The Role of Engineering in Endovascular Image-Guided Procedures: Present Challenges and Future Opportunities

Endovascular Image-Guided Interventions (EIGIs) are increasingly the preferred approach for diagnosing and treating a wide range of vascular diseases, including stroke and ischemic heart disease. These minimally invasive procedures involve inserting catheters into the vascular system—typically through the femoral or radial artery—and navigating them under X-ray imaging to the target site, where therapeutic devices such as stents are deployed. EIGIs represent a unique convergence of engineering, basic sciences, and medicine, requiring seamless integration of imaging technologies, medical devices, and procedural expertise. In this talk, we will explore the current landscape of EIGIs, identify critical research gaps, and discuss how engineering innovations can address these challenges. Particular emphasis will be placed on emerging technologies such as advanced imaging systems, artificial intelligence for real-time clinical decision support, and endovascular robotics. Finally, we will examine how these developments are shaping the future of autonomous treatment—enabling timely, life-saving interventions for stroke patients who currently lack access to comprehensive stroke centers.

S.V. Setlur Nagesh, PhD, MS, is a Research Scientist and Research Assistant Professor at the Canon Stroke and Vascular Research Center within the Department of Neurosurgery at the University at Buffalo. Originally from Bangalore, India, Dr. Nagesh moved to the United States in 2007 and earned both his MS and PhD in Electrical Engineering from the University at Buffalo. His doctoral research focused on developing high-spatial-resolution X-ray detectors for neuroendovascular procedures. His current research is dedicated to advancing technologies for endovascular image-guided interventions—specifically, next-generation X-ray detector systems, medical imaging integrated with artificial intelligence to provide real-time clinical decision support, and automation in endovascular robotics with an emphasis on robotic clinical training. Dr Setlur frequently collaborates with clinical and industry partners, including Canon Medical Systems, Siemens Healthineers, and QAS.AI, to translate these innovations into clinical practice. Outside of his professional work, Dr. Nagesh is passionate about photography, with a particular focus on documentary and street photography. His style emphasizes authentic storytelling and capturing candid moments that reflect the essence of everyday life. He also enjoys exploring new places, learning new skills, and spending quality time with his family and two children.