SYSTEM AND METHOD FOR INTRAOPERATIVE GUIDANCE OF STENT PLACEMENT DURING ENDOVASCULAR INTERVENTIONS

• US 20090088830A1
• Filed: 02/15/2008
• Published: 04/02/2009
• Est. Priority Date: 02/15/2007
• Status: Active Grant

• Current Assignee: Siemens Healthineers AG (Siemens AG)
• Original Assignee: Siemens Corporate Research Incorporated (Siemens AG)
• Inventors: Mohamed, Ashraf, Xu, Chenyang, Pfister, Marcus, Sauer, Frank, Hall, Andrew F., Klingenbeck-Regn, Klaus
• Granted Patent: US 8,060,186 B2
• Time in Patent Office: Days
• US Class Current: 623/1.110
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/108 Computer aided selection or customisation of medical implants or cutting guides
• CPC Class Codes: A61B 2090/365 augmented reality, i.e. correlating a live optical image with another image
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 6/4423 related to hygiene or sterilisation
• CPC Class Codes: A61B 6/487 involving fluoroscopy
• CPC Class Codes: A61B 6/504 for diagnosis of blood vessels, e.g. by angiography
• CPC Class Codes: A61F 2/91 made from perforated sheet material or tubes, e.g. perforated by laser cuts or etched holes
• CPC Class Codes: A61F 2250/0067 Means for introducing or releasing pharmaceutical products into the body
• CPC Class Codes: A61F 2310/0097 Coating or prosthesis-covering structure made of pharmaceutical products, e.g. antibiotics
• CPC Class Codes: G06T 19/006 Mixed reality object pose determination, tracking or camera calibration for mixed reality G06T7/00
• CPC Class Codes: G06T 2207/10121 Fluoroscopy
• CPC Class Codes: G06T 2207/30101 Blood vessel; Artery; Vein; Vascular
• CPC Class Codes: G06T 2207/30204 Marker
• CPC Class Codes: G06T 7/344 involving models
• CPC Class Codes: G06T 7/38 Registration of image sequences

Abstract

A method for guiding stent deployment during an endovascular procedure includes providing a virtual stent model of a real stent that specifies a length, diameter, shape, and placement of the real stent. The method further includes projecting the virtual stent model onto a 2-dimensional (2D) DSA image of a target lesion, manipulating a stent deployment mechanism to navigate the stent to the target lesion while simultaneously acquiring real-time 2D fluoroscopic images of the stent navigation, and overlaying each fluoroscopic image on the 2D DSA image having the projected virtual stent model image, where the 2D fluoroscopic images are acquired from a C-arm mounted X-ray apparatus, and updating the projection of the virtual stent model onto the fluoroscopic images whenever a new fluoroscopic image is acquired or whenever the C-arm is moved, where the stent is aligned with the virtual stent model by aligning stent end markers with virtual end markers.

Claims

1. A method for guiding stent deployment during an endovascular procedure, said method comprising the steps of:

constructing a 3-dimensional (3D) digital subtraction angiography (DSA) image of a target blood vessel lesion;

determining a length, diameter type, and placement location of a planned stent using said 3D DSA image, wherein a virtual model of said stent is created;

overlaying an outline and shape of said planned stent on a 2-dimensional (2D) DSA image of said target lesion;

manipulating a stent deployment mechanism to navigate said stent to said target lesion;

acquiring real-time 2D fluoroscopic images of said stent navigation, and projecting an image of said virtual stent model onto said fluoroscopic images, wherein 2D fluoroscopic images are acquired from a C-arm mounted X-ray apparatus; and

when said stent is aligned with said virtual stent model in said fluoroscopic images, deploying said stent.

2. The method of claim 1, wherein said 3D DSA image is constructed from a plurality of 2D DSA images acquired at different orientations with respect to said target lesion.

3. The method of claim 1, further comprising repeating said steps of determining a length, diameter type, and placement location of a planned stent and overlaying an outline and shape of said planned stent on a 2D DSA image of said target lesion until the stent placement location is determined to be satisfactory, wherein the placement location and configuration of said planned stent in 3 dimensions is fully specified.

4. The method of claim 1, wherein said stent includes radio-opaque end markers, and said virtual stent model includes virtual end markers that are projected onto said fluoroscopic images, wherein said stent is aligned with said virtual stent model by aligning said stent end markers with said virtual end markers.

5. The method of claim 1, further comprising updating said projection of said virtual stent model onto said fluoroscopic images whenever a new fluoroscopic image is acquired or whenever said C-arm is moved.

6. The method of claim 1, further comprising acquiring a 2D roadmap DSA image and overlaying said roadmap image on said fluoroscopic image, wherein said roadmap image aids in navigating said stent to said target lesion.

7. The method of claim 1, wherein projecting an image of said virtual stent model onto said fluoroscopic images comprises representing said virtual stent model by a centerline and a plurality of spaced perpendicular lines whose length is about equal to a diameter of expansion of said stent at a location of each said perpendicular line.

8. The method of claim 4, wherein said virtual end markers are represented by a cross hair surrounded by a circle, wherein a diameter of said circle is larger than the size of the actual end marker_[AM1].

9. A method for guiding stent deployment during an endovascular procedure, said method comprising the steps of:

providing a virtual stent model of a real stent that specifies a length, diameter, shape, and placement location of said real stent, wherein said stent includes radio-opaque end markers, and said virtual stent model includes virtual end markers that are projected onto said fluoroscopic images;

projecting an outline and shape taken from said virtual stent model onto a 2-dimensional (2D) DSA image of a target lesion;

manipulating a stent deployment mechanism to navigate said real stent to said target lesion while simultaneously acquiring real-time 2D fluoroscopic images of said stent navigation, and overlaying each said fluoroscopic image on said 2D DSA image having said projected virtual stent model image, wherein said 2D fluoroscopic images are acquired from a C-arm mounted X-ray apparatus; and

updating said projection of said virtual stent model onto said fluoroscopic images whenever a new fluoroscopic image is acquired or whenever said C-arm is moved, wherein said stent is aligned with said virtual stent model by aligning said stent end markers with said virtual end markers.

10. The method of claim 9, wherein said virtual stent model is created using a 3-dimensional (3D) image of a target blood vessel lesion, and determining a length, diameter type, and placement location of a planned stent using said 3D image.

11. The method of claim 10, wherein said 3D image of said target lesion is created by constructing a 3-dimensional (3D) digital subtraction angiography (DSA) image of said target blood vessel lesion, wherein said 3D DSA image is constructed from a plurality of 2D DSA images acquired at different orientations with respect to said target lesion.

12. The method of claim 10, wherein said 3D image of said target lesion is one of a magnetic resonance image and a computed tomography image, and further comprising registering said 3D image of said target lesion to a 3D DSA image of said target lesion.

13. The method of claim 9, wherein projecting said virtual stent model onto a 2D DSA image comprises determining 2D coordinates u, v of said virtual stent model in said 2D DSA image from an equation

14. The method of claim 9, further comprising deploying said stent, when said stent is aligned with said virtual stent model in said fluoroscopic images.

15. The method of claim 9, wherein projecting said virtual stent model onto a 2D DSA image comprises representing said virtual stent model by a centerline and a plurality of spaced perpendicular lines whose length is about equal to a diameter of expansion of said stent at a location of each said perpendicular line.

16. The method of claim 9, wherein an intensity I_o of said projected virtual end marker is I_o=I_max+I_min−

I_i, wherein I_max and I_min are the minimum and maximum intensity values of the display monitor, respectively, and I_i is the intensity of the pixel underlying said projected virtual end marker.

17. A program storage device readable by a computer, tangibly embodying a program of instructions executable by the computer to perform the method steps for guiding stent deployment during an endovascular procedure, said method comprising the steps of:

providing a virtual stent model of a real stent that specifies a length, diameter, shape, and placement location of said real stent, wherein said stent includes radio-opaque end markers, and said virtual stent model includes virtual end markers that are projected onto said fluoroscopic images;

projecting an outline and shape taken from said virtual stent model onto a 2-dimensional (2D) DSA image of a target lesion;

manipulating a stent deployment mechanism to navigate said real stent to said target lesion while simultaneously acquiring real-time 2D fluoroscopic images of said stent navigation, and overlaying each said fluoroscopic image on said 2D DSA image having said projected virtual stent model image, wherein said 2D fluoroscopic images are acquired from a C-arm mounted X-ray apparatus; and

updating said projection of said virtual stent model onto said fluoroscopic images whenever a new fluoroscopic image is acquired or whenever said C-aim is moved, wherein said stent is aligned with said virtual stent model by aligning said stent end markers with said virtual end markers.

18. The computer readable program storage device of claim 17, wherein said virtual stent model is created using a 3-dimensional (3D) image of a target blood vessel lesion, and determining a length, diameter type, and placement location of a planned stent using said 3D image.

19. The computer readable program storage device of claim 18, wherein said 3D image of said target lesion is created by constructing a 3-dimensional (3D) digital subtraction angiography (DSA) image of said target blood vessel lesion, wherein said 3D DSA image is constructed from a plurality of 2D DSA images acquired at different orientations with respect to said target lesion.

20. The computer readable program storage device of claim 18, wherein said 3D image of said target lesion is one of a magnetic resonance image and a computed tomography image, and further comprising registering said 3D image of said target lesion to a 3D DSA image of said target lesion.

21. The computer readable program storage device of claim 17, wherein projecting said virtual stent model onto a 2D DSA image comprises determining 2D coordinates u, v of said virtual stent model in said 2D DSA image from an equation

22. The computer readable program storage device of claim 17, the method further comprising deploying said stent, when said stent is aligned with said virtual stent model in said fluoroscopic images.

23. The computer readable program storage device of claim 17, wherein projecting said virtual stent model onto a 2D DSA image comprises representing said virtual stent model by a centerline and a plurality of spaced perpendicular lines whose length is about equal to a diameter of expansion of said stent at a location of each said perpendicular line.

24. The computer readable program storage device of claim 17, wherein an intensity I_o of said projected virtual end marker is I_o=I_max+I_min−

I_i, wherein I_max and I_min are the minimum and maximum intensity values of the display monitor, respectively, and I_i is the intensity of the pixel underlying said projected virtual end marker.