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Magnetic resonance guided renal denervation using active tracking: first in vivo experience in Swine

  • F. Bönner
  • S. Haberkorn
  • P. Behm
  • B. Schnackenburg
  • S. Krüger
  • S. Weiss
  • C. Meyer
  • M. Kelm
  • M. Neizel-WittkeEmail author
Original Paper

Abstract

Interventional cardiovascular magnetic resonance (iCMR) might evolve as a technique to improve procedural success rates in cardiovascular interventions by combining intraprocedural guidance and simultaneous lesion imaging. The objective of the present study was to prove feasibility and estimate safety of renal sympathetic denervation guided by real-time iCMR using active tracking. Six pigs were examined in a 1.5 T MRI-System (Achieva, Philips Healthcare, Best, Netherlands) equipped with non-invasive hemodynamic control and in-room monitors displaying an interventional software platform [Interventional MRI Suite (iSuite), Philips Research, Hamburg, Germany]. MR-guided renal denervation was performed using a MR conditional non-irrigated ablation catheter with active tracking (Imricor, Burnsville, MN, USA). Real-time imaging for device guidance was performed with a TFE sequence, vessel patency was assessed with a 3D non-contrast angiography and velocity encoded imaging. Oedema of the renal artery was visualized by a high-resolution T2 SPIR sequence. Renal sympathetic denervation was feasible in all cases with survival of all animals. Non-contrast angiography displayed renal artery patency accompanied by equal flow conditions before and after the ablation in all cases as measured by velocity encoded imaging. Oedema imaging displayed a significant increase in relative signal intensity at renal artery ablations sites pre and post intervention (p < 0.05). The histologic examination revealed no signs of perforation or bleeding, while sufficient ablation lesions could be depicted. MR-guided renal sympathetic denervation using active tracking is feasible and the initial data suggest safety of this procedure. MR-guided renal sympathetic denervation offers the inherent strength of high soft tissue contrast thereby providing target information without the use of iodinated contrast agents or radiation.

Keywords

Interventional MRI Renal denervation Arterial hypertension 

Abbreviations

bSSFP

Balanced steady state free precession

CMR

Cardiovascular magnetic resonance

ECG

Electrocardiogram

HE

Hematoxylin and eosin

iCMR

Interventional cardiovascular magnetic resonance

IVUS

Intravascular ultrasound

OCT

Optical coherence tomography

RDN

Renal sympathetic denervation

SI

Signal intensity

TRANCE

Triggered angiography non-contrast-enhanced

Notes

Acknowledgements

The authors thank Juliane Geisler and Anika Jahn for excellent technical support.

Funding

FB is funded by the German Research Council (Deutsche Forschungsgemeinschaft, DFG) BO-4264/1-1. MNW is funded by the Forschungskommission of the medical faculty Düsseldorf (14-2014). This study was in part supported by Cardiovascular Research Institute Düsseldorf (CARID).

Compliance with ethical standards

Competing interests

Dr. Schnackenburg is employed by Philips Healthcare. Dr. Weiss is employed by Philips Research Hamburg Dr. Krüger is employed by Philips Research Hamburg.

Ethical approval and consent to participate

Animal experiments were performed in accordance with the national guidelines on animal care and were approved by the state authority “Landesamt für Natur-, Umwelt- und Verbraucherschutz (LANUV)”.

Supplementary material

Supplementary material 1 (WMV 6713 KB)

Supplementary material 2 (WMV 1737 KB)

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Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • F. Bönner
    • 1
  • S. Haberkorn
    • 1
  • P. Behm
    • 1
  • B. Schnackenburg
    • 2
  • S. Krüger
    • 2
  • S. Weiss
    • 2
  • C. Meyer
    • 1
    • 3
  • M. Kelm
    • 1
    • 4
  • M. Neizel-Wittke
    • 1
    Email author
  1. 1.Division of Cardiology, Pulmonology and Vascular Medicine, Medical FacultyHeinrich Heine University DüsseldorfDüsseldorfGermany
  2. 2.Philips ResearchHamburgGermany
  3. 3.Department of Cardiology - Electrophysiology, University Heart CentreUniversity Hospital Hamburg-Eppendorf, (‘DZHK’ German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Luebeck, Germany)HamburgGermany
  4. 4.Medical Faculty, Cardiovascular Research Institute Düsseldorf (CARID)Heinrich Heine University DüsseldorfDüsseldorfGermany

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