4D Vessel Reconstruction for Benchtop Thrombectomy Analysis

While we are making progress in overcoming infectious diseases and cancer; one of the major medical challenges of the mid-21st century will be the rising prevalence of stroke. Large vessels occlusions are especially debilitating, yet effective treatment (needed within hours to achieve best outcomes) remains limited due to geography. One solution for improving timely access to mechanical thrombectomy in geographically diverse populations is the deployment of robotic surgical systems. Artificial intelligence (AI) assistance may enable the upskilling of operators in this emerging therapeutic delivery approach. Our aim was to establish consensus frameworks for developing and validating AI-assisted robots for thrombectomy. Objectives included standardizing effectiveness metrics and defining reference testbeds across in silico, in vitro, ex vivo, and in vivo environments. To achieve this, we convened experts in neurointervention, robotics, data science, health economics, policy, statistics, and patient advocacy. Consensus was built through an incubator day, a Delphi process, and a final Position Statement. We identified that the four essential testbed environments each had distinct validation roles. Realism requirements vary: simpler testbeds should include realistic vessel anatomy compatible with guidewire and catheter use, while standard testbeds should incorporate deformable vessels. More advanced testbeds should include blood flow, pulsatility, and disease features. There are two macro-classes of effectiveness metrics: one for in silico, in vitro, and ex vivo stages focusing on technical navigation, and another for in vivo stages, focused on clinical outcomes. Patient safety is central to this technology's development. One requisite patient safety task needed now is to correlate in vitro measurements to in vivo complications.

The treatment of ischemic stroke using mechanical thrombectomy involves difficult decisions under intense time constraints. Numerical physics simulations can in theory inform operators to make better decisions regarding treatment approaches and device selection, but are too slow to do so in practice. In this thesis, we investigate if current machine learning based surrogates can accurately emulate these simulations in a step-by-step manner while making them significantly faster. To do this we train three surrogate models on two simulations that involve a simplified aspiration procedure, with varying levels of geometric complexity. Our results show that two of our models accurately predict singular simulation steps and provide substantial speedups, especially when combined with specific data augmentations. However, the models showed a lack of stability when emulating simulations with complex geometries over longer time periods. Overall, this work provides a foundation for future studies to develop stable methods that scale to realistic numerical physics simulations of mechanical thrombectomy.

Blood vessel segmentation and -tracing are essential tasks in many medical imaging applications. Although numerous methods exist, the prevailing segment-then-fix paradigm is fundamentally limited regarding its suitability for modeling the task of complete and topologically accurate vascular network reconstruction. Here, we propose an approach to extract topologically more accurate vascular graphs from 3D image data, building upon highly successful ideas from the related biomedical tasks of cell segmentation and -tracking. Our approach first predicts voxel-wise vessel direction vectors joint with standard vessel segmentation masks. Second, to extract the vascular graph from these predictions, we introduce a direction-vector-guided extension of the TEASAR algorithm. Our approach achieves state-of-the-art performance on three benchmark datasets, spanning both synthetic and real imagery. We further demonstrate the applicability of our approach to challenging 3D micro-CT scans of rat heart vasculature. Finally, we propose meaningful and interpretable measures of topological error, namely false splits and false merges for graphs. Overall, our approach substantially improves the topological accuracy of reconstructed vascular graphs, being able to separate closely apposed vessel segments and handle multiple vascular trees within a single volume.