MR Imaging-guided Stent Placement in Iliac Arterial Stenoses: A Feasibility Study

Manke, C.; Nitz, Wolfgang R.; Djavidani, Behrus; Strotzer, M.; Lenhart, Markus; Völk, Markus; Feuerbach, Stefan; Link, J.

doi:10.1148/radiology.219.2.r01ma03527

Cited by 85 publications

(55 citation statements)

References 31 publications

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“…10,11 To our knowledge, the current report represents the first MR-guided coronary artery stent placement. Improved gradient performance, ultrafast reconstruction capabilities, 14 and recently developed software tools for "on-the-fly" interactive MR scanning 18 now offer the potential for real-time MR imaging with sufficient contrast and spatial resolution for MR-guided coronary interventions.…”

Section: Discussionmentioning

confidence: 88%

“…4 The combination of MR plaque information with interventional MR-guided coronary stent placement may provide a favorable clinical potential. In contrast to MR-guided stent placement in peripheral arteries, 10,11 coronary MR-guided interventions must accommodate the substantial motion artifacts originating from the respiratory and the cardiac cycles. 12 In addition, MR-guided coronary artery interventions are especially challenging because of the small size and the tortuous anatomy of the coronary vessels.…”

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confidence: 99%

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Magnetic Resonance–Guided Coronary Artery Stent Placement in a Swine Model

et al. 2002

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Background-Magnetic resonance (MR)-guided coronary artery stent placement is a challenging vascular intervention because of the small size of the coronary arteries combined with incessant motion during the respiratory and cardiac cycles. These obstacles necessitate higher temporal and higher spatial resolution real-time MR imaging techniques when compared with interventional peripheral MR angiography. Methods and Results-A new, ultrafast, real-time MR imaging technique that combines steady-state free precession (SSFP) for high signal-to-noise ratio and radial k-space sampling (rSSFP) for motion artifact suppression was implemented on a 1.5-T clinical whole-body interventional MR scanner. The sliding window reconstruction technique yielded a frame rate of 15/s allowing for data acquisition during free breathing and without cardiac triggering. Eleven balloon-expandable stainless steel coronary stents were placed in both coronary arteries of 7 pigs (40 to 70 kg body weight) using a nitinol guidewire and passive device visualization. Position of the coronary stents was controlled by a navigator-gated free-breathing ECG-triggered three-dimensional SSFP coronary MRA sequence and confirmed visually on the ex vivo heart. The presented real-time MR imaging sequence reliably allowed for high-quality coronary MR fluoroscopy without motion artifacts in all pigs. Ten of 11 coronary stents were correctly placed under MR guidance. One stent dislodged proximally from the left main coronary artery because of too-small balloon size. Stent dislocation was correctly predicted during real-time MR imaging. Conclusion-The presented approach allows for real-time MR-guided coronary artery stent placement in a swine model.

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Section: Discussionmentioning

confidence: 88%

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confidence: 99%

Magnetic Resonance–Guided Coronary Artery Stent Placement in a Swine Model

et al. 2002

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“…Advances in rapid imaging, combined with development of catheter devices visible under MRI, have made real-time MRI (rtMRI)-guided therapeutic interventions feasible. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] We hypothesize that rtMRI can guide catheter navigation within an occluded artery and that combined CTO recanalization and percutaneous transluminal angioplasty can be conducted en-tirely under rtMRI guidance with the use of custom MRIvisible devices in a swine model.…”

Section: Editorial P 1053 Clinical Perspective P 1107mentioning

confidence: 99%

Real-Time Magnetic Resonance Imaging–Guided Endovascular Recanalization of Chronic Total Arterial Occlusion in a Swine Model

et al. 2006

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Background-Endovascular recanalization (guidewire traversal) of peripheral artery chronic total occlusion (CTO) can be challenging. X-ray angiography resolves CTO poorly. Virtually "blind" device advancement during x-ray-guided interventions can lead to procedure failure, perforation, and hemorrhage. Alternatively, MRI may delineate the artery within the occluded segment to enhance procedural safety and success. We hypothesized that real-time MRI (rtMRI)-guided CTO recanalization can be accomplished in an animal model. Methods and Results-Carotid artery CTO was created by balloon injury in 19 lipid-overfed swine. After 6 to 8 weeks, 2 underwent direct necropsy analysis for histology, 3 underwent primary x-ray-guided CTO recanalization attempts, and the remaining 14 underwent rtMRI-guided recanalization attempts in a 1.5-T interventional MRI system. Real-time MRI intervention used custom CTO catheters and guidewires that incorporated MRI receiver antennae to enhance device visibility. The mean length of the occluded segments was 13.3Ϯ1.6 cm. The rtMRI-guided CTO recanalization was successful in 11 of 14 swine and in only 1 of 3 swine with the use of x-ray alone. After unsuccessful rtMRI (nϭ3), x-ray-guided attempts were also unsuccessful. Conclusions-Recanalization of long CTO is entirely feasible with the use of rtMRI guidance. Low-profile clinical-grade devices will be required to translate this experience to humans.

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“…MR HAS BEEN PROPOSED as an imaging modality to guide endovascular therapies (1)(2)(3)(4)(5)(6). Recent developments, demonstrated in animals, include positioning of catheters into the carotid arteries (2), the renal artery (4,5), and the iliac artery (3), and coil placement in experimental aneurysm models (6).…”

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confidence: 99%

“…Recent developments, demonstrated in animals, include positioning of catheters into the carotid arteries (2), the renal artery (4,5), and the iliac artery (3), and coil placement in experimental aneurysm models (6). In an editorial, Strother (1) suggested that the real advantage of MRguided endovascular therapies may not be to improve catheter guidance, but rather to provide added value by improving the monitoring of therapy.…”

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confidence: 99%

MRI of ischemic stroke in canines: Applications for monitoring intraarterial thrombolysis

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Kosior

Ryder

et al. 2007

Magnetic Resonance Imaging

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Purpose: To describe a canine embolic stroke model that is appropriate for endovascular procedure evaluations and develop local cerebral blood flow (CBF) maps to monitor the progression of stroke and thrombolysis. In the future, MR may displace X-ray imaging in some endovascular procedures, such as intraarterial (IA) thrombolysis for stroke therapy, due to increased monitoring capabilities. For MR to attain its full potential in endovascular therapy, the development of appropriate disease models and monitoring techniques is essential. Materials and Methods:The canine stroke model uses an injection of autologous clot to produce ischemic and infarcted tissue and produces a range of stroke severities within the anterior cerebral circulation. Local CBF maps were formed by using the catheter that would be in place to deliver the thrombolytic agent for treatment to deliver the gadolinium-based contrast agent for perfusion imaging. Results:After the injection of clot, changes on imaging were consistent with the progression of ischemic stroke. Local CBF maps showed perfusion changes with stroke progression and treatment. Conclusion:We successfully demonstrate the progression of ischemic stroke in the canine to mimic the progression of human stroke. CBF maps to show local perfusion characteristics show great potential in the evaluation of stroke therapy.

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MR Imaging-guided Stent Placement in Iliac Arterial Stenoses: A Feasibility Study

Abstract: MR imaging-guided stent placement in iliac arteries is feasible in select patients. The presented technique has limitations-that is, long procedure times, lack of real-time monitoring, and stent artifacts-that necessitate further modifications before it can be recommended for clinical use.

Cited by 85 publications

References 31 publications

Magnetic Resonance–Guided Coronary Artery Stent Placement in a Swine Model

Magnetic Resonance–Guided Coronary Artery Stent Placement in a Swine Model

Real-Time Magnetic Resonance Imaging–Guided Endovascular Recanalization of Chronic Total Arterial Occlusion in a Swine Model

MRI of ischemic stroke in canines: Applications for monitoring intraarterial thrombolysis

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