System architecture for a magnetically guided endovascular microcatheter.

Magnetic resonance imaging (MRI) guided minimally invasive interventions are an emerging technology. We developed a microcatheter that utilizes micro-electromagnets manufactured on the distal tip, in combination with the magnetic field of a MRI scanner, to perform microcatheter steering during endovascular surgery. The aim of this study was to evaluate a user control system for operating, steering and monitoring this magnetically guided microcatheter. The magnetically-assisted remote control (MARC) microcatheter was magnetically steered within a phantom in the bore of a 1.5 T MRI scanner. Controls mounted in an interventional MRI suite, along with a graphical user interface at the MRI console, were developed with communication enabled via MRI compatible hardware modules. Microcatheter tip deflection measurements were performed by evaluating MRI steady-state free precession (SSFP) images and compared to models derived from magnetic moment interactions and composite beam mechanics. The magnitude and direction of microcatheter deflections were controlled with user hand, foot, and software controls. Data from two different techniques for measuring the microcatheter tip location within a 1.5 T MRI scanner showed correlation of magnetic deflections to our model (R(2): 0.88) with a region of linear response (R(2): 0.98). Image processing tools were successful in autolocating the in vivo microcatheter tip within MRI SSFP images. Our system showed good correlation to response curves and introduced low amounts of MRI noise artifact. The center of the artifact created by the energized microcatheter solenoid was a reliable marker for determining the degree of microcatheter deflection and auto-locating the in vivo microcatheter tip.

Development and Validation of Endovascular Chemotherapy Filter Device for Removing High-Dose Doxorubicin: Preclinical Study.

To develop a novel endovascular chemotherapy filter (CF) able to remove excess drug from the blood during intra-arterial chemotherapy delivery (IAC), thus preventing systemic toxicities and thereby enabling higher dose IAC. A flow circuit containing 2.5 mL of ion-exchange resin was constructed. Phosphate-buffered saline (PBS) containing 50 mg doxorubicin (Dox) was placed in the flow model with the hypothesis that doxorubicin would bind rapidly to resin. To simulate IAC, 50 mg of doxorubicin was infused over 10 min into the flow model containing resin. Similar testing was repeated with porcine serum. Doxorubicin concentrations were measured over 60 min and compared to controls (without resin). Single-pass experiments were also performed. Based on these experiments, an 18F CF was constructed with resin in its tip. In a pilot porcine study, the device was deployed under fluoroscopy. A control hepatic doxorubicin IAC model (no CF placed) was developed in another animal. A second CF device was created with a resin membrane and tested in the infrarenal inferior vena cava (IVC) of a swine. In the PBS model, resin bound 76% of doxorubicin in 10 min, and 92% in 30 min (P < 0.001). During IAC simulation, 64% of doxorubicin bound in 10 min and 96% in 60 min (P < 0.001). On average, 51% of doxorubicin concentration was reduced during each pass in single pass studies. In porcine serum, 52% of doxorubicin bound in 10 min, and 80% in 30 min (P < 0.05). CF device placement and administration of IAC were successful in three animals. No clot was present on the resin within the CF following the in vivo study. The infrarenal IVC swine study demonstrated promising results with up to 85% reduction in peak concentration by the CF device. An endovascular CF device was developed and shown feasible in vitro. An in vivo model was established with promising results supporting high-capacity rapid doxorubicin filtration from the blood that can be further evaluated in future studies.

Bilateral cervical spinal dural arteriovenous fistulas with intracranial venous drainage mimicking a foramen magnum dural arteriovenous fistula.

We describe a unique case of bilateral cervical spinal dural arteriovenous fistulas mimicking an intracranial dural arteriovenous fistula near the foramen magnum. We review its detection via MRI and digital subtraction angiography and subsequent management through surgical intervention. Pitfalls in diagnostic angiography are discussed with reference to accurate location of the fistula site. The venous anastomotic connections of the posterior midline spinal vein to the medial posterior medullary vein, posterior fossa bridging veins, and dural venous sinuses of the skull base are discussed with reference to problem-solving in this complex case. The mechanism of myelopathy through venous hypertension produced by spinal dural fistulas is also emphasized.

Magnetic catheter manipulation in the interventional MR imaging environment.

PURPOSE: To evaluate deflection capability of a prototype endovascular catheter, which is remotely magnetically steerable, for use in the interventional magnetic resonance (MR) imaging environment. MATERIALS AND METHODS: Copper coils were mounted on the tips of commercially available 2.3-3.0-F microcatheters. The coils were fabricated in a novel manner by plasma vapor deposition of a copper layer followed by laser lithography of the layer into coils. Orthogonal helical (ie, solenoid) and saddle-shaped (ie, Helmholtz) coils were mounted on a single catheter tip. Microcatheters were tested in water bath phantoms in a 1.5-T clinical MR scanner, with variable simultaneous currents applied to the coils. Catheter tip deflection was imaged in the axial plane by using a "real-time" steady-state free precession MR imaging sequence. Degree of deflection and catheter tip orientation were measured for each current application. RESULTS: The catheter tip was clearly visible in the longitudinal and axial planes. Magnetic field artifacts were visible when the orthogonal coils at the catheter tip were energized. Variable amounts of current applied to a single coil demonstrated consistent catheter deflection in all water bath experiments. Changing current polarity reversed the observed direction of deflection, whereas current applied to two different coils resulted in deflection represented by the composite vector of individual coil activations. Microcatheter navigation through the vascular phantom was successful through control of applied current to one or more coils. CONCLUSIONS: Controlled catheter deflection is possible with laser lithographed multiaxis coil-tipped catheters in the MR imaging environment.