European Heart Journal Advance Access originally published online on January 23, 2006
European Heart Journal 2006 27(5):613-620; doi:10.1093/eurheartj/ehi732
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Feasibility of real-time magnetic resonance-guided stent-graft placement in a swine model of descending aortic dissection
1Department of Cardiology, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany
2Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany
3Department of General and Transplantation Surgery, University of Duisburg-Essen, Essen, Germany
4Institute of Pathophysiology, University of Duisburg-Essen, Essen, Germany
5Institute of Pathology, University of Duisburg-Essen, Essen, Germany
6Duke Clinical Research Institute, Durham, NC, USA
Received 17 October 2005; revised 20 December 2005; accepted 22 December 2005; online publish-ahead-of-print 23 January 2006.
* Corresponding author. Tel: +49 201 723 4888; fax: +649 201 723 5480.E-mail address: holger.eggebrecht{at}uni-essen.de
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.
Key Words: Magnetic resonance imaging • Endovascular aortic dissection • Stent-graft intervention
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