Magnetic Resonance Imaging-Guided Balloon Angioplasty of Coarctation of the Aorta A Pilot Study

Magnetic Resonance Imaging-Guided Balloon Angioplasty of Coarctation of the Aorta A Pilot Study,Julia J. Krueger,Peter Ewert,Sevim Yilmaz,Dinah Gelern

Magnetic Resonance Imaging-Guided Balloon Angioplasty of Coarctation of the Aorta A Pilot Study   (Citations: 10)
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Julia J. Krueger, Peter Ewert, Sevim Yilmaz, Dinah Gelernter, Björn Peters, Klaus Pietzner, Axel Bornstedt, Bernhard Schnackenburg, Hashim Abdul-Khaliq, Eckart Fleck, Eike Nagel, Felix Berger
Background—MRI guidance of percutaneous transluminal balloon angioplasty (PTA) of aortic coarctation (CoA) would be desirable for continuous visualization of anatomy and to eliminate x-ray exposure. The aim of this study was (1) to determine the suitability of MRI-controlled PTA using the iron oxide-based contrast medium Resovist (ferucarbotran) for catheter visualization and (2) to subsequently apply this technique in a pilot study with patients with CoA. Methods and Results—The MRI contrast-to-noise ratio and artifact behavior of Resovist-treated balloon catheters was optimized in in vitro and animal experiments (pigs). In 5 patients, anatomy of the CoA was evaluated before and after intervention with high-resolution respiratory-navigated 3D MRI and multiphase cine MRI. Position monitoring of Resovist-treated catheters was realized with interactive real-time MRI. Aortic pressures were continuously recorded. Conventional catheterization was performed before and after MRI to confirm interventional success. During MRI, catheters filled with 25 mol of iron particles per milliliter of Resovist produced good signal contrast between catheters and their background anatomy but no image distortion due to susceptibility artifacts. All MRI procedures were performed successfully in the patient study. There was excellent agreement between the diameters of CoA and pressure gradients as measured during MRI and conventional catheterization. In 4 patients, PTA resulted in substantial widening of the CoA and a decrease in pressure gradients. In 1 patient, PTA was ineffective. Conclusions—The MRI method described represents a potential alternative to conventional x-ray fluoroscopy for catheter-based treatment of patients with CoA. (Circulation. 2006;113:1093-1100.)
Published in 2011.
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    • ...MR guided intervention is attractive because its three dimensional nature allows accurate positioning of catheters and devices in a way that is difficult with two dimensional angiography. However, there are currently limitations which relate to catheter tracking in the CMR environment. Standard angiographic catheters are generally unsuitable since they contain ferromagnetic elements and require non-CMR compatible guidewires. Specially designed catheters are employed which are tracked under CMR either passively—that is, they contain a substance which either generates a signal or causes local signal loss in the magnetic field—or actively, in which case the catheter itself is designed to act as a CMR coil generating signal. Unfortunately, local tissue heating remains a cause for concern with active catheters and may limit the duration of CMR fluoroscopy. Passive tracking employing a balloon catheter filled with an iron oxide compound was used in an exciting study published last year in which five adult patients with coarctation of the aorta underwent stent placement under CMR guidance with a high degree of success....

    Andrew Crean. Cardiovascular MR and CT in congenital heart disease

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