3D Laser Fenestration Planning for Precise Catheter Guidance
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Solution Overview
Problem
Existing intravascular stent graft fenestration techniques face challenges such as difficulty in identifying the correct location to puncture the stent graft material, aligning the laser catheter, forming a circular opening, and avoiding over-bending, which complicates procedures like laser fEVAR and endoleak repair.
Innovation Solution
The use of pre-planning the puncturing point in 3D, defining the catheter laser path during surgical planning, adjusting the plan after stent graft placement to avoid stent struts, and image segmentation to ensure the catheter follows the planned trajectory, combined with real-time adjustment and enlargement of the opening using cutting balloons or glue injection, guided by computational modeling and imaging systems.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If the laser fiber is positioned precisely at the target vessel ostium, then the fenestration accuracy is improved, but the difficulty of positioning and maintaining stability increases
Solution Approach 1:
A steerable sheath is introduced as an intermediary device to guide and stabilize the laser fiber. The sheath provides a radiopaque tip that can be positioned at the target vessel ostium level and confirmed via fluoroscopy, while the steerable design allows precise angular adjustment to maintain optimal laser fiber positioning despite anatomical variations and patient movement
Solution Approach 2:
Fluoroscopy imaging is used to provide real-time feedback on the position of the steerable sheath tip and laser fiber relative to the target vessel ostium. This allows continuous monitoring and adjustment to maintain precise alignment throughout the laser fenestration procedure
2Manufacturing precision
If the laser energy is delivered to create a circular hole, then the fenestration quality is improved, but the risk of creating an elliptical or irregular opening increases
Solution Approach 1:
The system addresses the asymmetry problem by ensuring the laser fiber is positioned square-on (perpendicular) to the endograft fabric at the target vessel ostium. This symmetric positioning approach, combined with controlled laser energy delivery, minimizes the risk of elliptical or irregular openings and ensures circular fenestration geometry
3Reliability
If the laser fiber is stabilized correctly, then the procedure reliability is improved, but the complexity of positioning and stabilization increases
Solution Approach 1:
The positioning system is segmented into distinct functional components: the steerable sheath for guidance and positioning, the laser fiber for energy delivery, and the fluoroscopy system for imaging and feedback. This segmentation allows each component to be optimized independently while working together to achieve reliable and reproducible laser fenestration
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
Improves the precision and efficiency of stent graft fenestration procedures by providing evidence-based guidance, reducing procedural time, and enhancing the accuracy of fenestrations and endoleak repairs, thereby ensuring optimal blood flow and seal integrity.
Implementation Method 1
In-situ laser fenestration utilizes laser light energy to produce deliberate holes in the graft fabric of the main device after its deployment
Data Source
AI summary
A system is provided for fenestration within a body lumen. The system includes an intraluminal device and a processor. The processor is configured to, from an imaging system, obtain a planning image including the lumen and a branch lumen extending from the lumen, and, in the planning image: identify a treatment device; identify a centerline of the branch lumen extending from the branch lumen to a desired puncture point on the treatment device; and identify a desired trajectory of the intraluminal device relative to the puncture point. The processor is also configured to, from a second imaging system, obtain a live procedural image including the lumen and the branch lumen; and in the live procedural image, identify the treatment device, the centerline of the branch lumen, the desired puncture point, the desired trajectory of the intraluminal device, and the actual trajectory of the intraluminal device.