Carbon Dioxide Column Angioscopy: A New Endovascular Imaging Technique
László Miskolczia,
James D. Flahertya,
Lee R. Gutermana and
L. Nelson Hopkinsa
a From the Department of Neurosurgery (L.M.) and the Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences (J.D.F., L.R.G., L.N.H.), University at Buffalo, State University of New York.
View larger version (82K):
[in a new window]
|
FIG 1. Principles of the technique.
A, After predicting the appearance of a periodic comet, Sir Edmund Halley, in 1716, proposed that a diving bell could provide a pressurized compartment for deep-sea exploration. Air could not escape because the bell was closed at the top and sides. Water could not enter at the open bottom because buoyant air was trapped inside the bell, forming a stable chamber.
B, Our device traps a small column of CO2 in an artery by blocking proximal blood flow with a balloon and by positioning the target artery subhorizontally. The injected gas evacuates blood and buoys itself against the balloon.
C, The column of CO2, a negative contrast medium, is visible at fluoroscopy (arrows).
| |
View larger version (63K):
[in a new window]
|
FIG 2. Experimentally induced arterial occlusion.
A, The occlusion, with a helical platinum coil (arrow), is clearly depicted as a thrombus (double arrows) at angioscopy.
B, Line diagram of image in A.
| |
View larger version (62K):
[in a new window]
|
FIG 3. Stent deployment.
A, A self-expanding nitinol stent (Integra; Boston Scientific/SCIMED) was deployed in the carotid artery. Angioscopic image of the CO2 column shows each stent filament in detail (arrows) and confirms the stent was successfully deployed into the arterial wall.
B, Line diagram of image in A.
| |
View larger version (56K):
[in a new window]
|
FIG 4. GDC placement.
A, Several GDCs were used to pack an experimental venous pouch aneurysm grafted to the side of the carotid arterial wall. One month later, an angioscopic image shows the protruding coils (arrows), which have a transparent endothelial covering.
B, Line diagram of image in A.
| |
View larger version (53K):
[in a new window]
|
FIG 5. Depiction of the intimal flap.
A, Angioscopic image shows the intimal flap (arrow) that was not visible at DSA or intravascular sonography.
B, Line diagram of image in A.
| |
