Development of Methods for the MR-Guided Percutaneous Revascularization of Chronic Total Occlusions

The percutaneous revascularization of chronic total occlusions represents a major challenge to interventional cardiologists. Procedural success is currently limited by the inadequate soft-tissue contrast of x-ray fluoroscopy and the inability to visualize the position and orientation of a revascularization device with respect to the lesion and the vessel wall. In this thesis methods are developed that enable the percutaneous revascularization of occlusive lesions to be guided using magnetic resonance (MR) imaging. Unlike x-rays, MR has excellent soft-tissue contrast and this can be exploited to provide valuable information regarding the composition and geometry of the lesion.;A forward-looking intravascular imaging catheter is then presented that is capable of acquiring of high-resolution MR images of occlusive lesions and the vessel wall in front of the catheter. The imaging catheter consists of two orthogonal receive coils located at the distal tip of the catheter. The use of the imaging catheter is demonstrated in phantoms and in vivo.;A third method enables active visualization of MR compatible guidewires. The method utilizes a catheter-based pick-up coil that is magnetically coupled to the guidewire. The proposed technique enables one to concentrate all active components on a catheter thereby facilitating the use of safety features. Complete characterization is presented theoretically and validated experimentally. In addition, the use of a practical catheter device is demonstrated in an in situ environment.;Finally, future work required for the development of an integrated catheter-based device for the MR-guided revascularization of chronic total occlusions is discussed.;The first method is a robust and redundant technique for determining the position and orientation of a catheter inside an MR scanner. The technique uses phase information introduced into the MR signal by a small receive coil located at the distal tip of the catheter. The technique is developed theoretically and is demonstrated with a feasibility experiment.