Monitoring of Gadolinium-BOPTA Uptake into the Vessel Wall during Magnetic Resonance (MR)-Guided Angioplasty of the Peripheral Arteries with a Paclitaxel/Gadolinium-BOPTA-Coated Balloon: An Experimental Study at 3 Tesla

Abstract

Purpose: The success of paclitaxel distribution within the vessel wall during paclitaxel-coated balloon angioplasty to prevent restenosis cannot be monitored under X-ray guidance. The aim of this pilot study was to demonstrate the feasibility of monitoring Gadolinium-BOPTA delivery within the vessel wall during magnetic resonance (MR)-guided paclitaxel/Gadolinium-BOPTA-coated balloon angioplasty of the peripheral arteries.

Materials and Methods: 6 pigs (47 ± 2 kg) were investigated. All experiments were performed using a 3 Tesla MR scanner. MR-guided bilateral angioplasty of the iliac arteries was performed using a paclitaxel/MR contrast agent-coated balloon catheter. The feasibility of monitoring the delivery of Gadolinium-BOPTA to the vessel wall was assessed in 4 animals. In two additional animals, bilateral stenosis was surgically induced in the iliac arteries. Delivery of paclitaxel to the vessel wall was monitored using a 3 D T1-weighted gradient echo (GE) sequence for delineation of the vessel wall. Normalized signal intensity (SI) of the vessel wall was measured before and repeatedly after the intervention for 45 min. in all animals.

Results: Paclitaxel/gadolinium-BOPTA-coated balloon angioplasty was successfully accomplished in all iliac arteries (n = 12). In animals with stenosis MR-angiography demonstrated successful dilatation (n = 4). The normalized SI of the vessel wall on T1-weighted GE images significantly increased after the intervention in all animals with and without stenosis for more than 45 min. (p < 0.001).

Conclusion: Monitoring of Gadolinium-BOPTA into the vessel wall during MR-guided coated balloon angioplasty is feasible. This is a first step towards providing a tool for the online control of homogenous drug delivery after paclitaxel-coated balloon angioplasty.

Key Points:

• Monitoring of gadolinium-BOPTA uptake into the vessel wall during MR-guided coated balloon angioplasty is feasible.

• Endovascular MR-guided interventions on a 3 Tesla MR scanner are feasible.

• This is a first step towards providing a tool for online control of homogenous drug delivery after paclitaxel-coated balloon angioplasty.

Citation Format:

• Neizel M, Ruebben A, Weiss N et al. Monitoring of Gadolinium-BOPTA Uptake into the Vessel Wall during Magnetic Resonance (MR)-Guided Angioplasty of the Peripheral Arteries with a Paclitaxel/Gadolinium-BOPTA-Coated Balloon: An Experimental Study at 3 Tesla. Fortschr Röntgenstr 2014; 186: 388 – 393

Zusammenfassung

Ziel: Nach Paclitaxel-beschichteter Ballonangioplastie kann unter Röntgendurchleuchtung nicht kontrolliert werden, ob das Paclitaxel wirklich in die Gefäßwand aufgenommen wurde und so die Restenose-Rate vermindern kann. Ziel dieser Studie war es zu untersuchen, ob ein Monitoring von Gadolinium-BOPTA-Aufnahme in die Gefäßwand nach MR-gesteuerter beschichteter Ballon-Angioplastie der peripheren Gefäße möglich ist.

Material und Methoden: 6 Schweine (Gewicht 47 ± 2 kg) wurden untersucht. Alle Untersuchungen wurden an einem 3 Tesla MRT-Scanner durchgeführt. Eine MR-gesteuerte bilaterale Angioplastie der Iliacalgefäße wurde mit einem Paclitaxel/Gadolinium-BOPTA beschichtetem Ballonkatheter durchgeführt. Die Machbarkeit des Monitorings der Gadolinium-BOPTA-Aufnahme in die Gefäßwand wurde an 4 Schweinen untersucht. Zusätzlich wurden bei 2 weiteren Schweinen bilaterale Stenosen der Iliacalgefäße induziert. Die Aufnahme von Gadolinium-BOPTA in die Gefäßwand wurde mit einer T1-gewichteten Gradientenecho-Sequenz visualisiert. Zusätzlich wurde die normalisierte Signalintensität der Gefäßwand bei allen Tieren vor und bis zu 45 Minuten nach der Intervention gemessen.

Ergebnisse: Die Paclitaxel/Gadolinium-BOPTA beschichtete Ballonangioplastie wurde in allen Iliacalarterien erfolgreich durchgeführt (n = 12). Bei allen Tieren mit Iliaca-Stenose zeigte sich in der MR-Angiografie eine erfolgreiche Behandlung der Iliacalstenosen (n = 4). Die normalisierte Signalintensität der Gefäßwand stieg in beiden Gruppen signifikant nach der Intervention an (p < 0,001).

Schlussfolgerung: Visualisierung der Gadolinium-BOPTA-Aufnahme in die Gefäßwand während einer MR-gesteuerten Paclitaxel/Gadolinium-BOPTA beschichteten Ballonangioplastie ist machbar. Dies ist ein erster Schritt in die Richtung, eine Therapiekontrolle zu ermöglichen, mit welcher die homogene Medikamentenaufnahme nach beschichteter Ballonangioplastie nachgewiesen werden könnte.

Key words

interventional MRI - angioplasty - drug-eluting balloon - vascular - MR imaging

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