An Ultrasound-based Methodology for Endoluminal Robot Tracking in Cardiovascular Procedures

摘要

Cardiovascular diseases (CVDs) are the first cause of death globally and atherosclerotic plaque accumulating in the arteries is the leading cause of cardiac and vascular disorders. An estimated 17.3 million people died for CVDs in 2008, representing the 30% of all global deaths. Of these deaths, an estimated 7.3 million were due to coronary heart disease and 6.2 million were due to stroke [1], [2]. Current therapies for acute CVDs aim to restore blood flow. The traditional surgical techniques for vascular problems are angioplasty and bypass grafting. Typical inconveniences of these procedures are operation via fluoroscopy (dangerous for patients and operators) and the absence of a real removal for plaque and obstruction, which normally are by-passed or pushed against the vessel wall. In addition, although traditional diagnosis and therapy have advanced substantially, research efforts are devoted on the development of robotic-aided platforms for enhancing steerability of the interventional catheter. Recently, some remote catheter navigation systems have been introduced: they are based on steerable cable activated sheaths for catheters precise steering and coronary interventions, or on a controlled permanent magnetic field in which a magnetically equipped catheter can align and bend. All these platforms are based on catheters, they basically provide just steering and not propulsion abilities, and they cannot be adapted to wireless or softly wired endovascular devices. Moreover, another significant drawback of the mentioned platforms is related to the needs of a high radiations dose for the catheter localization for both operator and patients. In this framework, an innovative methodology, based on a computer-aided surgery architecture and developed by the authors (MicroVAST platform – Fig. 1), combines a magnetic locomotion approach for a vascular softly tethered endoluminal robot with an ultrasound (US) transducer-based algorithm for tracking purposes [3], [4]. In this paper, the authors describe an innovative ultrasound-based methodology for endoluminal robots tracking in cardiovascular procedures. The ultrasoundbased intra-operative data, together with pre-operative multimodal data (lumen centreline reconstruction for optimal path definition), would allow for the implementation of an assisted or autonomous safe propulsion of a endoluminal device in cardiovascular procedures. Fig. 1. (a) Schematic representation and (b) real development of the MicroVAST platform.