vascular interventions atalar- johns hopkins
TRANSCRIPT
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Vascular InterventionsVascular Interventions
Ergin Atalar, Ph.D.Ergin Atalar, Ph.D.
Johns Hopkins UniversityJohns Hopkins University
Departments of Radiology and Biomedical EngineeringDepartments of Radiology and Biomedical Engineering
DISCLOSURE:DISCLOSURE:
E. Atalar is a founder and stock holder of Surgi-Vision, Inc.E. Atalar is a founder and stock holder of Surgi-Vision, Inc.
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Johns Hopkins University
OverviewOverview
– Intravascular MRI (first human experiments)Intravascular MRI (first human experiments)– Balloon AngioplastyBalloon Angioplasty– Stent PlacementStent Placement– MR-guided Gene TherapyMR-guided Gene Therapy
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Johns Hopkins University
Intravascular MRIIntravascular MRI
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MR Imaging Guidewire
Surgi-Vision, Inc.
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mmB
FSE, 1200/13-msec TR/TE, Double IR blood suppression, 16 ETL, 4-cm FOV, 32 NEX,256x256 matrix, 10 min 14 sec acquisition time
ACM
• Resolution: 150 µm J. M. Serfaty et al.
Watanabe rabbit with a 0.032” MRI-Guidewire
Aortic wall imaging
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Johns Hopkins University
Post stent: human iliac IVMRIPost stent: human iliac IVMRI
L. Hofmann, D. Bluemke
Rt common iliac art.
Guidewire (venous)
Fibrous cap Lipid core
T1 - pre gad T1 - post gad
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Johns Hopkins UniversityL. Hofmann, D. Bluemke
Fibrous cap
Lipid core
Plaque CharacterizationPlaque Characterization
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Restenosis - s/p renal stentRestenosis - s/p renal stent
5 mm
L. Hofmann, D. Bluemke
Rt renal artery
Guidewire in IVC
restenosis
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In-Vivo Human Iliac Artery:In-Vivo Human Iliac Artery:Concentric AtherosclerosisConcentric Atherosclerosis
Angiography 20 MHz IVUS IVMRI
No Abnormality Concentric Atherosclerosis
5 mm 5 mmVein
K. Yucel, et. al. Brigham and Women’s Hospital
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MR-guided Balloon AngioplastyMR-guided Balloon Angioplasty
Technical Challenges:Technical Challenges:– MR compatible/visible Balloon Angioplasty MR compatible/visible Balloon Angioplasty
CatheterCatheter
– Methods for Monitoring Balloon Angioplasty Methods for Monitoring Balloon Angioplasty ProcedureProcedure
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Johns Hopkins University
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Johns Hopkins University
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Scan RoomScan Room
J. Serfaty et. al.
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MRI-guided PTCAMRI-guided PTCA
90° 10° 90°10°
slice selection projection
J. Serfaty et. al.
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DilatationDilatation of the Pulmonary Arteryof the Pulmonary Artery
C. Rickers, 2001
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Dilatation with Gd filled balloonDilatation with Gd filled balloon
C. Rickers, 2001
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Dilatation with air filled balloonDilatation with air filled balloon
C. Rickers, 2001
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MR-guided Stent PlacementMR-guided Stent Placement
Technical ChallengesTechnical Challenges– MR compatible and visible stent deployment MR compatible and visible stent deployment
devicedevice– MR compatible stentMR compatible stent– Methods of monitoring stent placement Methods of monitoring stent placement
procedureprocedure
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MR Guidewire Tracking/PlacementMR Guidewire Tracking/Placement
sheath
FGREFGRE 256x162256x162 20 mm slice20 mm slice 4 element 4 element
cardiac coilcardiac coil
A. Lardo et. al.
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MRI Guided Stent Positioning and DeploymentMRI Guided Stent Positioning and Deployment
stent
liver
stomach
Ao
SPGRSPGR 256x162256x162 TR/TE=4.4/1.2TR/TE=4.4/1.2 20 mm slice20 mm slice 4 element cardiac 4 element cardiac
coilcoil
A. Lardo et. al.
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Intravascular Wire Stent Intravascular Wire Stent CrossingCrossing
SPGRSPGR 256x162256x162 TR/TETR/TE 20 mm slice20 mm slice 3 element 3 element
cardiac coil cardiac coil + 1 element + 1 element internal coilinternal coil
stent 1
stent 2
MRIguidewire
A. Lardo et. al.
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High Resolution Aortic ImagingHigh Resolution Aortic Imaging
stent
MRIG(Imaging
Guidewire)
SPGR, 256x256, FOV=4 cm Guidewire element only
stented wall
156µm
A. Lardo et. al.
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Johns Hopkins University
MR-guided Gene Therapy
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A Remedy gene delivery balloon catheter
Gene delivery channel
Angioplasty balloon channel
Guidewire channel
0.014” MRIG
Tuning box
X. Yang, et al. Circulation 2001
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Design
Pla
qu
e
Pla
qu
e
Vessel
0.014” MRIG
Balloon inflation with 3% Gd
Gd/blue-dye medium or Gd/GFP-lentivirus medium
X. Yang, et al. Circulation 2001
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BA
X
Clinical significance?
X. Yang, et al. Circulation 2001
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ConclusionConclusion
MRI has potential to guide new and conventional vascular interventions