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(Circulation. 2005;112:699-706.)
© 2005 American Heart Association, Inc.

Imaging

Real-Time Magnetic Resonance Imaging–Guided Stenting of Aortic Coarctation With Commercially Available Catheter Devices in Swine

Amish N. Raval, MD^*; James D. Telep, MD^*; Michael A. Guttman, MSc; Cengizhan Ozturk, MD, PhD; Michael Jones, MD; Richard B. Thompson, PhD; Victor J. Wright, BS; William H. Schenke, BS; Ranil DeSilva, MBBS, PhD; Ronnier J. Aviles, MD; Venkatesh K. Raman, MD; Michael C. Slack, MD; Robert J. Lederman, MD

From the Cardiovascular Branch (A.N.R., J.D.T., C.O., M.J., V.K.R., V.J.W., W.H.S., R.D.S., R.J.A., R.J.L.) and the Laboratory of Cardiac Energetics (M.A.G., R.B.T., E.R.M.), Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md; Division of Pediatric Cardiology (J.D.T., M.C.S.), Children’s National Medical Center, Washington, DC; and Department of Biomedical Engineering (R.B.T.), University of Alberta, Edmonton, Canada.

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

Received July 16, 2004; de novo received February 12, 2005; revision received April 15, 2005; accepted April 22, 2005.

Background— Real-time MR imaging (rtMRI) is now technically capable of guiding catheter-based cardiovascular interventions. Compared with x-ray, rtMRI offers superior tissue imaging in any orientation without ionizing radiation. Translation to clinical trials has awaited the availability of clinical-grade catheter devices that are both MRI visible and safe. We report a preclinical safety and feasibility study of rtMRI-guided stenting in a porcine model of aortic coarctation using only commercially available catheter devices.

Method and Results— Coarctation stenting was performed wholly under rtMRI guidance in 13 swine. rtMRI permitted procedure planning, device tracking, and accurate stent deployment. "Active" guidewires, incorporating MRI antennas, improved device visualization compared with unmodified "passive" nitinol guidewires and shortened procedure time (26±11 versus 106±42 minutes; P=0.008). Follow-up catheterization and necropsy showed accurate stent deployment, durable gradient reduction, and appropriate neointimal formation. MRI immediately identified aortic rupture when oversized devices were tested.

Conclusions— This experience demonstrates preclinical safety and feasibility of rtMRI-guided aortic coarctation stenting using commercially available catheter devices. Patients may benefit from rtMRI in the future because of combined device and tissue imaging, freedom from ionizing radiation, and the ability to identify serious complications promptly.

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