E-104 Image guidance for mechanical thrombectomy in stroke using an optical see-through head-mounted display (OST-HMD): proof of concept and rationale

Background and Purpose Optical see-through head-mounted displays (OST-HMD) can enable a mixed reality (MR) experience for neurointerventionalists during procedures encompassing high resolution radiographic imaging and an unhindered view of the procedural site. The authors present a technical note detailing an approach to mechanical thrombectomy in stroke utilizing an OST-HMD as an alternative to traditional angiography suite display monitors. Methods Mixed reality visualization was achieved using the Microsoft HoloLens system. An anatomically realistic flow model was employed to perform the procedure. A commercially available guide sheath, intermediate aspiration catheter, microcatheter and mechanical thrombectomy device were utilized to perform a mechanical thrombectomy of a right M1 thrombus. The head mounted display created a real-time mixed reality environment by superimposing the virtual AP and lateral views onto the interventionalist’s field of view. The procedure was filmed through the point of view of the operator. The video was reviewed to assess whether key anatomic landmarks and materials could be consistently and reliably visualized. Dosimetry and time of procedure were recorded. The operator completed a questionnaire following the procedure detailing benefits, limitations, and visualization mode preferences. Results A right M1 thrombectomy was successfully performed using OST-HMD image guidance on an anatomically realistic flow model. Dosimetry and procedural time compared favorably to typical procedural times. All visualization modes were equally effective in providing image guidance. Key anatomic landmarks and materials were consistently and reliably visualized. Conclusions This preliminary study demonstrates that mechanical thrombectomy for stroke utilizing OST-HMDs for image guidance is feasible. This novel visualization approach may serve as a valuable tool for performing mechanical thrombectomy and other endovascular image-guided procedures. Disclosures G. Deib: None. T. Song: None. W. Gu: None. J. Perkowski: None. N. Navab: None. M. Unberath: None. F. Hui: None. P. Gailloud: None.