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Editorial
. 2024 Sep 26:15910199241285962.
doi: 10.1177/15910199241285962. Online ahead of print.

Shining light on neurovascular disease

Adnan H Siddiqui  1   2 , Tommy Andersson  3   4   5
Affiliations
Editorial

Shining light on neurovascular disease

Adnan H Siddiqui et al. Interv Neuroradiol. .

Abstract

Tortuosity and fragility of the intracranial vasculature have precluded the application of novel intravascular imaging modalities during the treatment of cerebrovascular pathologies. In other circulatory beds, these technologies have transformed clinical and therapeutic decision-making. A new report demonstrates the clinical use of high-resolution intravascular imaging in the human cerebrovasculature using neuro optical coherence tomography. This technology provides an unprecedented opportunity to examine the luminal dimensions of cerebrovascular disease. We expect that the neurointerventional community will rapidly adopt this technology-similar to wider adoptions by other vascular specialties-for both a better understanding of underlying disease and clarity of endovascular therapeutic safety and effectiveness.

Keywords: High resolution; intravascular imaging; neuro optical coherence tomography; neurovascular disease; technique-technology.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Tommy Andersson: Consultant: Anaconda, Cerenovus-Neuravi, Optimize Neurovascular, Rapid Medical; Shareholder: Ceroflo. Adnan H. Siddiqui: Financial Interest/Investor/Stock Options/Ownership: Adona Medical, Inc., Bend IT Technologies, Ltd, BlinkTBI, Inc, Borvo Medical, Inc., Cerebrotech Medical Systems, Inc., Code Zero Medical, Inc., Cognition Medical, Collavidence, Inc., CVAID Ltd, E8, Inc., Endostream Medical, Ltd, Galaxy Therapeutics, Inc., Hyperion Surgical, Inc., Imperative Care, Inc., InspireMD, Ltd, Instylla, Inc., Launch NY, Inc., Neurolutions, Inc., NeuroRadial Technologies, Inc. (Sold to Medtronic in 2021), Neurovascular Diagnostics, Inc., Peijia Medical, PerFlow Medical, Ltd, Piraeus Medical, Inc., Q’Apel Medical, Inc., QAS.ai, Inc., Radical Catheter Technologies, Inc., Rebound Therapeutics Corp. (Purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular, Inc. (Purchased 2020 by Medtronic), Sense Diagnostics, Inc., Serenity Medical, Inc., Silk Road Medical, Sim & Cure, Spinnaker Medical, Inc., StimMed, LLC, Synchron, Inc., Tulavi Therapeutics, Inc., Vastrax, LLC, Viseon, Inc., Whisper Medical, Inc., Willow Medtech, Inc. Consultant/Advisory Board: Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, Cordis, Corindus, Inc., Endostream Medical, Ltd, Hyperfine Operations, Inc., Imperative Care, InspireMD, Ltd, Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro, Inc., Peijia Medical, Penumbra, Piraeus Medical, Inc., Q’Apel Medical, Inc., Rapid Medical, Serenity Medical, Inc., Silk Road Medical, StimMed, LLC, Stryker Neurovascular, VasSol, Viz.ai, Inc., National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE and SWIFT DIRECT Trials; MicroVention FRED Trial & CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, INVEST Trial, MIVI neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; InspireMD C-GUARDIANS IDE Pivotal Trial; Patent: Patent No. US 11,464,528 B2, Date: October 11, 2022, Clot Retrieval System for Removing Occlusive Clot from a Blood Vessel, Applicant and Assignee: Neuravi Limited (Galway), Role: Co-Inventor.

Figures

Figure 1.
Figure 1.
Representative examples of nOCT imaging. (A) DSA image from a case with extensive ICA tortuosity (arrows). The dashed line in the M2 segment of the middle cerebral artery shows the location of the cross-sectional nOCT image depicted in (B). (B) Despite severe tortuosity, the nOCT image presents uniform brightness and contrast, as well as the absence of rotational distortion and other artifacts. nOCT shows clear details of the arterial wall microstructure, presenting a three-layer normal appearance (dotted square inset). The tunica media (lower arrow in B) is seen as a darker layer between the tunica intima and adventitia, showing a bright appearance. The artery is surrounded by CSF. Due to the transparent properties of the CSF to near-infrared light, nOCT visualizes the extravascular space with clarity. The arrow points to the location of small perforating arteries. The asterisk (*) indicates the location of a vein. The vein's lumen appears opaque to nOCT as it is filled with blood, a distinctive characteristic as compared to arteries that are rapidly filled with contrast after injections. The scale bars are equal to 1 mm. (C) DSA imaging of a restenosed stent in the intracranial segment of the vertebral artery (V4) (arrow). (D) No intraluminal thrombus is observed on nOCT and the tissue causing the restenosis appears eccentric, showing two distinct layers. A uniform, smooth and bright inner layer (arrows) suggests the presence of organized smooth muscle cells. A deeper layer with a dark, heterogeneous appearance indicates possible proteoglycan content and fibrin deposition (asterisks). The scale bars are equal to 1 mm. Images adapted from Pereira et al.
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