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Real-Time Magnetic Resonance-Guided Endovascular Repair of Experimental Abdominal Aortic Aneurysm in Swine

Venkatesh K. Raman, MD^_*, Parag V. Karmarkar, MSc^_*,, Michael A. Guttman, MSc, Alexander J. Dick, MD^_*, Dana C. Peters, PhD, Cengizhan Ozturk, MD, PhD^_*, Breno S.S. Pessanha, MD^_*, Richard B. Thompson, PhD, Amish N. Raval, MD^_*, Ranil DeSilva, MBBS, PhD^_*, Ronnier J. Aviles, MD^_*, Ergin Atalar, PhD, Elliot R. McVeigh, PhD and Robert J. Lederman, MD^_*,_*

^_* Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
Laboratory of Cardiac Energetics, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland

Manuscript received May 24, 2004; revised manuscript received February 20, 2005, accepted March 1, 2005.

^_* Reprint requests and correspondence: Dr. Robert J. Lederman, Cardiovascular Branch, Clinical Research Program, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, Maryland 20892-1538 (Email: Lederman{at}nih.gov).

OBJECTIVES: This study tested the hypotheses that endografts can be visualized and navigated in vivo solely under real-time magnetic resonance imaging (rtMRI) guidance to repair experimental abdominal aortic aneurysms (AAA) in swine, and that MRI can provide immediate assessment of endograft apposition and aneurysm exclusion.

BACKGROUND: Endovascular repair for AAA is limited by endoleak caused by inflow or outflow malapposition. The ability of rtMRI to image soft tissue and flow may improve on X-ray guidance of this procedure.

METHODS: Infrarenal AAA was created in swine by balloon overstretch. We used one passive commercial endograft, imaged based on metal-induced MRI artifacts, and several types of homemade active endografts, incorporating MRI receiver coils (antennae). Custom interactive rtMRI features included color coding the catheter-antenna signals individually, simultaneous multislice imaging, and real-time three-dimensional rendering.

RESULTS: Eleven repairs were performed solely using rtMRI, simultaneously depicting the device and soft-tissue pathology during endograft deployment. Active devices proved most useful. Intraprocedural MRI provided anatomic confirmation of stent strut apposition and functional corroboration of aneurysm exclusion and restoration of laminar flow in successful cases. In two cases, there was clear evidence of contrast accumulation in the aneurysm sac, denoting endoleak.

CONCLUSIONS: Endovascular AAA repair is feasible under rtMRI guidance. Active endografts facilitate device visualization and complement the soft tissue contrast afforded by MRI for precise positioning and deployment. Magnetic resonance imaging also permits immediate post-procedural anatomic and functional evaluation of successful aneurysm exclusion.

Abbreviations and Acronyms   3D = three dimensional   AAA = abdominal aortic aneurysm   MRA = magnetic resonance angiography   MRI = magnetic resonance imaging   rFOV = reduced field of view   SSFP = steady state free precession MRI   TE = echo time   TR = repetition time

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