Abstract
X-ray fluoroscopy is the gold standard for coronary diagnostics and intervention. Magnetic resonance imaging is a radiation-free alternative to x-ray with excellent soft tissue contrast in arbitrary slice orientation. Here, we assessed real-time MRI-guided coronary interventions from femoral access using newly designed MRI technologies. Six Goettingen minipigs were used to investigate coronary intervention using real-time MRI. Catheters were custom-designed and equipped with an active receive tip-coil to improve visibility and navigation capabilities. Using modified standard clinical 5 F catheters, intubation of the left coronary ostium was successful in all animals. For the purpose of MR-guided coronary interventions, a custom-designed 8 F catheter was used. In spite of the large catheter size, and therefore limited steerability, intubation of the left coronary ostium was successful in 3 of 6 animals within seconds. Thereafter, real-time guided implantation of a non-metallic vascular scaffold into coronary arteries was possible. This study demonstrates that real-time MRI-guided coronary catheterization and intervention via femoral access is possible without the use of any contrast agents or radiation, including placement of non-metallic vascular scaffolds into coronary arteries. Further development, especially in catheter and guidewire technology, will be required to drive forward routine MR-guided coronary interventions as an alternative to x-ray fluoroscopy.
Highlights
Introduction ofMR-safe coronary guidewires set the basis for coronary intervention (0.014 inch; MaRVis Interventional GmbH, Germany)
This study demonstrates that real-time MRI-guided coronary catheterization and intervention via femoral access is possible without the use of any contrast agents or radiation, including placement of non-metallic vascular scaffolds into coronary arteries
While intubation of the left main coronary ostium in Goettingen minipigs was validated in standard x-ray fluoroscopy (2 of 2 animals), MR-guided intubation with the same non-modified standard clinical guiding catheter
Summary
Introduction ofMR-safe coronary guidewires set the basis for coronary intervention (0.014 inch; MaRVis Interventional GmbH, Germany). The materials used in these MR-safe guidewires are not subject to RF-heating and passive-negative MR markers enable reliable localization of the wire position including the guidewire’s distal end. We introduced a non-metallic balloon-catheter carrying a non-metallic vascular scaffold into the left coronary artery. Due to the broad artifact of the coronary guidewire, the scaffold position could not be navigated in real-time. By filling the interventional balloon with diluted gadolinium contrast, implantation of the scaffold was visualized by means of real-time surveillance of the inflation and deflation of the balloon catheter. Available non-metallic vascular scaffold resolve previous challenges of susceptibility artifacts of standard bare metal or drug-eluting stents, and result in problems with visibility due to their non-metallic backbone and come with both advantages and disadvantages for MR-guided coronary interventions
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