Visualizing Carotid Stenoses for Stroke Treatment and Prevention

Abstract

Analyzing carotid stenoses - potentially lethal constrictions of the brain-supplying arteries - is a critical task in clinical stroke treatment and prevention. Determining the ideal type of treatment and point for surgical intervention to minimize stroke risk is considerably challenging. We propose a collection of visual exploration tools to advance the assessment of carotid stenoses in clinical applications and research on stenosis formation. We developed methods to analyze the internal blood flow, anatomical context, vessel wall composition, and to automatically and reliably classify stenosis candidates. We do not presume already segmented and extracted surface meshes but integrate streamlined model extraction and pre-processing along with the result visualizations into a single framework. We connect multiple sophisticated processing stages in one user interface, including a neural prediction network for vessel segmentation and automatic global diameter computation. We enable retrospective user control over each processing stage, greatly simplifying error detection and correction. The framework was developed and evaluated in multiple iterative user studies, involving a group of eight specialists working in stroke care (radiologists and neurologists). It is publicly available, along with a database of over 100 carotid bifurcation geometries that were extracted with the framework from computed tomography data. Further, it is a vital part of multiple ongoing studies investigating stenosis pathophysiology, stroke risk, and the necessity for surgical intervention.