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(Circulation. 2006;113:1101-1107.)
© 2006 American Heart Association, Inc.

Imaging

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

Amish N. Raval, MD; Parag V. Karmarkar, MSc; Michael A. Guttman, MSc; Cengizhan Ozturk, MD, PhD; Smita Sampath, PhD; Ranil DeSilva, MBBS, PhD; Ronnier J. Aviles, MD; Minnan Xu, BS; Victor J. Wright, BS; William H. Schenke, BS; Ozgur Kocaturk, MSc; Alexander J. Dick, MD; Venkatesh K. Raman, MD; Ergin Atalar, PhD; Elliot R. McVeigh, PhD; Robert J. Lederman, MD

From the Cardiovascular Branch (A.N.R., P.V.K., C.O., R.D., R.J.A., V.J.W., W.H.S., O.K., A.J.D., V.K.R., R.J.L.) and the Laboratory of Cardiac Energetics (M.A.G., S.S., E.R.M.), Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md; Cardiovascular Section, Department of Medicine, University of Wisconsin, Madison (A.N.R.); and Department of Radiology, The Johns Hopkins University, Baltimore, Md (P.V.K., M.X., E.A.).

Correspondence to Robert J. Lederman, MD, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538. E-mail lederman{at}nih.gov

Received September 29, 2005; revision received December 13, 2005; accepted December 19, 2005.

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 13.3±1.6 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 (n=3), 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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