Extra & Intravascular Ultrasound (E&IVUS) Guided Intervention for Femoropopliteal Arterial Occlusive Lesions.

Background: Intravascular ultrasound (IVUS) shows vascular structures and positions of interventional devices in cross sectional-short axis to support interventions, especially for complex lesions. On the other hand, extravascular ultrasound (EVUS) visualizes the devices and vessel structures in long and short axis and reduces the radiation exposure by avoiding the use of fluoroscopy during guidewire manipulation. The images obtained from EVUS handling to guide the guidewire manipulation in both long and short axis is more difficult, time consuming, and stressful than IVUS, which is in short axis only. To solve this issue, we propose a novel guidewire crossing method in conjunctive with the use of both modalities, named “extra and intravascular ultrasound (E&IVUS)” guided intervention.Main text: This is the first report of a combined use of EVUS and IVUS for femoropopliteal occlusions. EVUS-guided intervention is mandatory to check the position of the device in long and short axis. However, the images of long axis are sometimes different from the original ones when EVUS is required to image from the short axis to the long axis. E&IVUS allows to dedicate EVUS to acquisition of the long axis and IVUS to the short axis view when confirming the device position. As a result, E&IVUS shortens the operation time and reduces the stress due to the manipulation of the probe to switch from the long to short axis image and vice versa. Moreover, we can accurately manipulate the guidewire to perform intimal tracking according to the information of EVUS long axis and the IVUS short axis images. Case involved a 76-year-old female with right superficial femoral artery occlusion was angiographically contrasted from a contralateral 6-Fr sheath. A hard wire supported with an over-the-wire typed IVUS was advanced into the CTO with EVUS and IVUS to confirm their positions until the guidewire crossing. We repeatedly performed this process, and all intimal tracking succeeded. The drug-coating balloons appropriately sized by IVUS measurement were deployed. Finally, a sufficient blood flow was achieved without complications.Conclusions: E&IVUS is a preferred strategy than using EVUS or IVUS alone. We should evaluate the clinical outcomes of this technique.

Abstract 1122‐000141: Initial Experience of Using a Large‐Bore (0.096” Inner Diameter) Access Catheter in Neurovascular Interventions

Introduction : Larger‐bore access catheters can improve endovascular therapy by facilitating delivery of interventional devices and reducing the number of exchange maneuvers needed. Advances in technology have allowed for the manufacture of larger‐bore access catheters that maintain necessary performance characteristics, such as a stiffer proximal segment for stability and a flexible distal segment for vessel catheterization. The purpose of this study was to report our initial experience of using a large‐bore (0.096” inner diameter) access catheter in neurovascular interventions. Methods : Data were prospectively collected from 7 sites in the US for procedures performed using a large‐bore (0.096” inner diameter) access catheter from January 15, 2020, to April 21, 2021. Effectiveness outcome was technical success, defined as successful access to the target vessel. Safety outcomes were access‐related and device‐related related complications. Results : One hundred and fourteen patients were included in this study (Table). The mean age of the patients was 67.6 years (SD 16.1), and about half (49.6%, 56/113) were female. The most common treatment conditions were stroke, 64 (56.1%); aneurysm, 24 (21.1%); carotid atherosclerosis, 19 (16.7%); and intracranial atherosclerosis, 3 (2.6%). Most approaches were by the femoral (66.4%, 73/110) or radial (33.6%, 37/110) artery and the most common target vessels were the left (49.1%, 55/112) or right (42.9%, 48/112) carotid artery. Anatomic variations included severe vessel tortuosity (32.1%, 26/81), type 2 aortic arch (19.3%, 17/88), type 3 aortic arch (15.9%, 14/88), bovine arch (15.4%, 16/104), severe angle (<30°) between the subclavian and target vessel (14.9%, 11/74), and subclavian loop (8.9%, 7/79). The median access time to branch was 18 minutes (IQR 11–28, N = 75). The most common treatments were mechanical thrombectomy, 51 (44.7%); stenting, 25 (21.9%); Pipeline/flow diversion, 10 (8.8%); and stent‐assisted coiling, 8 (7.0%). Technical success was achieved in most (94.7%, 108/114) patients. Access site complications occurred in 3 patients (2.6%). Two complications (1.8%) were related to the large‐bore access catheter. Conclusions : A large‐bore (0.096” inner diameter) access catheter could be used with both femoral and radial arterial approaches, had a high technical success rate, and had a low rate of periprocedural complications.

Uncommon Iatrogenic Devices Seen on Chest Radiographs

Chest radiograph (CXR) is the most common imaging performed for both inpatients and outpatients. With advances in medicine and technology, newer devices/prosthesis are being used in the treatment of cardiothoracic conditions. Some of these are common while others are seen only in a handful of cases, especially in patients being treated or referred from tertiary care centers. It is important to know about these devices, their functionality, and radiographic appearances. Many of these devices also help us in understanding the clinical condition of the patient, as some are only used in unstable patients. Newer methods of life support are now available in intensive care units and these also can be seen on CXRs. In this review, we present various iatrogenic devices that we come across on a CXR and highlight important features to determine their correct placement and potential complications. The review looks at cardiac temporary and permanent pacing devices, cardiac interventional devices used to treat congenital heart disease, newer cardiac monitoring devices, and unusual surgical devices that one may come across on a CXR. We also suggest a stepwise algorithm to assess these devices on a CXR.

Intestinal Ischemia Mirrors Cardiac Angina- A Case Report

Chronic mesenteric ischemia (intestinal angina) is a condition that is caused by stenosis or occlusion of the mesenteric arteries (Superior mesenteric artery, inferior mesenteric artery and celiac artery) and usually manifest as abdominal pain which is usually post - prandial in nature. If plaque or lesion in an artery supplying the intestines narrows the vessel so severely that sluggish blood flow causes a clot, blood flow through that artery can become completely blocked, which can lead to ischemia .While surgical revascularization has been the standard treatment for symptomatic patients in past , recent advances in interventional devices and techniques have made endovascular treatment easily available and effective treatment. Endovascular treatment is considered as minimally invasive means of obtaining good long-term results. The Coronary arteries are common hiding places for cholesterol-filled plaque and blood clots. Plaque can limit blood flow during exercise or stress, causing the chest pain or pressure known as angina. Clots may completely block blood flow, causing a heart attack or cardiac arrest. These two leading perpetrators can do similar things elsewhere in the body. When they interfere with blood flow to the digestive system, the effects can range from a stomach ache after every meal to a life threatening emergency. We report a similar case who present with unstable angina. During hospitalization he was having persistent abdominal pain and who was investigated with CT abdomen and later Angioplasty was done which further showed significant benefit to patient.

Modelling and manufacturing of 3D-printed, patient-specific, and anthropomorphic gastric phantoms: a pilot study

Interventional devices including intragastric balloons are widely used to treat obesity. This study aims to develop 3D-printed, patient-specific, and anthropomorphic gastric phantoms with mechanical properties similar to those of human stomach. Using computed tomography gastrography (CTG) images of three patients, gastric phantoms were modelled through shape registration to align the stomach shapes of three different phases. Shape accuracies of the original gastric models versus the 3D-printed phantoms were compared using landmark distances. The mechanical properties (elongation and tensile strength), number of silicone coatings (0, 2, and 8 times), and specimen hardness (50, 60, and 70 Shore A) of three materials (Agilus, Elastic, and Flexa) were evaluated. Registration accuracy was significantly lower between the arterial and portal phases (3.16 ± 0.80 mm) than that between the portal and delayed phases (8.92 ± 0.96 mm). The mean shape accuracy difference was less than 10 mm. The mean elongations and tensile strengths of the Agilus, Elastic, and Flexa were 264%, 145%, and 146% and 1.14, 1.59, and 2.15 MPa, respectively, and their mechanical properties differed significantly (all p < 0.05). Elongation and tensile strength assessments, CTG image registration and 3D printing resulted in highly realistic and patient-specific gastric phantoms with reasonable shape accuracies.

Integration of Acoustic Emission and Ultrasound for Needle Guidance in Interventional Procedures

Challenges like interrupted visualization and artifacts are common during interventional surgery while guiding medical interventional devices (MIDs) such as needles, catheters, etc. This proclaims the need of efficient accessories for improving simultaneous targeting and visualization of MIDs during interventional surgeries. Diagnostic devices are often used, but only visual perception is not enough due to image-related shortcomings. This article proposes a novel approach that reads audio signals via microphone attached to the proximal end of a biopsy needle to support verification and tracking during a surgery. A needle tracking algorithm was also integrated for visual support of intervention. The algorithm acquires the audio signal due to tissue-needle interaction and simultaneously detects the needle in the ultrasound frames using progressive regional properties. The proposed combination has ability to solve problems related to MID localization during interventional procedures, where it is crucial to maintain information flow for verification and target location.