Volumetric microscopy of cerebral arteries with a miniaturized optical coherence tomography imaging probe.

Endovascular interventions are increasingly becoming the preferred approach for treating strokes and cerebral artery diseases. These procedures rely on sophisticated angiographical imaging guidance, which encounters challenges because of limited contrast and spatial resolution. Achieving a more precise visualization of the underlying arterial pathology and neurovascular implants is crucial for accurate procedural decision-making. In a human study involving 32 patients, we introduced the clinical application of a miniaturized endovascular neuro optical coherence tomography (nOCT) imaging probe. This technology was designed to navigate the tortuous paths of the cerebrovascular circulation and to offer high-resolution imaging in situ. The nOCT probe is compatible with standard neurovascular microcatheters, integrating with the procedural workflow used in clinical routine. Equipped with a miniaturized optical fiber and a distal lens, the probe illuminates the tissue and collects the backscattered, near-infrared light. While rotating the fiber and the lens at high speed, the probe is rapidly retracted, creating a spiral-shaped light pattern to comprehensively capture the arterial wall and implanted devices. Using nOCT, we demonstrated volumetric microscopy of cerebral arteries in patients undergoing endovascular procedures. We imaged the anterior and posterior circulation of the brain, including distal segments of the internal carotid and middle-cerebral arteries, as well as the vertebral, basilar, and posterior cerebral arteries. We captured a broad spectrum of neurovascular pathologies, such as brain aneurysms, ischemic stroke, arterial stenoses, dissections, and intracranial atherosclerotic disease. nOCT offered artifact-free, high-resolution visualizations of intracranial artery pathology and neurovascular devices. Editor's summary: Cerebrovascular conditions are often treated with endovascular interventions, and it remains difficult to diagnose intracranial artery pathology. Pereira et al. adapted neuro optical coherence tomography (nOCT) technology to image cerebral arteries under different conditions in 32 patients. The nOCT probe was used inside standard microcatheters to produce volumetric microscopic images of cerebral arteries by detection of near-infrared light scattering. Images were acquired in the contexts of aneurysm, ischemic stroke, arterial stenoses, dissections, and atherosclerotic disease. The resulting images provided high-resolution visualization of vessel morphology both before and after clinical interventions in several independent cases. This study provides proof of concept for using optical coherence tomography devices to better understand cerebrovascular pathology and intervention for a range of conditions in the human brain. —Brandon Berry [ABSTRACT FROM AUTHOR]