1125. Initial Clinical Experiences of a New Generation of X-Ray Detector Systems with High Definition (HiDef) Imaging Capabilities for Neurointervention Procedures

Authors: Swetadri Vasan Setlur Nagesh; Kunal Vakharia; Stephan Munich; Muhammad Waqas; Daniel Bednarek; Jason Davies; Kenneth Snyder; Maxim Mokin; Stephen Rudin; Elad Levy; Adnan Siddiqui (Buffalo, NY)

Introduction:

We present our initial clinical experiences with a new x-ray biplane angiography system from Canon Medical Systems Corp, having two resolution imaging modes: a large-Field-of-View (FOV), 194 µm pixel, flat-panel detector (FPD) mode as well as a new small–FOV, 76 µm high-resolution (HiDef) mode in one physical package, used during neurointervention treatment of aneurysms in 20 patients.

Methods:

During such interventional procedures, catheter systems are first guided to the aneurysm area using the large-FOV FPD. During the actual intervention, to better visualize the aneurysm region, the image acquisition is electronically switched to the high-resolution, magnified, smaller-FOV HiDef mode, during which treatment devices are deployed and DSA contrast injections for evaluation are done. Finally, the image acquisition mode is instantaneously switched back to the large-FOV FPD mode and the catheter systems are retrieved. The new imaging system was used for treatment using flow diverter stent, stent assisted coiling and primary coiling techniques.

Post procedure a Likert scale was used to collect a physician survey about the improvement in visualization of devices and aneurysm region under HiDef mode.

Results:

The new HiDef system was easily incorporated into clinical practice and preliminary feedback was that the improved visualization of the devices made deployment quicker and more accurate including critical visualization of the changes in stent structure.  For coil deployments, visualization of the coil at the distal tip of the micro-catheter and the coil detachment zones and visualization of secondary coil deployments was better appreciated. Survey results indicate that compared to the regular resolution FPD mode,  clinicians strongly agree that the visualization of the devices and the aneurysm treatment area is improved with the new HiDef mode.

Conclusion:

The new detector biplane angiography system was successfully used during clinical procedures showing promise to improve the accuracy for neurointervention procedures.