Magnetic Resonance-Guided Percutaneous Angioplasty of Femoral and Popliteal Artery Stenoses Using Real-Time Imaging and Intra-arterial Contrast-Enhanced Magnetic Resonance Angiography

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Abstract
The aim of this study was to demonstrate the possibility of performing magnetic resonance (MR)-guided interventional therapy for femoral and popliteal artery stenoses with commercially available materials supported by MR real-time imaging and intra-arterial MR angiography. A total of 15 patients suffering from symptomatic arterial occlusive disease of the lower limbs with 19 stenoses were included. Interventional intra-arterial digital subtraction angiography was performed before and after angioplasty on each patient as standard of reference. MR images were acquired on a 1.5-T MR scanner. A fast-low-angle shot (FLASH) 3D sequence was applied for a contrast enhanced MR-angiography (ceMRA). A total of 5 mL of diluted gadodiamide was injected via the arterial access. Maximum intensity projections (MIPs) were used as roadmaps and localizers for the interactive positioning of a continuously running 2D-FLASH sequence with a temporal solution of 2 images/second. The lesion was crossed by a balloon-catheter, which was mounted on a guidewire. The visibility was provided by the radiopaque markers on the balloon and was improved by injection of 1 mL of gadolinium into the balloon. Postinterventional control was performed by intra-arterial MR angiography and catheter angiography. Stenoses were localized by intra-arterial MR angiography. The guidewire/balloon combination was visible, and the balloon was placed correctly to cover the entire stenoses. Balloon dilation reduced the degree of stenosis by approximately 57% on average. No complications were observed. MR-guided balloon dilation of femoral and popliteal artery stenoses supported by real-time MR imaging and intra-arterial MR angiography is feasible with commercially available materials.

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