Biomed Microdevices (2008) 10:379–392
DOI 10.1007/s10544-007-9146-3
Long term, implantable blood pressure monitoring systems
Joseph A. Potkay
Published online: 20 December 2007
# Springer Science + Business Media, LLC 2007
Abstract An overview of implantable measurement sys-
tems suitable for the long-term, continuous monitoring of
blood pressure is presented in this paper. The challenges,
design considerations and tradeoffs inherent in these
systems are overviewed and implantable sensors from both
industrial and research environments are reviewed. The
paper is concluded with an outlook of future directions for
implantable blood pressure monitoring systems.
Keywords Pressure sensor . Blood pressure .
Microsystems . Implanted systems . Telemetry . Wireless
1 Introduction
Long-term, continuous blood pressure monitoring is criti-
cally needed for a number of applications including the
monitoring of an animal’s cardiovascular function in
genetic and disease research (Whitesall et al. 2004), to
monitor repaired aneurysms (Allen 2005), for the measure-
ment of the intracardiac pressure of patients with congestive
heart failure (Becker 2006), and for the monitoring of
patients with a spinal cord injury (SCI; The National Spinal
Cord Injury Association 2006). Furthermore, long term
monitoring of a person’s blood pressure may lead to the
early diagnosis of health problems and reduced health care
costs (Mayo Clinic Staff 2006; O’Brien et al. 2003).
The most common methods for blood pressure measure-
ment are through the use of an external cuff or through a
J. A. Potkay (*)
Advanced Platform Technology (APT) Center,
Louis Stokes Cleveland Veterans Affairs Medical Center,
Cleveland, OH 44106, USA
e-mail: jpotkay@fes.case.edu
catheter-based system. The fundamental reasons that these
methods fail for long term, continuous pressure measure-
ment are comfort, intermittent measurement, occlusion of
blood flow, and percutaneous connections (e.g. an external
cuff utilizing the oscillatory method; Staessen et al. 2000).
In addition, non-invasive blood pressure measurements are
usually less accurate and stable than invasive methods
(Triedman and Saul 1994; Epstein et al. 1991; Kemmotsu et
al. 1991; Kermode et al. 1989). Methods using a catheter-
ization procedure and a pressure transducer, on the other
hand, are very accurate, but prohibit free movement of the
subject and may be unsafe for long-term use due compli-
cations such as trauma to the arterial vessel and infection
(Bowdle 2002; Scheer et al. 2002; Frezza and Mezghebe
1998; Wilkins 1985). One solution that does not occlude
flow or prohibit free movement and can provide continu-
ous, accurate data is an implantable device. In addition, in
certain cases, such as when the blood pressure at a specific
area of the body needs to be monitored over an extended
period of time, implantable devices may provide the only
possible solution.
The ability to create long-term, implantable blood
pressure measurement systems is the culmination of many
technological advancements in the fields of electrical and
biomedical engineering. The first of these advancements
was the development of wireless power transmission and
transformers by Nikola Tesla in the late 1800s (Tesla 1900,
1897). The theory of loosely coupled transformers, now
used for power and data transfer, was fully developed by
Terman in 1943 (Terman 1943). The next major advance-
ment was the invention of the transistor in 1948 and the
subsequent progress in the field of microelectronics driven
by Moore’s Law. These developments led to a reduction in
the size and power consumption of electronic circuitry and,
thus, the size of implanted systems. The combination of
380
microelectronic circuits and wireless technology led to the
first efforts in the 1960s and 1970s towards developing
implantable pressure sensors (Van Citters et al. 1966; Olsen
et al. 1967; Casadei et al. 1972; Cooper and Beale 1977).
The next major advancement was the development of
micro-electro-mechanical systems (MEMS) technology
(Petersen 1982; Wise and Clark 1978), spurred by
microelectronic fabrication technology; MEMS technology
enabled the creation of miniature sensors (Lee and Wise
1982) and integration of the sensor and circuitry on the
same silicon chip (Borky and Wise 1979), further minimiz-
ing the total size of the system. Developments in bio-
materials and packaging for implants (Ratner et al. 2004)
were the final major advancement enabling the creation of
long-term, implantable blood pressure monitoring systems.
This development has occurred over many years and has
increased the biocompatibility, performance, and lifetime of
the system when implanted. However, all of these areas
continue to advance, promising to enable new implantable
pressure sensors with increased performance, lifetime, and
biocompatibility.
This paper reviews the work and progress in the area of
continuous, long-term, implantable blood pressure sensors
and monitors; it is separated into four sections. First, the
device and system design issues and challenges of these
systems are considered. Then, the current methods, prod-
ucts, and research for intra-arterial and extra-arterial blood
pressure measurement are covered. Finally, the paper is
wrapped up with an outlook for the future application of
implantable blood pressure monitors.
2 System overview and considerations
A block diagram of a generic implantable blood pressure
sensing system is shown in Fig. 1 showing the various
components in the system. The implanted sensor is shown
on the right and is encapsulated in a biocompatible package.
The external block on the left is needed to interface with,
possibly provide power to, and download data from the
implanted sensor. Wireless data transfer is utilized, as wired
Fig. 1 Diagram of an implant-
able blood pressure sensing
system using active telemetry
Biomed Microdevices (2008) 10:379–392
communication is unsuitable for long-term applications in
which the patient is freely moving. A more in depth look at
the sensor and circuitry considerations, data and power
transfer, and biological and implant considerations of these
systems is given in the following subsections.
2.1 Sensor and circuitry considerations
There are a number of important considerations for the
sensor and circuitry in an implanted blood pressure
monitoring system, many of which strongly depend on the
application. First, the sensor should have an appropriate
measurement range and signal bandwidth, high resolution
and accuracy, and low signal drift. Resolution and accuracy
are related, but not equivalent. Accuracy is the ability of the
sensor to measure the true or actual value. Resolution is the
smallest signal change that the sensor can distinguish. A
sensor can have excellent resolution, but poor accuracy
(e.g. if it has not been calibrated). The converse is not true. A
list of sensing requirements for common ailments is given in
Table 1. As can be seen, the required sensing parameters
vary strongly based on the application. For example, heart
failure is typically monitored by measuring the pressure in
the pulmonary artery. This application requires a small
measurement range and high resolution and bandwidth, but
can tolerate a larger device due to the size of the pulmonary
artery. On the other hand, coronary heart disease is
monitored at the site of blockage in the coronary arteries
and requires a large measurement range and very small
device. Figure 2 shows a typical arterial blood pressure
waveform with a blood pressure of 115/80 mmHg and a
heart rate of 60 beats per minute (bpm). However, blood
pressure and heart rate can vary between 40 and 250 mmHg
and 40 and 200 bpm, respectively. Thus, for ailments such as
hypertension and autonomic dysreflexia, a measurement
range from 20 to 250 mmHg, a resolution of a couple
mmHg, and a bandwidth of 20 Hz are sufficient (Webster
1997). However, applications interested in other features of
the blood pressure waveform (such as aortic valve closure)
may require much higher resolution and larger bandwidth
(up to 200 Hz; Najafi and Ludomirsky 2004).
Biomed Microdevices (2008) 10:379–392 381

Table 1 Estimated requirements of various applications of blood pressure monitoring

Ailments Measurement Typical Measurement Measurement Measurement Signal Arterial

location values range resolution absolute bandwidth diameter
(mmHg) (mmHg) (mmHg) accuracy (Hz) (mm)
(mmHg)

Heart failure Pulmonary artery 8 to 30 0 to 100 0.3 2 0 to 200 25 to 35

Coronary artery disease Down stream of stent 60 to 150 20 to 250 1 5 0 to 80 3 to 5
or blockage
Abdominal aortic aneurysm Between graft and 20 to 90 20 to 250 1 5 0 to 80 15 to 40
aneurysm wall
Hypertension and Artery 60 to 150 20 to 250 2 5 0 to 20 2 to 20
autonomic dysreflexia

The data is inferred from various sources in the literature (Webster 1997; Receveur 2007; US Department of Health and Human Services 2005;
Pickering et al. 2005).

In addition to the device’s resolution, signal drift may
also affect the accuracy of the measurement over time; it
can be grouped into two categories and has two main
causes. The two categories are offset drift and sensitivity
drift. The two causes of drift are (1) changes in the
performance of the sensor from its calibrated state
independent of its surrounding environment, and, (2)
changes due to the environment in which the device is
implanted. The first cause can occur due to a number of
reasons, including aging of the device and mechanical
fatigue; it can be minimized through device and system
design. Additionally, the environment can cause drift in the
device through the attachment of tissue to (or encapsulation
of) the sensor over time, to diffusion of substances from the
environment into the sensing system, to the sensor’s
position physically changing or drifting over time, and to
variations to the local pressure and composition within the
body, among others. These causes can be reduced through
the careful design of device packaging and materials (see
Section 2.3). Both causes of drift can lead to sensitivity and
offset drift; some drift is present in all devices. If there is
significant drift, at best, the sensor will need to be
frequently calibrated and, at worst, its readings will be
unreliable. Some commercial devices have achieved a
signal drift of less than 2 mmHg per month (Data Sciences
International 2005).
Next, power consumption of the implanted sensor and
circuitry should be minimized as much as possible for a
number of reasons. First, power consumption generates
heat which may damage the surrounding tissue (see
Biological and Implant Considerations). Second, if the
system is battery driven, a low power consumption will
reduce the frequency of recharges, increase the system’s
lifetime, and reduce the required battery size. On the other
hand, if the system is remotely powered, decreasing its
power consumption will increase its communication dis-
tance due to the fact that it will require less transmitted
energy to operate. The next section has more information

Fig. 2 Diagram of a typical

arterial blood pressure
waveform
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on the communication and power options for implanted
systems.
Finally, the overall size of the implanted sensor and
circuitry should be small in order to minimize its impact on
the body (e.g. blood flow). For this reason, microtechnol-
ogy (micro-electro-mechanical systems or MEMS) and
nanotechnology (nano-electro-mechanical systems or
NEMS) are favorable techniques for device fabrication
due to their ability to create miniature devices.
2.2 Communication and power
Wireless communication systems can be grouped into three
categories based on the characteristics of the primary and
secondary communication nodes (in this case, the external
implanted node, respectively; DeHennis 2004). In the first
category, known as wireless communication, both nodes
have internal power sources and only data is transmitted
wirelessly. This category has the advantages of high data
bandwidth and a large wireless range. However, the power
sources are typically batteries with finite lifetimes and
requiring frequent charging. In addition, these systems tend
to be large in order to accommodate the power source and
associated circuitry. For long-term implants, the finite
lifetime and large size of this category may not be
acceptable, depending on the application. However, having
an on-board power source enables continuous or periodic
data collection without the need for an external interface.
Overall, this category has a wireless range between 20 and
1000 cm. The PA-C10 from Data Sciences International
(Data Sciences International 2005) implements wireless
communication to achieve a device with a size of 1.1 cm3
and a communication distance of up to 10 m; however, its
lifetime is only 1.5 months.
In the second category, known as active telemetry, the
power source is only located in the primary node, the
secondary node is remotely powered by the primary node,
and each node has a transmitter and receiver for commu-
nication. Relative to the first category, active telemetry has
a longer lifetime due to no power system in the secondary
node, but it has a limited communication range due to its
limited (remotely delivered) power. In addition, wireless
communication and power transfer can theoretically occur
via a number of means, including antenna-based transmis-
sion, inductively coupled transmission, and optical trans-
mission. Overall, this category has a wireless range
between 5 and 30 cm. To date, very few implantable
pressure sensors have utilized active telemetry, likely due to
the increased complexity compared to passive telemetry
(see below). However, a wireless environmental monitor
implementing active telemetry (DeHennis and Wise 2005)
achieved a communication distance of 4 cm and a size of
0.32 cm3 without an integrated battery.
Biomed Microdevices (2008) 10:379–392
The third category, or passive telemetry, is different from
active telemetry in that there is only one transmitter and
receiver for communication. In this case, the secondary
node passively loads the primary node and that loading can
be correlated to the measurement of the secondary node. In
practice, passive telemetry is typically achieved through the
use of coupled inductors. This type of system has an
extended lifetime and minimized secondary node size, but
has the smallest data bandwidth and wireless range of the
three systems. This category is thus highly suited for
implanted applications that are close to the surface of the
body and require low data rates and minimum size.
However, both the second and third categories require an
external interface for operation and frequent or continuous
measurements may not be possible. This category has a
wireless range around 0.5 to 20 cm. CardioMEMS has
achieved a passive-telemetry-based system (Becker 2006;
Ellozy 2004) with a communication distance of 20 cm, size
less than 0.23 cm3 and lifetime greater than 3 years.
Overall, the type of wireless communication is deter-
mined by the required communication distance (location of
the implant in the body and of the external node), by the
required device lifetime (battery versus remotely powered),
by the required device size (implant location), and by the
required data bandwidth (informational content of the
specific blood pressure waveform). More examples of
devices that utilize each type of communication are given
in Sections 2 and 3. For all three of the categories of
wireless communication, however, it is important that the
data and power transmission does not cause tissue damage,
as discussed in the next section.
2.3 Biological and implant considerations
For long-term operation, the implanted blood pressure
monitor must additionally be designed so that it has a
minimal impact on the body that will host it and vice-versa.
Biocompatibility is a complex subject with many compo-
nents and issues. A thorough treatment is given elsewhere
(Harsanvi 2000); however, an overview of the most
relevant issues and packaging solutions is given below.
2.3.1 Influence of the body on the system
The body is a harsh environment and it will do its best to
isolate and passivate any object that appears foreign or
impacts its function. Thus, the implanted blood pressure
monitoring system must be designed not only to appear
native to the body, but also to be minimally impacted by the
properties and actions of the body. Most generally, the body
can be approximated as a warm saline bath. Thus, the
system must be able to withstand submersion in a wet
solution at a mean temperature of 37°C with a variation of
Biomed Microdevices (2008) 10:379–392
plus or minus a few degrees. Therefore, the systems are
typically designed with hermetic packages (see Section 2.3.3)
to prohibit the diffusion of substances into the device. In
addition, the system must be designed so that it is not
impacted by the attachment of various biological substances,
such as connective tissue. In the case of diaphragm pressure
sensors, the mechanical stiffness of the diaphragm must be
much greater than the mechanical stiffness of the potential
attached tissues in order to minimize their impact on the
device’s functionality.
2.3.2 Impact of the device on the body
In general, the implantation and long term impact of the
device on the body should be minimized. Thus, the device
should be implanted non-invasively, if possible—perhaps
delivered by a catheter or through a needle injection. The
sensor materials must also be biocompatible and cause very
little or no short or long-term damage to the artery or
inflammation of the surrounding tissue. The sensor should
not lead to an infection or hardening of the artery wall, and
should not restrict blood flow or cause the blood to
coagulate or clot significantly. It should be designed so
that it does not become dislodged and its location does not
migrate. The system may not contain toxic materials that
may be released into the blood or body tissue if the device
is fractured or destroyed.
Next, the wireless implanted system should not exceed
recommended levels for electromagnetic radiation and
tissue heating (Tech. Rep. ANCI 1982; Tech. Rep. IEEE
1992; Lin 2003; Yu 2004; Adair and Petersen 2002). In
1966, the American Standards Association set a recom-
mended limit of 10 mW/cm2 for frequencies from 10 MHz
to 100 GHz (Tech. Rep. USASI Standard 1966). More
recently, the recommendations have been updated to
include frequency dependent limits (Tech. Rep. ANCI
1982; Tech. Rep. IEEE 1992). For instances where only a
small part of the body is exposed to the field (as in wireless
implants), the limits are substantially relaxed (Tech. Rep.
IEEE 1992; Yu 2004), resulting in a magnetic and electric
field and power density limits shown in Table 2. If the
Table 2 A subset of the recommended limits of human exposure to
radio frequency electromagnetic fields for partial body exposure in
controlled environments
Frequency Electrical Magnetic Power density E-field,
(MHz) field (V/m) field (A/m) H-field (W/cm2)
0.1–3.0 2745 73/f 2, 200/f2
3.0–30 8238/f 73/f 18/f2, 200/f2
30–100 230 73/f 0.20, 200/f2
f is the frequency in MHz.
383
implanted system uses radio frequency (RF) communica-
tion or emits electromagnetic fields, these limits should be
followed.
In addition, it is recommended that the implanted system
should not cause greater than a 1°C temperature rise in the
surrounding tissue to avoid tissue damage (Yu 2004). Thus,
its power dissipation should be closely regulated. For a 15×
15×2 mm implant, approximately 23 mW is required to
increase the temperature of surrounding body tissue by 1°C
(Yu 2004) and, thus, a device of this size should be
designed to consume less than 23 mW.1 The power required
to achieve a 1°C temperature rise increases with the square
root of the device’s surface area. Thus, a larger device can
consume more power because that power is spread out over
a larger area. In general, for an implant utilizing RF
communication, a frequency in the low-MHz region
provides a good compromise between bandwidth and tissue
absorption (DeHennis 2004; Yu 2004). Similarly, for a
device utilizing optical wireless communication, such as in
(Ackermann et al. 2006; Kudo et al. 1988), tissue damage
due to heating and radiation exposure should be minimized.
For wavelengths from 600 to 1300 nm (from the orange
region of the visible spectrum to the near infrared), light
absorption of most tissues is minimal permitting significant
penetration of the signal into the body (Vo-Dinh 2003).
Even so, some absorption occurs and long-term tissue
damage must be avoided.
2.3.3 Biocompatible packaging
In order the meet the requirements of the two subsections
above, various materials and packaging technologies have
been developed for implantable blood pressure monitoring
systems. The most common approach utilizes a hermetic
enclosure that is coated with a biocompatible material. The
hermetic enclosure protects the sensitive portion of the
system from the body and the biocompatible coating is used
to improve the interface of the implant with body. In
previous work, the hermetic housing has been formed from
a silicon-glass anodic bond (Najafi and Ludomirsky 2004;
Park et al. 1998; Takahata et al. 2004; DeHennis and Wise
2006; Ziaie and Najafi 2001), a glass-glass fusion bond
(Allen 2005), chemical vapor deposited oxide (Eggers et al.
2000), and ceramic (Fonseca et al. 2006).
Various coatings have also been utilized; in addition to
being biocompatible and hemocompatible, an ideal coating
should uniformly cover the entire implanted system and
have good adhesion to the device (Behrend et al. 1998).
1
This calculation assumes a tissue thermal conductivity of 4.2 mW/
cm-°C. This value will vary based on the location in the body and the
composition of the surrounding tissue.
384
The most widely used coating is silicone rubber (Allen
2005; Becker 2006; Data Sciences International 2005;
Cong et al. 2004), which can be injection molded to
completely encapsulate the implanted device. Parylene has
been utilized as well (DeHennis and Wise 2006), mainly
due to its reduced water absorption compared to silicone.
Thus, it serves as a secondary barrier to the harsh
environment of the body or to protect components outside
the hermetic housing. Other encapsulants that have been
utilized include polytetrafluoroethylene (PTFE; Fonseca et
al. 2006) and parylene (DeHennis and Wise 2006).
2.4 Impacts of potential energy, kinetic energy, and absolute
pressure sensing
The measurement of blood pressure is affected by a number
of practical issues which must be taken into account when
designing the measurement system. Most significantly, it is
affected by potential energy and kinetic energy at the site of
measurement, and, if an absolute pressure sensor is used, by
changes in the surrounding atmospheric pressure. These
issues are discussed below.
Blood pressure, by definition, is a relative quantity; its
value is the absolute pressure of blood minus the absolute
pressure of the surrounding atmosphere. However, many
micromachined and miniature sensors today are absolute
pressure sensors. Systems that employ absolute sensors
must therefore include a secondary sensor to measure
atmospheric pressure, so that this value may be subtracted
from the pressure measured by the sensor to achieve a true
measurement of blood pressure. If this is not done, blood
pressure measurements will vary with changes in atmo-
spheric pressure. For remotely powered passive systems
(Najafi and Ludomirsky 2004; CardioMEMS 2007a), an
atmospheric pressure sensor may be included in the
external interface. For other systems, the solution is not as
straight forward and a means to measure the pressure of
blood relative to atmospheric pressure must be imple-
mented. To solve this problem, implantable sensors that
measure the pressure of blood relative to that of the body
have been investigated (Cong et al. 2004).
In various practical situations, potential and kinetic
energy may also impact the accuracy of blood pressure
measurements (Webster 1997). This can be seen through
Bernoulli’s equation for frictionless flow (Burton 1972):
rv2
PT ¼ P þ rgh þ ð1Þ
2 sensor with a 3 mm titanium diaphragm. It boasted an
In Equation 1, PT is the total measured pressure, P is the
blood pressure, ρ is the density of blood, g is the
acceleration of gravity, h is the height of the sensor above
the heart, and v is the velocity of blood flow. As can be
seen, the measured blood pressure, PT, can differ from the
Biomed Microdevices (2008) 10:379–392
desired static blood pressure, P, due to the potential energy
(ρgh) and kinetic energy (ρv2/2) terms. Because of potential
energy, the measured value of blood pressure will change if
the position of the sensor is varied relative to the heart. In
fact, each 1.3-cm increase in the height of the sensor
relative to that of the heart will increase the blood pressure
reading by 1 mmHg (Webster 1997). This clearly has an
impact on long-term monitoring of blood pressure. Either a
means to ensure that the sensor is always at the same height
relative to the heart or a way to compensate for changes in
potential energy must be incorporated into the system for
accuracy. Note that sensors that are placed close to the heart
or in the heart will undergo very little change in potential
energy, and thus will not suffer as much from this problem.
Finally, because of the impact of kinetic energy on
measurement energy, care must be taken in the positioning
of the sensor in the body and to ensure that its position will not
change over time. Since this effect is highly dependent on
blood flow velocity, it can be minimized by placing the sensor
parallel to the flow of blood and near the wall of the artery.
Note that kinetic energy will only impact sensors that are in
direct contact with blood flow. More details on this artifact can
be found elsewhere (Webster 1997; Burton 1972).
The next sections review the current industrial work and
research in the area of implantable intra-arterial and extra-
arterial blood pressure sensor systems.
3 Intra-arterial blood pressure monitors
As covered in the previous section, there are numerous
tradeoffs and considerations for implantable blood pressure
monitors. This section looks at the various approaches that
have been taken in academia and industry. Although the
pressure sensing techniques and considerations reviewed in
this paper are suitable for other applications including the
long-term measurement of intraocular (Frischholz 2006;
Scknakenberg et al. 2000), intracranial (Frischholz 2006;
Banister et al. 2000; Flick and Orglmeister 2000) and
bladder pressures (Siwapornsathain et al. 2002; Coosemans
and Puers 2005), only the work related to blood pressure
measurement is reviewed in this paper.
In 1972, an early effort in the area of implanted wireless
pressure monitoring devices utilized an active transmitter
and integrated battery (Casadei et al. 1972). The system
consisted of a 13×47×67 mm transmitter coated with an
epoxy resin and weighing 58 g, and a commercial pressure
impressive 20 m telemetry range, but its total lifetime was
estimated at 1 year assuming 2 h of operation each day. It
was successfully tested in dogs for periods of up to
9 months and exhibited an implanted signal drift of 7%
per month. Overall, the size and limited lifetime of the
Biomed Microdevices (2008) 10:379–392
device were its major drawbacks. With the improvements in
the field of rechargeable batteries and microfabrication,
more recent efforts have investigated devices with longer
lifetimes and smaller sizes.
In 1998, Park, et al., at the Korea Advanced Institute of
Science and Technology (KAIST), investigated a capacitive
pressure sensor with passive telemetry (Park et al. 1998)
that was targeted towards the measurement of cardiovascu-
lar, intraocular and brain pressure monitoring. The compact
device was the first of its kind to integrate a pressure sensor and
inductor on the same chip, minimizing the size of the device
and maximizing its performance (by minimizing parasitic
capacitance and resistance). The 3×3×0.6 mm structure,
shown in Fig. 3, was formed using bulk micromachining
and silicon–glass anodic bonding and had a pressure range
from 0 to 100 mmHg. Both the pressure sensitive capacitor
and inductor for passive telemetry were encased in hermetic
chambers. The compact, high-performance device only
lacked a biocompatible coating and acute and chronic in vivo
testing before it would be applicable for clinical use (likely
for monitoring heart failure due to its limited measurement
range). However, its efficient design likely inspired later work
in the field.
In 2000, Chatzandroulis et al., at the NCSR “Demokritos”
Institute of Microelectronics in Athens, Greece, continued
the work in implantable blood pressure monitors through
their investigation of a passive telemetry system using a
capacitive pressure sensor with a SiGeB diaphragm and a
capacitance-to-frequency converter to control the RF mod-
ulator (Chatzandroulis et al. 2000). The system performed
well in a simulated arterial environment and consumed
4 mW of power. However, due to the small device size
(~3×2×0.6 mm), the power required to operate the device
may result in a temperature increase that is dangerous to
surrounding tissue (depending on the implant location). For
clinical application, the device would need to be encased in
a biocompatible package, its power consumption possibly
Fig. 3 A passive telemetry, LC
resonant pressure sensor with
integrated inductor and capacitor
by Park et al. (1998)
385
reduced, and its short and long-term in vivo performance
verified.
In 2004, Takahata, et al., at the University of Michigan
presented a combination of an arterial stent and a passive
telemetry (no battery) blood flow and pressure sensor
(Takahata et al. 2004, 2003). The stainless steel stent was
fabricated using micro-electro-discharge machining and the
pressure sensors were formed using bulk and surface
micromachining and anodic bonding. The 20 mm-long
and 3.5 mm-diameter device was deployed in an artificial
artery using a standard angioplasty balloon. Once inflated,
the stent also served as the inductor in the inductive link.
The work at Michigan continued with the development, by
DeHennis et al., of a fully integrated, battery free, remotely
powered system for arterial pressure and flow sensing
(DeHennis and Wise 2006). The inductor for telemetry,
pressure sensors and circuitry were fabricated using a
combination BiCMOS process and bulk micromachining
on a single 2 mm3 chip and consumed only 340 μW of
power. The device was coated in a 1 μm layer of parylene-
C to improve its biocompatibility and successfully tested in
a mock artery. It had a minimum detectible differential
pressure of 3 mmHg (corresponding to a 13% reduction in
arterial flow) and is shown in Fig. 4. In this novel work,
greater attention was given to designing the device for
implantation than previous work; a large portion of the
device was formed from stainless steel, it was coated in
parylene, and it had a very thin profile. However, no in-
vivo testing was performed to investigate hemocompati-
bility and biocompatibility.
In 2006 at Georgia Institute of Technology, Fonseca, et
al., reported the first flexible micromachined wireless
pressure sensor (Fonseca et al. 2006). Made out of Liquid
Crystal Polymer (LCP), polytetrafluoroethylene (PTFE),
and Fluorinated Ethylene Propylene copolymer (FEP), the
devices (Fig. 5) are flexible and can be folded into shapes
suitable for injection into the body via a catheter. An acute
386
Fig. 4 A fully integrated, pas-
sive telemetry, arterial pressure
and flow sensor by DeHennis, et
al. (DeHennis and Wise 2006)
version of the device was successfully tested in canines
over a 60-day period and improved results are expected for
the chronic version. Targeted at monitoring abdominal
aortic aneurisms (AAAs), this work represents one of the
first academic implantable blood pressure monitors with
strong consideration for biocompatibility and minimally
invasive delivery. However, the device’s in vivo accuracy
has thus far been limited by signal drift.
In industry, Data Sciences International (DSI) of St.
Paul, MN, has developed a series of implantable trans-
mitters that can measure various physical parameters in
research animals. The PA-C10, PA-C40 and PA-D70 (Data
Sciences International 2005), shown in Fig. 6, measure
pressure and activity in small, medium, and large animals,
respectively. The integrated catheter transfers pressure from
the specified measurement location (in this case, the artery)
to the body of the transmitter. These systems have
successfully been used to measure arterial systolic and
diastolic pressure, mean pressure and heart rate. The PA-
C10, PA-C40, PA-D70 weigh 1.4, 9.0, and 37 g, have
volumes of 1.1, 4.5 and 25 cc, and have batteries with
warranted lives of 1.5, 4, and 4 months, respectively. All of
the transmitters are encapsulated in silicone elastomer and
have initial accuracies of ±3 mmHg. The drift of the PA-
C10 and PA-D70 is less than 2 mmHg per month. Research
studies have utilized DSI’s devices (Kramer et al. 2000;
Mills et al. 2000) and a study in 2004 (Whitesall et al.
Fig. 5 Cross-section (left) and
picture (right) of the Georgia
Tech flexible wireless pressure
sensor (Fonseca et al. 2006)
Biomed Microdevices (2008) 10:379–392
2004) showed that a DSI PA transmitter compared
favorably with the tail-cuff blood pressure measurement
method in mice. There are two main drawbacks of the DSI
devices. First, an incision must be made in the artery to
insert the integrated catheter and measure arterial pressure.
This incision may result in possible complications. Second,
the batteries in the devices have a warranted lifetime of less
than 4 months and would need to be surgically replaced
after expiration. For these reasons, the devices are only
suitable for the short or medium term measurement of
blood pressure in laboratory animals.
Integrated Sensing Systems, Inc., of Ypsilanti, MI, is
developing an ultraminiature, battery-less, capacitive pres-
sure sensor that can be implanted via a minimally invasive,
outpatient procedure (Najafi and Ludomirsky 2004; Inte-
grated Sensing Systems 2002). In 2004, the battery-less, RF
device was successfully tested in animals and achieved a
real time, 400 samples/second heart pressure waveform that
was in good agreement with a catheter-based pressure
sensor, had an accuracy less than 1 mmHg, and achieved a
communication/powering (using a handheld unit) distance
of 3–4 cm. The device is formed using etched-back
anodically bonded silicon and glass wafers in the Dissolved
Wafer Process (Zhang et al. 2001). The second revision of
the device, in development, will have a volume less than
20 mm3, a resolution less than 0.1 mmHg, a handheld
readout up to 10 cm from the implanted system and a
Biomed Microdevices (2008) 10:379–392
Fig. 6 The PA-C10, PA-C40,
and PA-D70 implantable pres-
sure sensors from Data Sciences,
International (Data Sciences In-
ternational 2005)
10-year, implanted lifetime. This device, shown in Fig. 7,
has not yet been approved for use in humans.
CardioMEMS, founded in 2001 on technology from the
Georgia Institute of Technology and located in Atlanta, GA,
has successfully implanted wireless blood pressure sensors
in humans for the monitoring of abdominal aortic aneur-
ysms and heart failure (Becker 2006; CardioMEMS 2007b).
As of December 2005, the EndoSensor™ has been
implanted in over 100 patients with abdominal aortic
aneurysms in 4 countries. The battery-less, 5×30 mm
device has a wireless range of about 20 cm. The micro-
machined device, shown in Fig. 8, is formed utilizing two
Fig. 7 Second generation implantable cardiovascular monitor from
ISSYS, Inc. (Integrated Sensing Systems 2002)
387
fused silica wafers, electrodeposited inductors, and fusion
bonding (Allen 2005). In February of 2006, CardioMEMS
achieved the first human implant of a wireless catheter-
based pressure sensor (CardioMEMS 2007b). The device,
known as the HeartSensor™ and targeted at detecting heart
failure, utilizes a capacitive pressure sensor and measures a
resonant frequency shift with changes in pressure. The
clinical success of the CardioMEMS devices can be
attributed to several factors. First, the designs (both
performance and biocompatibility) were targeted at specific
niche applications. Also, the structure and operation of the
device are simple and elegant. Finally, it should also be
noted that in the case of the EndoSensor™ device, the
implanted device is not located within the bloodstream, but
instead outside of the endovascular repair. Thus, clotting
Fig. 8 Picture of the CardioMEMS EndoSensor™ (Becker 2006)
388
Fig. 9 An extra-arterial implant-
able blood pressure microsystem
by Ziaie and Najafi (Ziaie and
Najafi 2001)
and coagulation of blood are not as much of an issue as in
other blood pressure monitoring applications.
Campus Micro Technologies is a German company
developing a family of implantable telemetric pressure
monitoring systems (Campus Micro Technologies GmbH
2007). Its system targeted at monitoring aneurysm repair is
based, in part, off of technology developed by Eggers et al.
in 2000 (Eggers et al. 2000). The wirelessly powered
system developed by Eggers et al. consisted of a surface
micro-machined capacitive type absolute pressure sensor
(0.8×2×0.5 mm) and two low power ASIC for sensor read-
out and telemetry. The sensor technology consisted of an
array of 16 75×75 μm capacitive pressure sensors and an
identical pressure-insensitive reference array. The complete
system demonstrated a resolution less than 1 mmHg, a
frequency response of 15 Hz, a power consumption less
than 350 μW, and a transmission distance up to 5 mm. It
was encased in a silicone-based coating to improve its
biocompatibility and decrease moisture absorption.
Medtronic has also entered into the field of implantable
blood pressure monitoring devices with its implantable
haemodynamic monitoring (IHM) series of devices. The
wristwatch-sized product line was intended to continuously
monitor patients with heart failure and provide data to
doctors via the internet. Although the devices achieved
some clinical success (Steinhaus et al. 2005; Braunschweig
Fig. 10 An improved drift,
long-term arterial cuff devel-
oped at Case Western Reserve
University (Cong et al. 2006)
Biomed Microdevices (2008) 10:379–392
et al. 2006), it failed to be approved by the FDA in 2007
(Feder 2007). According to a panel of experts assembled by
the FDA, the device did not keep enough patients out of the
hospital to prove its effectiveness.
Remon Medical Technology, an Isreali company, is
developing implantable sensing systems tartgeted at
monitoring congestive heart failure (CHF) and sac pres-
sure after an abdominal aortic aneurysm (AAA) repair
(Remon Medical Technologies Inc. 2007). Both devices
utilize acoustic waves to transmit power and data. The
advantage of this approach is that acoustic waves are not
absorbed by tissue and, thus, data and power can be
transmitted very efficiently. In addition, it does not require
an antenna and, thus, helps to minimize the device size.
The company achieved the first human implantation of its
ImPressure® device to monitor intra-aneurysm pressures
in 2003 (Ellozy 2004; Remon Medical Technologies Inc.
2007) and its first European use of its implantable CHF
monitor in 2006 (Remon Medical Technologies Inc.
2007). In the clinical trials of the ImPressure®, the 3×
9×1.5 mm devices were hand-sewn to the outside of a
stent graft. Excellent agreement was found between a
catheter-based and the ImPressure® device and it success-
fully detected endoleaks in several patients. Despite their
clinical success, sensor details and specifications are
difficult to find.
Biomed Microdevices (2008) 10:379–392 389

Campus Micro Technologies (Campus Micro

4 Extra-arterial blood pressure monitors

Only a wired version has been tested

Most of the work to date has focused on developing
implantable intra-arterial blood pressure sensors. In this

Measures differential pressure

Measures differential pressure

technique, the pressure of the artery is directly measured.

Technologies GmbH 2007)

However, because the devices are located inside the artery,
there is a risk of dislocation, blood coagulation and clotting.

Utilized tonomotry
Extra-arterial blood pressure monitors seek to mitigate this
problem by measuring pressure indirectly through the
arterial wall or through the expansion and contraction of

Comments

Key: I intra-arterial; E extra-arterial; A active telemetry; P passive telemetry; - not available; * programmable through choice of commercial pressure sensor
Flexible
the artery. However, these devices have the disadvantage
that they must usually be implanted via an invasive surgical

–
procedure.
In 2001 at the University of Michigan, Ziaie and Najafi

Communication
distance (cm)
presented an implantable pressure microsystem based on
the principle of tonometry (Ziaie and Najafi 2001). The
device consisted of a bulk micromachined silicon capacitive

2000

>20
0.5
pressure sensors and a miniature titanium cuff. The cuff

0.0054 –

–
surrounds and reshapes the artery, forcing contact between

~.004

0.002

0.001
(cm3)

~0.6

0.77

0.20
Size

~45
the pressure sensors and the arterial wall, as shown in

–
Fig. 9. The 10×6.5×3 mm device contained integrated
electronics and had a resolution of 0.5 mmHg. The device
was tested using a silastic tube that mimicked a blood consumption
vessel; however, no in vivo tests or long-term tests that
Power

(mW)

0.35

0.34

0.12
investigated device drift were performed. A potential ~1

–
drawback of this design is that the long term reshaping of
response (Hz)

the artery may have adverse physiological effects and long

Frequency

term in vivo tests would be needed to verify its safety.

0–100

In 2004 at Case Western Reserve University in Cleve-

0–49

0–15

0–60

0–50
land, OH, Cong, et al., presented an implantable pressure
–

*
sensor targeted at long-term applications (Cong et al. 2004).
Resolution
(mmHg)

The prototype device consisted of a soft biocompatible

Table 3 A summary of implantable arterial pressure sensors from academia

rubber cuff filled with a low viscosity, biocompatible liquid

0.5
<1
–

*
and wrapped around a mock artery. A high resolution
MEMS pressure sensor immersed in the fluid detects a
(mmHg)

0–1900
Telemetry Range

0–300

0–100

0–120

0–200
scaled version of the blood pressure waveform. An
0–30

additional benefit of this design is that it measures the

–

*
pressure difference between the blood and the body and,
thus, does not require an additional atmospheric sensor. The
extra-arterial type

stiffness of the cuff was chosen to be much less than that of

A

A
P

the blood vessel, hopefully minimizing any restriction of

the artery and, thus, mitigating long-term adverse biological
Intra- or

effects. Experimental results for the prototype had excellent

agreement with a reference pressure sensor in the mock
E

E
I

artery. In 2005, the investigators presented an updated

Cong, 2006 (Cong et al. 2004,
(Takahata et al. 2004, 2003)
(Chatzandroulis et al. 2000)

(DeHennis and Wise 2006)

version of the cuff (Cong et al. 2005) that was molded from
(Ziaie and Najafi 2001)

a medical-grade silicone elastomer and implanted in

(Casadei et al. 1972)

(Fonseca et al. 2006)

(Eggers et al. 2000)
Chatzandroulis, 2000

laboratory rats. The 5 mm×2 mm×100 μm device was

(Park et al. 1998)

compared to a commercial catheter-tip transducer; the two

DeHennis, 2006
Takahata, 2006

Fonseca, 2006
Casadei, 1972

2005, 2006)
Eggers, 2000

in vivo measured blood waveforms closely matched (with a

Ziaie, 2001
Park, 1998

scaling factor). In 2006, this work was further improved

Device

with the integration of a rigid isolation ring that surrounds

and isolates the cuff from its environment leading to
390 Biomed Microdevices (2008) 10:379–392

Minimally invasive implantat

reduced long-term sensor drift (Cong et al. 2006). Devices
with and without the isolation ring were wrapped around

Successfully tested in
the right carotid artery of a laboratory rat and the improved

For medium animals

For small animals
device displayed a baseline drift of 0.6 mmHg in 120 s,

For large animals

In development

FDA approved
three times smaller than the original device and dominated

procedure
Comm. distance Lifetime Commercially Comments
by drift in the commercial pressure sensor. The improved

humans
device is shown in Fig. 10.

5 Conclusion and outlook

(months) available?
This paper has given an overview of long-term implantable

N
blood pressure monitoring technology and reviewed the
industrial work and research in that area. Tables 3 and 4

>120
summarize the work in this area to date. Thus far, intra-

>60

>36
1.5

–
arterial devices specifically targeted at niche clinical
applications have been the most successful. Extra-arterial
devices have the benefit of a reduced risk of blood-related

300–1,000

300–1000
complications; however, future devices should be designed

>300
(cm)

>15
to have little impact on the artery and their signal drift

20
4

–
(when implanted) needs to be improved before they achieve
clinical success. The need for invasive surgical implantation
response (cm3) (mmHg/
month)
may continue to hamper these devices, however.
Resolution Frequency Size Drift

<2
Overall, significant progress has been made in the field

<5

<2

<0.02 −
–

–
since the idea was first introduced in the 1960s (Van Citters

0.23

0.13
1.1

4.5
et al. 1966; Olsen et al. 1967), with advances in batteries,

25

–
wireless communication, wireless power transmission,
miniaturization and microtechnology, and biocompatible

0–200

0–100
(Hz)

materials. Companies are offering long-term implantable

–

–
blood pressure sensors for animal research and one has

Key: W wireless communication; P passive telemetry; Y yes; N no; - not available

received FDA approval and been implanted in over 100
(mmHg)

human subjects (Becker 2006). To date, most devices have

<0.3
<3

<3

<3

<1

contained capacitive sensors, required remote powering,

1

–
and utilized RF communication. However, devices utilizing
(mmHg)

−200 to

−200 to
−20 to

−20 to

−20 to

−20 to

−20 to
Telemetry Range
Table 4 A summary of implantable pressure sensors from industry

optical communication and powering are being investigated

300

300

300

300

300

300

300
and promise to possibly reduce communication error and
improve transmission distance into the body. In addition,
acoustic waves have been utilized in industry to achieve
type

wireless powering and communication (Remon Medical

W

Technologies Inc. 2007). MEMS technology has been

utilized to micromachine sensors and sensors systems. This
trend will continue along with the use of nanotechnology to
ISSYS v1 (Najafi and Ludomirsky 2004;

ISSYS v2 (Najafi and Ludomirsky 2004;

CardioMEMS HearSensor (Becker 2006;

CardioMEMS EndoSensor (Allen 2005;

miniaturize systems further. Next, research has been

All of the devices are intra-arterial.
Integrated Sensing Systems 2002)

Integrated Sensing Systems 2002)

suggested or performed on scavenging energy from the

environment (Starner and Paradiso 2004; Paradiso ans
CardioMEMS 2007b, 2006)
DSI PA-D70 (Data Sciences
DSI PA-C10 (Data Sciences

DSI PA-C40 (Data Sciences

Starner 2005). Future implants may utilize energy sources

CardioMEMS 2007a, b)

within the body to achieve self-powering (Ko 1980;

International 2005)

International 2005)

International 2005)

Lewandowski et al. 2007). Such abilities will remove the

lifetime restriction of batteries and enable continuous data
collection and storage without remote powering. Such
advancements will continue to improve the field of long-
Device

term blood pressure monitoring and will benefit patients

that critically need such technology.
Biomed Microdevices (2008) 10:379–392
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