Visualization of the Human Intracranial Vasculature and Intracranial Implants Using Microangioscopy

BACKGROUND: – Cerebral angiography cannot directly assess the intimal surface of a vessel. The MicroAngioscope is a small and flexible catheter that allows visualization of the inside of the cerebral vasculature. Our objective is to report our first-in-human experience with the live visualization of intracranial vasculature using the MicroAngioscope. METHODS: – This was a prospective, single-arm, national multi-center observational study of consecutive intracranial endovascular cases treated using the MicroAngioscope as an adjunct. This first-in-human study aimed at assessing the safety of the technology by prospectively collecting any procedural complications. A secondary end point was the successful visualization of the vasculature and the implants. RESULTS: – The MicroAngioscope, used in 31 cases, was successfully delivered to the location of interest and allowed for a direct live visualization of the condition and the implant that had been deployed. There was no vessel injury based on cerebral angiography. The cases included 9 cases of carotid stent, 6 cases of flow diversion, 11 cases of transverse sinus stenting, 2 cases of aneurysm intrasaccular flow-disruption, 1 case of aneurysm treatment with stent-assisted coiling, and 2 cases of mechanical thrombectomy. All cases were successfully completed without complications. All patients were neurologically unchanged following their respective procedures. Angioscopy was helpful in making the diagnosis in the case of the carotid web, assessing vessel wall apposition immediately after flow diverter and venous stent deployment, and assessing the degree of strut coverage in both arterial and venous stents in follow-up. CONCLUSIONS: – This First-in-Human study demonstrated the early feasibility and safety of the MicroAngioscope in neurointerventional procedures. Further studies are needed to determine its relevance in daily practice.