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Updated: Feb 23, 2026
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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
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3D Image Fusion to Localise Intercostal Arteries During TEVAR
G Koutouzi1, C Sandström1, P Skoog2
1Institute of Clinical Sciences, Department of Radiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
EJVES Short Reports
|September 1, 2017
Summary
This study introduces a 3D image fusion technique to precisely locate intercostal arteries during thoracic endovascular aortic repair (TEVAR). This method aids in preserving these vital arteries, significantly reducing the risk of spinal cord ischemia after surgery.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Interventional Cardiology
Background:
- Preserving intercostal arteries during thoracic aortic procedures is crucial for preventing post-operative paraparesis.
- Pre-operative computed tomography angiography (CTA) visualizes intercostal artery origins, but intra-operative visualization is often limited.
Purpose of the Study:
- To present a novel 3D image fusion technique for the intra-operative localization of intercostal arteries during thoracic endovascular aortic repair (TEVAR).
Main Methods:
- Pre-operative CTA images were used to identify and mark intercostal artery origins.
- 3D/3D image fusion combined pre-operative CTA with intra-operative cone-beam CT (CBCT).
- Markings were overlaid onto live fluoroscopy for guidance, with adjustments made based on digital subtraction angiography (DSA).
Main Results:
- 3D image fusion was successfully implemented in all seven patients.
- Post-procedure CTAs confirmed the patency of all preserved intercostal arteries.
- No patients experienced spinal cord ischemia post-operatively.
Conclusions:
- 3D image fusion is a feasible technique for intra-operative intercostal artery localization during TEVAR.
- This approach can facilitate the preservation of intercostal arteries, thereby reducing the risk of post-operative spinal cord ischemia.
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