endovascular cannulation of visceral arteries. No contrast medium was used, and median radiation dose was 4.5 mGy per cannulation. An average of approximately 2 minutes was used per cannulation. This study motivates further testing in a more comprehensive study to evaluate reproducibility in several animals and with inclusion of more operators. Further development by integrating the new catheter tool in a navigation system is also an interesting next step, combining fine control of catheter tip movements and 3D image guidance without ionizing radiation.
Purpose: Cannulation of visceral vessels is necessary during fenestrated and branched endovascular aortic repair. In an attempt to reduce the associated radiation and contrast dose, an electromagnetically (EM) trackable and manually steerable catheter has been developed. The purpose of this preclinical swine study was to evaluate the cannulation performance and compare the cannulation performance using either EM tracking or image fusion as navigation tools. Materials and Methods: Both renal arteries, the superior mesenteric artery, and the celiac trunk were attempted to be cannulated using a 7F steerable, EM trackable catheter in 3 pigs. Seven operators attempted cannulation using first 3-dimensional (3D) image navigation with EM tracking and then conventional image fusion guidance. The rate of successful cannulation was recorded, as well as procedure time and radiation exposure. Due to the lack of an EM trackable guidewire, cannulations that required more than 1 attempt were attempted only with image fusion. The EM tracking position data were registered to preoperative 3D images using a vessel-based registration algorithm. Results: A total of 72 cannulations were attempted with both methods, and 79% (57) were successful on the first attempt for both techniques. There was no difference in cannulation rate (p=1), and time-use was similar. Successful cannulation with image fusion was achieved in 97% of cases when multiple attempts were allowed. Conclusion: This study demonstrated the feasibility of a steerable and EM trackable catheter with 3D image navigation. Navigation performance with EM tracking was similar to image fusion, without statistically significant differences in cannulation rates and procedure times. Further studies are needed to demonstrate this utility in patients with aortic disease. Clinical Impact Electromagnetic tracking in combination with a novel steerable catheter reduces radiation and contrast media doses while providing three-dimensional visualization and agile navigation during endovascular aortic procedures.
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