Ferumoxytol MR angiography for pre-TAVR assessment
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KeywordsRenal Impairment Aortic Stenosis Aortic Valve Replacement Volume Rendering Access Route
CT angiography (CTA) is standard for assessment of arterial access anatomy prior to transcatheter aortic valve replacement (TAVR) procedures . However, TAVR candidates are generally elderly with a higher prevalence of renal impairment than the general population and it is desirable to eliminate the use of iodinated contrast prior to catheterization because of the severe consequences of post-procedural renal failure . Further, gadolinium based contrast agents may be problematic in renal impairment because of the perceived risk of NSF. We hypothesized that ferumoxytol may be a suitable alternative to CTA and Gd contrast enhanced MRA in these patients.
Following informed consent and with approval from our IRB, we performed ferumoxytol enhanced MRA (FEMRA) for assessment of arterial access anatomy prior to TAVR in 20 patients (M/F = 15/5, mean age 84.5 yrs (+/- 8) with aortic stenosis and renal impairment (eGFR < 30 mls /m2.mn). FEMRA was performed at 3.0T in 15 patients and at 1.5T in 5, using a total dose of 4 mg /kg. Two patients had cardiac pacemakers. First pass and steady state FEMRA was performed in 16 patients and steady state imaging only in 4. The field of view extended from the neck to the proximal thighs in two overlapping stations. Images were post-processed with MIP and Volume Rendering.
In the current study, FEMRA was diagnostic, practical and safe at both 3.0T and 1.5T and provided sufficient information for confident planning of the access route for TAVR. FEMRA holds promise as an alternative to CTA and Gd CEMRA in patients with renal impairment.
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