Guiding endovascular catheters using electromagnetic tracking and path-based registration for brain aneurysm treatment

Purpose. Neuroendovascular procedures, characterized by their minimally invasive nature and effectiveness, are increasingly used in the management of cerebrovascular diseases such as acute stroke and cerebral aneurysms. These procedures, however, rely on x-ray fluoroscopy for catheter guidance, exposing patients, surgeons, and surgical staff to ionizing radiation with associated health risks. To address this problem, this work introduces a new electromagnetic-based (EM) catheter navigation solution. Methods. A custom catheter was designed and constructed to integrate a 5-degree-of-freedom EM coil sensor at its tip. The recorded sensor position was used in: (1) estimating the tip direction to guide it through vessel bifurcations; and (2) dynamically reconstructing the catheter shape as it is advanced or retracted within the vessels. Instrument overlay on angiography CT images is enabled by registering the reconstructed shape to the extracted vessel centerlines. The accuracy of direction estimation, shape sensing, and path-based registration was evaluated in experimental studies on an anthropomorphic phantom. Results. The results demonstrated a mean deviation of 4.1 mm for catheter shape estimation. The catheter tip direction was resolved to within 3.4° error to permit navigation through vessel bifurcations. Registration of reconstructed instrument poses to vessel centerlines achieved 5.1 mm TRE. The results demonstrate sufficient guidance accuracy within the main arteries, such as the femoral artery (⌀8.2-9.8 mm) or the abdominal aorta (⌀30 mm). Conclusions. This work reports a new system for catheter navigation during endovascular interventions. The proposed solution provides a new mode of image guidance that offers accurate treatment for the patient and helps reduce radiation exposure to the surgeon and the surgical staff.