Co-registration of Intravascular Ultrasound with Angiographic Imaging for Carotid Artery Disease

Abstract Objective Intravascular ultrasound (IVUS) provides endoluminal views and cross-sectional images of carotid arteries but lacks overview of vascular territory provided by angiography. Co-registration of IVUS with angiographic images may provide the potential to navigate both imaging modalities in a synchronous manner. The objective of this study is to evaluate the feasibility and accuracy of co-registering both imaging modalities in the carotid vasculature of the neck. Methods Fourteen patients with 15 cervical carotid artery lesions underwent angiography and subsequent treatment. In each case, an IVUS catheter was advanced to the target lesion and a reference angiography sequence was acquired. This was followed by a electrocardiography (ECG) - triggered fluoroscopy sequence that was initiated upon IVUS catheter pullback. IVUS data collected during pullback was registered with fluoroscopy and evaluated for error and clinical usability. Results A total of 32 landmarks were identified which demonstrated reasonable agreement during IVUS - angiography co-registration. There was a mean registration error distance of 3.36mm (SD 2.82mm) between targets. The longitudinal extent and severity of the disease through the target segment could be more easily evaluated after co-registration. Conclusion Semi – automatic tracking and co-registration of angiography and IVUS is a new technology and has the potential to increase the use of IVUS in carotid disease and to the opportunity to optimize procedural outcomes.