Magnetic resonance guided renal denervation using active tracking: first in vivo experience in Swine
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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.
KeywordsInterventional MRI Renal denervation Arterial hypertension
Balanced steady state free precession
Cardiovascular magnetic resonance
Hematoxylin and eosin
Interventional cardiovascular magnetic resonance
Optical coherence tomography
Renal sympathetic denervation
Triggered angiography non-contrast-enhanced
The authors thank Juliane Geisler and Anika Jahn for excellent technical support.
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
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)”.
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