Novel radiation-sparing imaging techniques in transcarotid stenting

Area of Science:

• Vascular Surgery
• Medical Imaging
• Interventional Radiology

Background:

• Transcarotid artery revascularization (TCAR) is a growing procedure for carotid artery disease.
• Current TCAR relies heavily on fluoroscopy, posing radiation exposure risks to patients and staff.
• There is a need for alternative imaging modalities to reduce radiation in TCAR.

Purpose of the Study:

• To review existing literature on alternative and adjunct imaging methods for carotid stenting.
• To assess the feasibility and adoption of ultrasound-guided techniques in vascular procedures.
• To introduce a novel ultrasound-guided TCAR technique using image registration technology.

Main Methods:

• Literature review of alternative imaging in carotid stenting (CTA, MRA fusion, ultrasound-assisted).
• Review of ultrasound guidance in other vascular interventions (IVC filters, EVAR, peripheral stenting).
• Development and exploration of a novel technique fusing preoperative CT angiography with live ultrasound for TCAR.

Main Results:

• Previous alternative methods showed technical success but limited adoption.
• Ultrasound guidance is feasible in various vascular beds but requires usability improvements.
• The novel fusion technology demonstrated potential to reduce uncertainty in real-time ultrasound guidance for TCAR.

Conclusions:

• Alternative imaging methods for TCAR have not achieved widespread adoption.
• Ultrasound guidance is a promising adjunct for vascular procedures, but requires refinement.
• Novel image registration technology offers a potential solution for improving ultrasound-guided TCAR and reducing radiation exposure.