Current State of MRI‐Guided Endovascular Arterial Interventions: A Systematic Review of Preclinical and Clinical Studies

BACKGROUND: MRI guidance of arterial endovascular interventions could be beneficial as it does not require radiation exposure, allows intrinsic blood‐tissue contrast, and enables three‐dimensional and functional imaging, however, clinical applications are still limited. PURPOSE: To review the current state of MRI‐guided arterial endovascular interventions and to identify the most commonly reported challenges. STUDY TYPE: Systematic review. POPULATION: Pubmed, Embase, Web of Science, and The Cochrane Library were systematically searched to find relevant articles. The search strategy combined synonyms for vascular pathology, endovascular therapy, and real‐time MRI guidance. FIELD STRENGTH/SEQUENCE: No field strength or sequence restrictions were applied. ASSESSMENT: Two reviewers independently identified and reviewed the original articles and extracted relevant data. STATISTICAL TESTS: Results of the included original articles are reported. RESULTS: A total of 24,809 studies were identified for screening. Eighty‐eight studies were assessed for eligibility, after which data were extracted from 43 articles (6 phantom, 33 animal, and 4 human studies). Reported technical success rates for animal and human studies ranged between 42% to 100%, and the average complication rate was 5.8% (animal studies) and 8.8% (human studies). Main identified challenges were related to spatial and temporal resolution as well as safety, design, and scarcity of current MRI‐compatible endovascular devices. DATA CONCLUSION: MRI guidance of endovascular arterial interventions seems feasible, however, included articles included mostly small single‐center case series. Several hurdles remain to be overcome before larger trials can be undertaken. Main areas of research should focus on adequate imaging protocols with integrated tracking of dedicated endovascular devices.