Feasibility of real-time magnetic resonance-guided stent-graft placement in a swine model of descending aortic dissection

• Published in: European heart journal Vol. 27; no. 5; pp. 613 - 620
• Main Authors: Eggebrecht, Holger, Kühl, Hilmar, Kaiser, Gernot M., Aker, Stephanie, Zenge, Michael O., Stock, Frank, Breuckmann, Frank, Grabellus, Florian, Ladd, Mark E., Mehta, Rajendra H., Erbel, Raimund, Quick, Harald H.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.03.2006; Oxford Publishing Limited (England)
• Subjects: Aneurysm, Dissecting - surgery; Animals; Aortic Aneurysm, Thoracic - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis; Cardiology. Vascular system; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Endovascular aortic dissection; Feasibility Studies; Magnetic Resonance Angiography; Magnetic resonance imaging; Medical sciences; Stents; Stent‐graft intervention; Sus scrofa; Swine; Cardiovascular disease; Phlebology; Stent; Arterial disease; Vascular disease; Swine; Surgery; Graft; Cardiology; Ungulata; Endoprosthesis; Stent-graft intervention; Magnetic resonance; Instrumentation therapy; Real time; Nuclear magnetic resonance imaging; Endovascular aortic dissection; Guidance; Vertebrata; Mammalia; Magnetic resonance imaging; Medical imagery; Aortic dissection; Feasibility; Models; Artiodactyla; Circulatory system; Aortic disease
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehi732

Aims To evaluate the pre-clinical feasibility of real-time magnetic resonance imaging (rtMRI) to guide stent-graft placement for experimental aortic dissection (AD) and to alleviate disadvantages of ionising radiation and nephrotoxic contrast media. Endovascular stent-graft placement for thoracic aortic disease is usually performed under X-ray guidance. The feasibility of rtMRI-guided stent-graft placement is currently not known. Methods and results By using a catheter-based technique, dissections of the descending thoracic aorta were successfully created in eight domestic pigs. Subsequent implantation of commercially available, nitinol-based stent-grafts was performed entirely under rtMRI guidance. By pre-interventional MRI, the mean minimal true-lumen diameter was 0.9 (0.825–0.975) cm. rtMRI permitted not only the successful and safe device navigation within the true lumen from the iliac arteries to the thoracic aorta, but also the precise positioning and deployment of the stent-graft and safe withdrawal of the delivery catheter in seven of eight pigs. This was achieved without any other complications. After the stent-graft placement, MRI demonstrated complete obliteration of the false lumen, which was confirmed at autopsy. All stent-grafts were well expanded resulting in an increase in the size of the true-lumen diameter to 2.05 (1.925–2.1) cm (P=0.066 vs. baseline). Conclusion In experimental AD, rtMRI-guided endovascular stent-graft placement is feasible and safe and has the potential for mitigating radiation and contrast-related side effects. Additionally, it allows not only pre-interventional diagnosis and detailed anatomic diagnosis, but also permits immediate post-interventional, anatomical, and functional delineation of procedure success that may serve as a baseline for future comparison during follow-up.