In March 2019, we had decided to install the Alphenix Hi-Def Detector and Alphenix Workstation.

As a neurovascular surgeon, it is my job to perform both neurosurgery and neuroendovascular therapy, and I can tell you from experience, the new Alphenix platform solution have changed the way we practice intervention for us. Here’s why:

The Alphenix Hi-Def Detector has achieved the world's smallest pixel size (at 76 µm) for a detector used in any angiography system. To put this in context, this is more than half the pixel size of any other detector in the market, allowing the system to provide high-definition images in both fluoroscopy and radiography. Now, a field size as small as 1.5 inches (3.89 cm × 3.89 cm), which is the minimum FOV of the Alphenix Hi-Def Detector, can be enlarged and displayed as extremely sharp images on the large monitor.

I first used a prototype of the Alphenix Hi-Def Detector about two years ago and was amazed at how clearly it could depict small microcatheters. I had the same feeling when I used the system installed at our hospital. The position of a microcatheter introduced into an aneurysm can be precisely determined, and the coils placed in the aneurysm can be distinctly visualized. Indeed, the ability to view the placement of the framing coil in the aneurysm is far superior to anything we had experienced in the past. In the course of our practice, we often employ flow-diverter stents for large/giant aneurysms, and the detector allows even the finest struts of such stents to be visibly depicted.
I believe that the main advantage of the Alphenix Hi-Def Detector is its high definition zoom capability, which makes it possible to observe extremely small structures in enlarged views (down to 76 µm pixels) on the large monitors and ensures extremely fine control by the surgeon for increased precision.

By using the Alphenix Hi-Def Detector, it makes it possible to increase the packing density in coil embolization procedures for aneurysms. Even when surgeons feel that much of the space within an aneurysm has been packed with coils, viewing an enlarged Hi-Def detailed image of the aneurysm often reveals remaining space for the placement of additional coils.

It is my opinion that the coil packing ratio of aneurysms could be increased from the usual 30% to around 40%, or even 50%, by employing this simple technique. This, of course, requires further study for verification, but I am planning to conduct research on this matter in the future.

During postoperative follow-up, the use of the Alphenix Hi-Def Detector can increase accuracy in evaluating recanalization. And in the placement of flow-diverter stents, the images acquired using the Alphenix Hi-Def Detector are totally different visual experience from those acquired using a conventional detector. When the Alphenix Hi-Def Detector is used, it is possible to place the stent at the optimal position in closer contact with the vessel wall, and even small perforating vessels to be conserved can be depicted, allowing us to determine the optimal position for placement of the flow-diverter stent.

Outside Japan, a new endovascular flow disruptor device, known as the WEB (Woven Endo Bridge) by Microvention, for reducing blood flow within an aneurysm has been introduced in clinical practice, and it is anticipated that this device will also be introduced in clinical practice in Japan within the next few years. Alphenix’s Hi-Def imaging would also be useful for further enhancing such novel treatment methods, and the Alphenix Hi-Def Detector is expected to play a significant role in this field.

The ability of the Alphenix Hi-Def Detector to provide Hi-Def images may expand the application of neuroendovascular therapy to treat finer vessels in the future. In addition to the treatment of the cerebral arteries as discussed above, the detector may also help physicians accurately determine the extent of shunt flow in a variety of conditions, such as cerebral arteriovenous malformations and dural arteriovenous fistulas (d-AVF).

• Color-Coded Circulation (CCC) is a function that simultaneously shows both the anatomical course of blood vessels and blood flow by displaying color information as a dynamic image based on the contrast medium arrival time.

I believe that the effectiveness of neuroendovascular therapy could be evaluated by using both PI and CCC in preoperative and postoperative imaging.

• In Cerebral Aneurysm Analysis (CAA), aneurysms are semi-automatically detected in 3D images acquired using Alpha CT (cone-beam CT imaging). When the neck of an aneurysm is selected, the parent blood vessel is segmented and the measurement results are displayed. The size and volume of the aneurysm are measured automatically, and the results can be used to evaluate the embolization ratio.

The images acquired using Alpha CT (CBCT) with the Alphenix detector are significantly superior to those acquired using other conventional detectors, and I look forward to additional progress in the future. It is my firm hope that the Alphenix Hi-Def Detector will undergo further development to achieve high-definition Alpha CT (CBCT) using the high-definition detector technology. Such high-definition 3D images would lead to more accurate diagnosis and treatment for clinicians.

Concerning workstation functions, such as CFD (computational flow dynamics analysis) and 4D-Perfusion (flow dynamics analysis on the temporal axis), these could be further improved. Ultimately, it would be advantageous if the entire course of stroke care, including all the steps in evaluating and determining infarction, neuroendvascular treatment, and post treatment follow-up could be conducted with solely the angiography system used for stroke patients admitted in emergency cases.