Endovascular Optical Coherence Tomography Imaging in Cerebrovascular Disease

Neurointerventional surgery is a subspecialty focused on the diagnosis and treatment of vascular diseases of the central nervous system. The appeal of treating vascular diseases through minimally invasive techniques without the need for open surgery has led to continued technological innovation and device development. Endovascular optical coherence tomography (OCT) is the highest resolution intravascular imaging modality available, utilizing near-infrared light with a wavelength of approximately 1300 nm and excellent spatial resolution of 10µm is achievable. With near histologic resolution, OCT has been described as an optical biopsy modality. The adoption of endovascular OCT imaging in the evolving field of neurointerventional surgery seems instinctive. The goal of this doctoral thesis was to utilize OCT as an adjunct in the diagnosis and treatment of cerebrovascular diseases. Towards that goal, preclinical animal and human investigations were performed. We assessed the feasibility of OCT imaging in quantifying vascular injury after endovascular thrombectomy (EVT) in a swine model. OCT was found to be feasible in assessing vascular injury after EVT with histological accuracy. Varying degrees of vessel wall injury occur after EVT, and residual luminal thrombus was present despite complete angiographic revascularization. Next, we designed a preclinical swine model of cerebral venous sinus thrombosis (CVST) with subsequent EVT and OCT imaging. OCT revealed that residual bridging cortical vein thrombus may be present despite complete sinus recanalization on angiography. This thrombus may be the etiology of poor clinical outcome despite technical success. Establishing preclinical feasibility with novel findings of undetected residual thrombus allowed for research ethics board approval for human OCT imaging. OCT imaging in patients with basilar stroke was undertaken. OCT was safe and capable of producing cross-sectional images displaying evidence of endothelial injury and residual thrombus. OCT may guide future antithrombotic treatment for patients with demonstrated residual thrombus. OCT carries great promise in the future of neurointerventional surgery.

Department dc:contributor.department

Medical Science

Year dc:date.issued

2021

Author dc:creator

• Pasarikovski, Christopher R

Advisor dc:contributor.advisor

• Yang, Victor XD

Handle dc:identifier.uri

http://hdl.handle.net/1807/106307

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/106307