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  1. 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. 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. 3. Johns Hopkins University Intravascular MRIIntravascular MRI
  4. 4. MR Imaging Guidewire Surgi-Vision, Inc.
  5. 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. 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. 7. Johns Hopkins University L. Hofmann, D. Bluemke Fibrous cap Lipid core Plaque CharacterizationPlaque Characterization
  8. 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. 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. 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. 11. Johns Hopkins University
  12. 12. Johns Hopkins University
  13. 13. Johns Hopkins University Scan RoomScan Room J. Serfaty et. al.
  14. 14. Johns Hopkins University MRI-guided PTCAMRI-guided PTCA 90° 10° 90°10° slice selection projection J. Serfaty et. al.
  15. 15. DilatationDilatation of the Pulmonary Arteryof the Pulmonary Artery C. Rickers, 2001
  16. 16. Dilatation with Gd filled balloonDilatation with Gd filled balloon C. Rickers, 2001
  17. 17. Dilatation with air filled balloonDilatation with air filled balloon C. Rickers, 2001
  18. 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. 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. 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. 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. 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. 23. Johns Hopkins University MR-guided Gene Therapy
  24. 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. 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. 26. Johns Hopkins University BA X Clinical significance? X. Yang, et al. Circulation 2001
  27. 27. Johns Hopkins University ConclusionConclusion  MRI has potential to guide new and conventional vascular interventions