title: Endovascular MR-guided Renal Embolization by Using a Magnetically Assisted Remote-controlled Catheter System.
abstract: Purpose To assess the feasibility of a magnetically assisted remote-controlled (MARC) catheter system under magnetic resonance (MR) imaging guidance for performing a simple endovascular procedure (ie, renal artery embolization) in vivo and to compare with x-ray guidance to determine the value of MR imaging guidance and the specific areas where the MARC system can be improved. Materials and Methods In concordance with the Institutional Animal Care and Use Committee protocol, in vivo renal artery navigation and embolization were tested in three farm pigs (mean weight 43 kg ± 2 [standard deviation]) under real-time MR imaging at 1.5 T. The MARC catheter device was constructed by using an intramural copper-braided catheter connected to a laser-lithographed saddle coil at the distal tip. Interventionalists controlled an in-room cart that delivered electrical current to deflect the catheter in the MR imager. Contralateral kidneys were similarly embolized under x-ray guidance by using standard clinical catheters and guidewires. Changes in renal artery flow and perfusion were measured before and after embolization by using velocity-encoded and perfusion MR imaging. Catheter navigation times, renal parenchymal perfusion, and renal artery flow rates were measured for MR-guided and x-ray-guided embolization procedures and are presented as means ± standard deviation in this pilot study. Results Embolization was successful in all six kidneys under both x-ray and MR imaging guidance. Mean catheterization time with MR guidance was 93 seconds ± 56, compared with 60 seconds ± 22 for x-ray guidance. Mean changes in perfusion rates were 4.9 au/sec ± 0.8 versus 4.6 au/sec ± 0.6, and mean changes in renal flow rate were 2.1 mL/min/g ± 0.2 versus 1.9 mL/min/g ± 0.2 with MR imaging and x-ray guidance, respectively. Conclusion The MARC catheter system is feasible for renal artery catheterization and embolization under real-time MR imaging in vivo, and quantitative physiologic measures under MR imaging guidance were similar to those measured under x-ray guidance, suggesting that the MARC catheter system could be used for endovascular procedures with interventional MR imaging. (©) RSNA, 2016.
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: Prasheel V
authors.initials: PV
authors.lastname: Lillaney
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Yang
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Losey
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: Alastair J
authors.initials: AJ
authors.lastname: Martin
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Cooke
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: Bradford R H
authors.initials: BR
authors.lastname: Thorne
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: David C
authors.initials: DC
authors.lastname: Barry
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: Andrew
authors.initials: A
authors.lastname: Chu
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: Carol
authors.initials: C
authors.lastname: Stillson
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: Loi
authors.initials: L
authors.lastname: Do
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Arenson
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: Maythem
authors.initials: M
authors.lastname: Saeed
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: Mark W
authors.initials: MW
authors.lastname: Wilson
authors.affiliation: From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.).
authors.forename: Steven W
authors.initials: SW
authors.lastname: Hetts
mesh_terms: D000818:Animals; D002406:Catheterization, Peripheral / Q000295:instrumentation*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000295:instrumentation*; D053783:Magnetic Resonance Imaging, Interventional; D008280:Magnetics; D023421:Models, Animal; D010865:Pilot Projects; D015641:Radiography, Interventional; D012077:Renal Artery; D013552:Swine