SHAPE Society

1. 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.

2. 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

3. Johns Hopkins University
Intravascular MRIIntravascular MRI

4. MR Imaging Guidewire
Surgi-Vision, Inc.

5. Johns Hopkins University
mm
B
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

6. 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

7. Johns Hopkins University
L. Hofmann, D. Bluemke
Fibrous cap
Lipid
core
Plaque CharacterizationPlaque Characterization

8. Johns Hopkins University
Restenosis - s/p renal stentRestenosis - s/p renal stent
5 mm
L. Hofmann, D. Bluemke
Rt renal artery
Guidewire
in IVC
restenosis

9. 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 mm
Vein
K. Yucel, et. al. Brigham and Women’s Hospital

10. Johns Hopkins University
MR-guided Balloon AngioplastyMR-guided Balloon Angioplasty
 Technical Challenges:Technical Challenges:
– MR compatible/visible Balloon AngioplastyMR compatible/visible Balloon Angioplasty
CatheterCatheter
– Methods for Monitoring Balloon AngioplastyMethods for Monitoring Balloon Angioplasty
ProcedureProcedure

11. Johns Hopkins University

12. Johns Hopkins University

13. Johns Hopkins University
Scan RoomScan Room
J. Serfaty et. al.

14. Johns Hopkins University
MRI-guided PTCAMRI-guided PTCA
90° 10° 90°10°
slice selection projection
J. Serfaty et. al.

15. DilatationDilatation of the Pulmonary Arteryof the Pulmonary Artery
C. Rickers, 2001

16. Dilatation with Gd filled balloonDilatation with Gd filled balloon
C. Rickers, 2001

17. Dilatation with air filled balloonDilatation with air filled balloon
C. Rickers, 2001

18. Johns Hopkins University
MR-guided Stent PlacementMR-guided Stent Placement
 Technical ChallengesTechnical Challenges
– MR compatible and visible stent deploymentMR compatible and visible stent deployment
devicedevice
– MR compatible stentMR compatible stent
– Methods of monitoring stent placementMethods of monitoring stent placement
procedureprocedure

19. Johns Hopkins University
MR Guidewire Tracking/PlacementMR Guidewire Tracking/Placement
sheath
 FGREFGRE
 256x162256x162
 20 mm slice20 mm slice
 4 element4 element
cardiac coilcardiac coil
A. Lardo et. al.

20. Johns Hopkins University
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 cardiac4 element cardiac
coilcoil
A. Lardo et. al.

21. Johns Hopkins University
Intravascular Wire StentIntravascular Wire Stent
CrossingCrossing
 SPGRSPGR
 256x162256x162
 TR/TETR/TE
 20 mm slice20 mm slice
 3 element3 element
cardiac coilcardiac coil
+ 1 element+ 1 element
internal coilinternal coil
stent 1
stent 2
MRI
guidewire
A. Lardo et. al.

22. Johns Hopkins University
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.

23. Johns Hopkins University
MR-guided Gene Therapy

24. 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

25. Johns Hopkins University
Design
Plaque
Plaque
Vessel
0.014” MRIG
Balloon
inflation
with 3% Gd
Gd/blue-dye medium or
Gd/GFP-lentivirus medium
X. Yang, et al. Circulation 2001

26. Johns Hopkins University
BA
X
Clinical significance?
X. Yang, et al. Circulation 2001

27. Johns Hopkins University
ConclusionConclusion
 MRI has potential to guide new and
conventional vascular interventions