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Real-time vascular interventional magnetic resonance imaging

The future of aortic stent-graft placement?

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Abstract

Endovascular stent-graft placement is emerging as a promising alternative to medical and surgical treatment of patients with diseases of the descending thoracic and abdominal aorta. Precise placement of the stentgraft, which is currently performed under x-ray control, remains, however, challenging as there are several shortcomings to fluoroscopic guidance beyond that related to the harmful effect of radiation exposure and nephrotoxic contrast media. While transesophageal echocardiography and intravascular ultrasound have been used as adjunct imaging modalities during endovascular stent-graft procedures to overcome the limitations of angiography, these techniques have not mitigated the need for fluoroscopy.

Magnetic resonance imaging (MRI) guidance of vascular interventional procedures offers several potential advantages over fluoroscopy-guided techniques, including image acquisition in any desired orientation, superior 3D soft-tissue contrast with simultaneous visualization of the interventional device, absence of ionizing radiation, and avoidance of nephrotoxic contrast media. Magnetic resonance imaging is often used for pre-operative diagnosis of aortic disease and can provide all relevant information for the planning of endovascular stent-graft procedures as well as for accurate and immediate post-interventional evaluation. However, visualization of interventional instruments by MRI has proven to be the chief obstacle. This article will review current approaches that have been developed for depicting vascular instruments by MRI and will also discuss the first experimental experiences with MRI-guided endovascular stent-graft placement in a swine model of aortic dissection.

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Authors and Affiliations

  1. Klinik für Kardiologie, Westdeutsches Herzzentrum Essen, Klinikum der Universität Duisburg-Essen, Essen, Germany

    H. Eggebrecht MD & R. Erbel MD

  2. Dept. of Cardiology, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany

    H. Eggebrecht MD

  3. Institut für Pathophysiologie, Klinikum der Universität Duisburg-Essen, Essen, Germany

    G. Heusch MD

  4. Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Klinikum der Universität Duisburg-Essen, Essen, Germany

    M. E. Ladd PhD & H. H. Quick PhD

Authors
  1. H. Eggebrecht MD
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  2. G. Heusch MD
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  3. R. Erbel MD
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  4. M. E. Ladd PhD
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  5. H. H. Quick PhD
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Corresponding author

Correspondence to H. Eggebrecht MD.

Additional information

Source of funding: Dr. Eggebrecht was supported by a research grant from the University Duisburg-Essen (IFORES 10 + 2).

Prof. Dr. med. H.-R. Figulla (Jena, Germany) served as guest editor for the manuscript and was responsible for all editorial decisions, including the selection of reviewers. The policy applies to all manuscripts with authors from the editor’s institution.

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Eggebrecht, H., Heusch, G., Erbel, R. et al. Real-time vascular interventional magnetic resonance imaging. Basic Res Cardiol 102, 1–8 (2007). https://doi.org/10.1007/s00395-006-0624-1

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  • DOI: https://doi.org/10.1007/s00395-006-0624-1

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