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Xie Y, Yao T, Zhu X, Yang F, Fan H, Cao S, Chen H, Liao M, Xia Y, Liu J, Xiao Z, Yang Z, Xiao Y. High-intensity Focused Ultrasound-A New Choice to Conduct Pulmonary Artery Denervation. J Cardiovasc Transl Res 2024:10.1007/s12265-024-10531-9. [PMID: 38971920 DOI: 10.1007/s12265-024-10531-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/06/2024] [Indexed: 07/08/2024]
Abstract
This research aimed to explore whether high-intensity focused ultrasound (HIFU) could conduct pulmonary artery denervation (PADN). HIFU was performed in pulmonary arteries of 6 normotensive rabbits at dose of 250W, 6 times for each rabbit, and an additional 6 rabbits served as controls. Then ATEPH was induced in both groups by intravenous infusion of autogeneic thrombus. Hemodynamics and ultrasonography parameters were measured by right heart catheter and echocardiography pre- and post-establishment of ATEPH models in both groups. Histological analysis and immunohistochemistry of tyrosine hydroxylase (TH) were also performed. After PADN procedures, 5 rabbits were successfully conducted PADN, of which ablation zone was also observed in right auricle or right lung in 4 rabbits. Ablation zone was detected only in right lung in 1 rabbit. Compared with control group, milder right heart hemodynamic changes were found in PADN group, accompanied by improved ultrasound parameters in PADN group. HIFU can acutly damage SNs around pulmonary artery successfully, which may be a new choice to conduct PADN. However, the accuracy of HIFU with PADN needs to be improved.
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Affiliation(s)
- Yonghui Xie
- Academy of Pediatrics, University of South China, Changsha, 410007, China
- Department of Cardiology, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children's hospital), Changsha, 410007, China
| | - Taoyue Yao
- Department of Ultrasound, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children's hospital), Changsha, 410007, China
| | - Xiaogang Zhu
- Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Fan Yang
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Haoqin Fan
- Academy of Pediatrics, University of South China, Changsha, 410007, China
- Department of Cardiology, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children's hospital), Changsha, 410007, China
| | - Shirui Cao
- Class 2115, Changsha Yali High School, Changsha, 410007, China
| | - Huaiyang Chen
- Academy of Pediatrics, University of South China, Changsha, 410007, China
- Department of Cardiology, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children's hospital), Changsha, 410007, China
| | - Manzhen Liao
- Academy of Pediatrics, University of South China, Changsha, 410007, China
- Department of Cardiology, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children's hospital), Changsha, 410007, China
| | - Yuanxi Xia
- Department of Anesthesiology, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children's hospital), Changsha, 410007, China
| | - Jinqiao Liu
- Department of Ultrasound, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children's hospital), Changsha, 410007, China
| | - Zhenghui Xiao
- Department of Pediatric Intensive Care, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children's hospital), Changsha, 410007, China
| | - Zhou Yang
- Department of Cardiology, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children's hospital), Changsha, 410007, China.
| | - Yunbin Xiao
- Department of Cardiology, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children's hospital), Changsha, 410007, China.
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Balaji P, Barry MA, Tran VT, Marschner S, Lu J, Nguyen DM, Mina A, Bandodkar S, Alvarez S, James V, Ronquillo J, Varikatt W, Kovoor P, McEwan A, Thiagalingam A, Thomas SP, Qian PC. Long-Term Safety and Efficacy of Transcatheter Microwave and Radiofrequency Denervation in a Chronic Ovine Model. J Am Heart Assoc 2024; 13:e031795. [PMID: 38664237 PMCID: PMC11179908 DOI: 10.1161/jaha.123.031795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 02/26/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Transcatheter renal denervation (RDN) has had inconsistent efficacy and concerns for durability of denervation. We aimed to investigate long-term safety and efficacy of transcatheter microwave RDN in vivo in normotensive sheep in comparison to conventional radiofrequency ablation. METHODS AND RESULTS Sheep underwent bilateral RDN, receiving 1 to 2 microwave ablations (maximum power of 80-120 W for 240 s-480 s) and 12 to 16 radiofrequency ablations (180 s-240 s) in the main renal artery in a paired fashion, alternating the side of treatment, euthanized at 2 weeks (acute N=15) or 5.5 months (chronic N=15), and compared with undenervated controls (N=4). Microwave RDN produced substantial circumferential perivascular injury compared with radiofrequency at both 2 weeks [area 239.8 (interquartile range [IQR] 152.0-343.4) mm2 versus 50.1 (IQR, 32.0-74.6) mm2, P <0.001; depth 16.4 (IQR, 13.9-18.9) mm versus 7.5 (IQR, 6.0-8.9) mm P <0.001] and 5.5 months [area 20.0 (IQR, 3.4-31.8) mm2 versus 5.0 (IQR, 1.4-7.3) mm2, P=0.025; depth 5.9 (IQR, 1.9-8.8) mm versus 3.1 (IQR, 1.2-4.1) mm, P=0.005] using mixed models. Renal denervation resulted in significant long-term reductions in viability of renal sympathetic nerves [58.9% reduction with microwave (P=0.01) and 45% reduction with radiofrequency (P=0.017)] and median cortical norepinephrine levels [71% reduction with microwave (P <0.001) and 72.9% reduction with radiofrequency (P <0.001)] at 5.5 months compared with undenervated controls. CONCLUSIONS Transcatheter microwave RDN produces deep circumferential perivascular ablations without significant arterial injury to provide effective and durable RDN at 5.5 months compared with radiofrequency RDN.
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Affiliation(s)
- Poornima Balaji
- Cardiology DepartmentWestmead HospitalSydneyNSWAustralia
- Westmead Applied Research CentreUniversity of SydneyNSWAustralia
| | | | - Vu Toan Tran
- Cardiology DepartmentWestmead HospitalSydneyNSWAustralia
| | - Simone Marschner
- Westmead Applied Research CentreUniversity of SydneyNSWAustralia
| | - Juntang Lu
- Cardiology DepartmentWestmead HospitalSydneyNSWAustralia
| | - Duc Minh Nguyen
- Cardiology DepartmentWestmead HospitalSydneyNSWAustralia
- Westmead Applied Research CentreUniversity of SydneyNSWAustralia
| | - Ashraf Mina
- NSW Health PathologyInstitute of Clinical Pathology and Medical Research, Westmead HospitalSydneyNSWAustralia
| | - Sushil Bandodkar
- Biochemistry Department, Faculty of Medicine and HealthUniversity of Sydney Children’s Hospital at Westmead Clinical SchoolSydneyNSWAustralia
| | - Shirley Alvarez
- Biochemistry Department, Faculty of Medicine and HealthUniversity of Sydney Children’s Hospital at Westmead Clinical SchoolSydneyNSWAustralia
| | - Virginia James
- The Westmead Institute of Medical ResearchSydneyNSWAustralia
| | - John Ronquillo
- Department of Anatomical PathologyInstitute of Clinical Pathology and Medical Research, Westmead HospitalSydneyNSWAustralia
| | - Winny Varikatt
- Department of Anatomical PathologyInstitute of Clinical Pathology and Medical Research, Westmead HospitalSydneyNSWAustralia
| | - Pramesh Kovoor
- Cardiology DepartmentWestmead HospitalSydneyNSWAustralia
- Westmead Applied Research CentreUniversity of SydneyNSWAustralia
- Sydney Medical SchoolUniversity of SydneyNSWAustralia
| | - Alistair McEwan
- Westmead Applied Research CentreUniversity of SydneyNSWAustralia
- School of Electrical and Information EngineeringUniversity of SydneyNSWAustralia
| | - Aravinda Thiagalingam
- Cardiology DepartmentWestmead HospitalSydneyNSWAustralia
- Westmead Applied Research CentreUniversity of SydneyNSWAustralia
- Sydney Medical SchoolUniversity of SydneyNSWAustralia
| | - Stuart P. Thomas
- Cardiology DepartmentWestmead HospitalSydneyNSWAustralia
- Westmead Applied Research CentreUniversity of SydneyNSWAustralia
- Sydney Medical SchoolUniversity of SydneyNSWAustralia
| | - Pierre C. Qian
- Cardiology DepartmentWestmead HospitalSydneyNSWAustralia
- Westmead Applied Research CentreUniversity of SydneyNSWAustralia
- Sydney Medical SchoolUniversity of SydneyNSWAustralia
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Vakhrushev AD, Condori Leandro HI, Goncharova NS, Korobchenko LE, Mitrofanova LB, Makarov IA, Andreeva EM, Lebedev DS, Mikhaylov EN. Laser renal denervation: A comprehensive evaluation of microstructural renal artery lesions. Anat Rec (Hoboken) 2023; 306:2378-2387. [PMID: 36173027 DOI: 10.1002/ar.25068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/01/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022]
Abstract
Renal artery denervation (RDN) has been proposed for resistant arterial hypertension. Beyond conventional radiofrequency (RF) ablation, there are emerging RDN technologies, including laser catheter ablation. We aimed at evaluamting the local effects of laser ablation on the renal artery and perivascular nerve injury in comparison with radiofrequency ablation. Thirteen pigs (mean weight 36.7 ± 4.7 kg, age 3 months) were divided into three groups: (1) laser ablation in normotensive pigs (LA; n = 3), (2) bipolar RF ablation in normotensive pigs (RF; n = 7), and (3) a sham group (SHAM; n = 3). Transcatheter laser and RF ablations were performed under general anesthesia. After euthanasia, pathology and immunohistochemical studies were performed. Artery wall and perivascular nerve lesions were found in the LA and RF groups. A lower rate of intimal microdissections was evaluated after laser ablation when compared with RF ablation (0 vs. 1.5 [1;2.75] per artery; p < .05). There was a numerical prevalence of nerves with tyrosine hydroxylase expression loss after laser RDN when compared with RF ablation (16.7 [4; 18] vs. 9.1 [0;18] per specimen). Laser ablation is noninferior to RF ablation regarding perivascular nerve injury and is associated with less intimal layer damage.
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Affiliation(s)
| | | | | | - Lev E Korobchenko
- Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
| | - Lubov B Mitrofanova
- Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
| | - Igor A Makarov
- Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
| | | | - Dmitry S Lebedev
- Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
| | - Evgeny N Mikhaylov
- Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
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Wagener M, Dolan E, Arnous S, Galvin J, Murphy AW, Casserly I, Eustace J, O’Connor S, McCreery C, Shand J, Wall C, Matiullah S, Sharif F. Renal Denervation as a Complementary Treatment Option for Uncontrolled Arterial Hypertension: A Situation Assessment. J Clin Med 2023; 12:5634. [PMID: 37685701 PMCID: PMC10488551 DOI: 10.3390/jcm12175634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Uncontrolled arterial hypertension is a major global health issue. Catheter-based renal denervation has shown to lower blood pressure in sham-controlled trials and represents a device-based, complementary treatment option for hypertension. In this situation assessment, the authors, who are practicing experts in hypertension, nephrology, general practice and cardiology in the Republic of Ireland, discuss the current evidence base for the BP-lowering efficacy and safety of catheter-based renal denervation with different modalities. Although important questions remain regarding the identification of responders, and long-term efficacy and safety of the intervention, renal denervation has the potential to provide much-needed help to address hypertension and its adverse consequences. The therapeutic approach needs to be multidisciplinary and personalised to take into account the perspective of patients and healthcare professionals in a shared decision-making process.
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Affiliation(s)
- Max Wagener
- University Hospital Galway, University of Galway, H91 TK33 Galway, Ireland
| | - Eamon Dolan
- Stroke and Hypertension Unit, Connolly Hospital, D15 X40D Dublin, Ireland
| | - Samer Arnous
- University Hospital Limerick, V94 F858 Limerick, Ireland
| | - Joseph Galvin
- The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
| | - Andrew W. Murphy
- Turloughmore Medical Centre, University of Galway, H91 TK33 Galway, Ireland
| | - Ivan Casserly
- The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
| | | | | | | | - James Shand
- St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | | | | | - Faisal Sharif
- University Hospital Galway, University of Galway, H91 TK33 Galway, Ireland
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Katsurada K, Kario K. Emerging topics on renal denervation in hypertension: anatomical and functional aspects of renal nerves. Hypertens Res 2023:10.1038/s41440-023-01266-2. [PMID: 36991064 DOI: 10.1038/s41440-023-01266-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/27/2023] [Indexed: 03/31/2023]
Abstract
Inappropriate sympathetic activation is closely associated with the development and progression of hypertension. Renal denervation (RDN) is a neuromodulation therapy performed using an intraarterial catheter in patients with hypertension. Recent randomized sham-operated controlled trials have shown that RDN has significant antihypertensive effects that last for at least 3 years. Based on this evidence, RDN is nearly ready for general clinical application. On the other hand, there are remaining issues to be addressed, including elucidation of the precise antihypertensive mechanisms of RDN, the appropriate endpoint of RDN during the procedure, and the association between reinnervation after RDN and the long-term effects of RDN. This mini review focuses on studies implicating anatomy of the renal nerves, which consist of afferent or efferent and sympathetic or parasympathetic nerves, the response of blood pressure to renal nerve stimulation, and reinnervation of renal nerves after RDN. A comprehensive understanding of the anatomical and functional aspects of the renal nerves and the antihypertensive mechanisms of RDN, including its long-term effects, will enhance our ability to incorporate RDN into strategies to treat hypertension in clinical practice. This mini review focuses on studies implicating anatomy of the renal nerves, which consist of afferent or efferent and sympathetic or parasympathetic nerves, the response of blood pressure to renal nerve stimulation, and reinnervation of renal nerves after renal denervation. Whether the ablation site is sympathetic dominant or parasympathetic dominant, and afferent dominant or efferent dominant, would in turn determine the final output of renal denervation. BP: blood pressure.
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Affiliation(s)
- Kenichi Katsurada
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
- Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
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Sato Y, Sharp ASP, Mahfoud F, Tunev S, Forster A, Ellis M, Gomez A, Dhingra R, Ullman J, Schlaich M, Lee D, Trudel J, Hettrick DA, Kandzari DE, Virmani R, Finn AV. Translational value of preclinical models for renal denervation: a histological comparison of human versus porcine renal nerve anatomy. EUROINTERVENTION 2023; 18:e1120-e1128. [PMID: 36214318 PMCID: PMC9909452 DOI: 10.4244/eij-d-22-00369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/11/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Preclinical models have provided key insights into the response of local tissues to radiofrequency (RF) renal denervation (RDN) that is unobtainable from human studies. However, the anatomic translatability of these models to the procedure in humans is incompletely understood. Aims: We aimed to compare the renal arterial anatomy in normotensive pigs treated with RF-RDN to that of human cadavers to evaluate the suitability of normotensive pigs for determining the safety of RF-RDN. METHODS Histopathologic analyses were performed on RF-treated renal arteries in a porcine model and untreated control renal arteries. Similar analyses were performed on untreated renal arteries from human cadavers. Results: In both human and porcine renal arteries, the median number of nerves was lower in the more distal sections (the numbers in the proximal, middle, distal, 1st bifurcation, and 2nd bifurcation sections were 65, 58, 47, 22.5, and 14.7 in humans, respectively, and 39, 26, 29, 16.5, and 9.3 in the porcine models, respectively). Renal nerves were common in the regions between arteries and adjacent veins, but only 3% and 13% of the renal nerves in humans and pigs, respectively, were located behind the renal vein. The semiquantitative score of RF-induced renal arterial nerve necrosis was significantly greater at 7 days than 28 days (0.98 vs 0.75; p=0.01), and injury to surrounding organs was rarely observed. CONCLUSIONS The distribution of nerve tissue and the relative distribution of extravascular anatomic structures along the renal artery was similar between humans and pigs, which validates the translational value of the normotensive porcine model for RDN.
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Affiliation(s)
- Yu Sato
- CVPath Institute Inc., Gaithersburg, MD, USA
| | | | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Hamburg, Germany
| | | | | | | | - Ana Gomez
- CVPath Institute Inc., Gaithersburg, MD, USA
| | | | | | | | - David Lee
- Stanford Hospital and Clinics, Palo Alto, CA, USA
| | | | | | - David E Kandzari
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | | | - Aloke V Finn
- CVPath Institute Inc., Gaithersburg, MD, USA
- University of Maryland, Baltimore, MD, USA
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Histological evidence supporting the durability of successful radiofrequency renal denervation in a normotensive porcine model. J Hypertens 2022; 40:2068-2075. [PMID: 35866489 PMCID: PMC9451943 DOI: 10.1097/hjh.0000000000003236] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sustained blood pressure reductions after radiofrequency (RF) renal denervation (RDN) have been reported to 3 years in patients with uncontrolled hypertension. However, mechanistic data to support procedural durability are lacking. We aimed to quantify the long-term nerve anatomic and functional effects of RF RDN in a preclinical model. METHODS Bilateral RF RDN was performed in 20 normotensive swine. Renal tissue samples were obtained in the RDN-treated groups at 7 ( n = 6), 28 ( n = 6), and 180 days ( n = 8) postprocedure for quantification of cortical norepinephrine (NE) levels and renal cortical axon density. Tissue fibrosis, necrosis and downstream nerve fiber atrophy (axonal loss) were also scored for each sample. Three additional untreated groups ( n = 6, n = 6 and n = 8, respectively) served as control. RESULTS Pathologic nerve changes were characterized by necrosis in the ablated region at 7 days that partially resolved by 28 days and fully resolved at 180 days. Axonal loss was apparent within and downstream to the ablation regions and was evident at 7, 28 and 180 days in the main vessel and branch vessels. Consequently, renal cortical axon density and corresponding cortical NE levels were significantly reduced at 7 days in the RDN vs. control group and remained suppressed at 180 days. CONCLUSIONS Reductions in renal NE, cortical axon density and downstream axonal loss caused by axonal destruction persisted through 180 days post-RDN in a normotensive swine model. These results suggest functional nerve regrowth after RF RDN is unlikely and support published clinical evidence that the procedure results in durable blood pressure reduction.
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Schmieder RE. Renal denervation in patients with chronic kidney disease: current evidence and future perspectives. Nephrol Dial Transplant 2022; 38:1089-1096. [PMID: 35617138 PMCID: PMC10157753 DOI: 10.1093/ndt/gfac189] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Indexed: 11/14/2022] Open
Abstract
Supported by several high-quality randomised clinical trials and registry analyses, catheter-based renal denervation is becoming an important adjunctive treatment modality for the safe and efficacious treatment of hypertension besides lifestyle modifications and antihypertensive medication. Renal denervation is of particular interest to nephrologists as the intervention may provide additional benefits to hypertensive people with chronic kidney disease (CKD), a condition typically characterised by sympathetic hyperactivity. A growing body of clinical evidence supports the safety and efficacy of renal denervation in this difficult-to-control population. In addition, preclinical and clinical research indicate potential nephroprotective effects in CKD patients. The current review examines recent research on renal denervation with focus on renal disease and assesses the latest findings and their implications from a nephrologist's perspective.
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Affiliation(s)
- Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany
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Shah RT, Wang BX. Effectiveness of renal denervation in the treatment of hypertension: a literature review. Clin Hypertens 2022; 28:11. [PMID: 35422052 PMCID: PMC9012033 DOI: 10.1186/s40885-022-00194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catheter-based renal denervation has been studied as a potential therapeutic option to reduce high blood pressure (BP). Preclinical studies in some experimental models have demonstrated an antihypertensive effect of renal denervation but reports from clinical trials have been mixed METHODS: We performed a literature search using combinations of the key terms 'Cardiovascular diseases, Clinical trial, Pre-clinical trials, Resistant hypertension, Renal denervation, Ablation technique, Radiofrequency ablation, Ultrasound ablation, RADIANCE SOLO, SYMPLICITY HTN, SYPRAL HTN'. The databases searched were PubMed and OVID Medline. RESULTS The initial SYMPLICITY HTN-1 AND HTN-2 clinical trials reported significant decreases in office BP but results from the more robustly designed SYMPLICITY HTN-3 trial, which included sham controls and ambulatory BP monitoring, showed no significant antihypertensive effect. Interest in the use of renal denervation in hypertension was once again sparked by favourable results from the SPYRAL HTN-OFF Med trial CONCLUSION: We provide a thorough, critical analysis of key preclinical and clinical studies investigating the efficacy of catheter-based renal denervation as a treatment for hypertension and highlight future areas for research to allow better translation into clinical practice.
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Affiliation(s)
| | - Brian Xiangzhi Wang
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.
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Coates P, Tunev S, Trudel J, Hettrick DA. Time, temperature, power, and impedance considerations for radiofrequency catheter renal denervation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:171-177. [DOI: 10.1016/j.carrev.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
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Pulmonary and Systemic Hemodynamics following Multielectrode Radiofrequency Catheter Renal Denervation in Acutely Induced Pulmonary Arterial Hypertension in Swine. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4248111. [PMID: 34765677 PMCID: PMC8577935 DOI: 10.1155/2021/4248111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
Objective We aimed to assess the effects of renal denervation (RDN) on systemic and pulmonary hemodynamics in a swine model of thromboxane A2- (TXA2-) induced pulmonary arterial hypertension (PAH). Methods The study protocol comprised two PAH inductions with a target mean pulmonary artery pressure (PAP) of 40 mmHg at baseline and following either the RDN or sham procedure. Ten Landrace pigs underwent the first PAH induction; then, nine animals were randomly allocated in 1 : 1 ratio to RDN or sham procedure; the second PAH induction was performed in eight animals (one animal died of pulmonary embolism during the first PAH induction, and one animal died after RDN). In the RDN group, ablation was performed in all available renal arteries, and balloon inflation within artery branches was performed in controls. An autopsy study of the renal arteries was performed. Results At baseline, the target mean PAP was achieved in all animals with 25.0 [20.1; 25.2] mcg of TXA2. The second PAH induction required the same mean TXA2 dose and infusion time. There was no statistically significant difference in the mean PAP at second PAH induction between the groups (39.0 ± 5.3 vs. 39.75 ± 0.5 mmHg, P > 0.05). In the RDN group, the second PAH induction resulted in a numerical but insignificant trend toward a decrease in the mean systemic blood pressure and systemic vascular resistance, when compared with the baseline induction (74 ± 18.7 vs. 90.25 ± 28.1 mmHg and 1995.3 ± 494.3 vs. 2433.7 ± 1176.7 dyn∗sec∗cm−5, P > 0.05, respectively). No difference in hemodynamic parameters was noted in the sham group between the first and second PAH induction. Autopsy demonstrated artery damage in both groups, but RDN resulted in more severe lesions. Conclusions According to our results, RDN does not result in significant acute pulmonary or systemic hemodynamic changes in the TXA2-induced PAH model. The potential chronic effects of RDN on PAH require further research.
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Liao Q, Yang F, Xiong B, Zheng X, Wang Y, Qian J, Qiao Z, Huang J. Optimal Strategy for HIFU-Based Renal Sympathetic Denervation in Canines. Front Cardiovasc Med 2021; 8:739560. [PMID: 34722673 PMCID: PMC8551579 DOI: 10.3389/fcvm.2021.739560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The association between the treatment efficacy and safety of high-intensity focused ultrasound (HIFU)-based renal sympathetic denervation (RDN) and the acoustic energy dose applied has not been fully studied and may provide important understanding of the mechanism that led to failure of the WAVE IV trial. The objective of this study was to externally deliver different HIFU doses to canines for RDN treatment and to investigate the optimal energy dose for HIFU-based RDN. Methods: Thirty canines were divided into five RDN groups according to dose of acoustic energy applied, and a sham control group that consisted of four canines was used for comparisons. All animals in the RDN groups underwent the RDN procedure with different acoustic energy doses, while in the sham control group, renal arteries were harvested without being subjected to acoustic energy delivery and were imaged using color Doppler flow imaging (CDFI). Blood pressure (BP) was recorded, and blood samples were collected before the RDN procedure and at 28 days after the RDN procedure. Histological examinations and measurement of renal tissue norepinephrine concentration were performed in all retrieved samples. Results: Suppression of BP was significant in the 300 W (15.17/8.33 ± 1.47/1.21 mmHg), 250 W (14.67/9.33 ± 1.21/1.37 mmHg), and 200 W (13.17/9.17 ± 2.32/1.84 mmHg) groups. Semiquantitative histological assessment of periarterial nerves around the kidney revealed that target nerves in the 300 W (9.77 ± 0.63), 250 W (9.42 ± 0.67), and 200 W (9.58 ± 0.54) groups had the highest nerve injury scores, followed by the 150 W group (5.29 ± 0.62). Furthermore, decreased renal tissue norepinephrine concentration, together with decreased expression of tyrosine hydroxylase in the 300, 250, and 200 W groups demonstrated effective sympathetic depression following sufficient acoustic energy deposition. However, the renal artery injury score in the 300 W group (0.93 ± 0.13) was significantly higher than in the other groups (p < 0.001). Conclusion: This study provides evidence that RDN effectiveness is based on the energy dose delivered and that 200–250 W is effective and safe in normal-sized canines.
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Affiliation(s)
- Qingyao Liao
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fang Yang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Xiong
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoyu Zheng
- Department of Clinical Medicine, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Yue Wang
- Ultrasonic Technology Center, Institute of Acoustics, Chinese Academy of Sciences, Beijing, China
| | - Jun Qian
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhao Qiao
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Huang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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13
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Cai X, Shen Y, Yang Y, Wang W, Qian L, Cai J, Chi R, Yu S, Li K, Wei Z, Chen T, Fei Y, Han Y, Chen X, Liu M, Liu Y, Wang D, Jiang M, Li YG. Renal Denervation by Noninvasive Stereotactic Radiotherapy Induces Persistent Reduction of Sympathetic Activity in a Hypertensive Swine Model. J Am Heart Assoc 2021; 10:e020068. [PMID: 34369204 PMCID: PMC8475062 DOI: 10.1161/jaha.120.020068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background We have previously reported the feasibility of noninvasive stereotactic body radiotherapy (SBRT) as a novel approach for renal denervation. Methods and Results Herein, from a translational point of view, we assessed the antihypertensive effect and chronological evolution of SBRT‐induced renal nerve injury within 6 months in a hypertensive swine model. Hypertension was induced in swine by subcutaneous implantation of deoxycorticosterone acetate pellets in combination with a high‐salt diet. A single dose of 25 Gy with SBRT was delivered for renal denervation in 9 swine within 3.4±1.0 minutes. Blood pressure levels at baseline and 1 and 6 months post‐SBRT were comparable to control (n=5), whereas renal norepinephrine was significantly lower at 6 months (P<0.05). Abdominal computed tomography, performed before euthanasia and renal function assessment, remained normal. Standard semiquantitative histological assessment showed that compared with control (1.4±0.4), renal nerve injury was greater at 1 month post‐SBRT (2.3±0.3) and peaked at 6 months post‐SBRT (3.2±0.8) (P<0.05), along with a higher proportion of active caspase‐3–positive nerves (P<0.05). Moreover, SBRT resulted in continuous dysfunction of renal sympathetic nerves and low level of nerve regeneration in 6 months by immunohistochemistry analysis. Conclusions SBRT delivering 25 Gy for renal denervation was safe and related to sustained reduction of sympathetic activity by aggravating nerve damage and inhibiting nerve regeneration up to 6 months; however, its translation to clinical trial should be cautious because of the negative blood pressure response in the deoxycorticosterone acetate–salt hypertensive swine model.
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Affiliation(s)
- Xingxing Cai
- Department of Cardiology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Yichen Shen
- Department of Oncology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Yuli Yang
- Department of Cardiology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Wei Wang
- Department of Oncology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Li Qian
- Department of Pathology Affiliated Hospital of Nantong University China
| | - Jing Cai
- Department of Radiology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Runmin Chi
- Department of Radiology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Shunxuan Yu
- Department of Oncology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Keke Li
- Department of Oncology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Zhixing Wei
- Department of Cardiology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Taizhong Chen
- Department of Cardiology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Yudong Fei
- Department of Cardiology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Yaqin Han
- Department of Cardiology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Xiu Chen
- Department of Cardiology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Ming Liu
- Department of Radiology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Yifei Liu
- Department of Pathology Affiliated Hospital of Nantong University China
| | - Dengbin Wang
- Department of Radiology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Mawei Jiang
- Department of Oncology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
| | - Yi-Gang Li
- Department of Cardiology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine China
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14
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Pan T, Li L, Wei Q, Wang Z, Zhang Q, Qian Y, Li R, Liu DC, Wang Y, Sun ZL, Teng GJ. Endovascular Celiac Denervation for Glycemic Control in Patients with Type 2 Diabetes Mellitus. J Vasc Interv Radiol 2021; 32:1519-1528.e2. [PMID: 34364991 DOI: 10.1016/j.jvir.2021.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/16/2021] [Accepted: 07/23/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To investigate the safety and effects of catheter-based endovascular denervation (EDN) at the celiac artery, and the abdominal aorta around celiac artery on glycemic control in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS With a novel catheter system, EDN was conducted at the celiac artery along with the abdominal aorta around the celiac artery in patients with T2DM whose hemoglobin A1c (HbA1c) was >7.5%. The primary outcome was HbA1c at 6-month. Other outcomes included safety, oral glucose tolerant test (OGTT), homeostasis-model assessment of insulin resistance (HOMA-IR), fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2hPG), and C-peptide test. RESULTS A total of 11 subjects were included for analysis. The technical success was 100% and no severe treatment-related adverse events or major complications were observed. Both HbA1c and HOMA-IR were significantly reduced at 6 months (9.9 vs. 8.0 %, P = 0.005; 13.3 vs. 6.0, P = 0.016). Decreases in FPG and 2hPG were observed (227.2 vs. 181.8 mg/dL, P < 0.001; 322.2 vs. 205.2 mg/dL, P = 0.001). C-peptide test indicated improved beta-cell function (area under curve [AUC] 0.23 vs. 0.28 pmol/mL, P =0.046). A reduction of daily insulin injection (P = 0.02) and improvement of liver function (alanine aminotransferase, P = 0.014; γ-glutamyl transpeptidase, P = 0.021) were also observed. CONCLUSION EDN at the celiac artery and the abdominal aorta around celiac artery elicited a clinically significant improvement in glycemic control and insulin resistance in patients with T2DM, with good tolerability as 6-month follow-up demonstrated.
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Affiliation(s)
- Tao Pan
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Ling Li
- Department of Endocrinology, ZhongDa Hospital, School of Medicine, Southeast University; Institute of Pancreas, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Qiong Wei
- Department of Endocrinology, ZhongDa Hospital, School of Medicine, Southeast University; Institute of Pancreas, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Zhi Wang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Qi Zhang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Yue Qian
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing 210008, China
| | - Rui Li
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - De-Chen Liu
- Department of Endocrinology, ZhongDa Hospital, School of Medicine, Southeast University; Department of Clinical Science and Research, ZhongDa Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Yao Wang
- Department of Clinical Science and Research, ZhongDa Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Zi-Lin Sun
- Department of Endocrinology, ZhongDa Hospital, School of Medicine, Southeast University
| | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China.
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15
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Sato Y, Kawakami R, Sakamoto A, Cornelissen A, Mori M, Kawai K, Guo L, Romero ME, Kolodgie FD, Virmani R, Finn AV. Paradise™ Ultrasound Renal Denervation System for the treatment of hypertension. Future Cardiol 2021; 17:931-944. [PMID: 33876697 DOI: 10.2217/fca-2020-0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Catheter-based renal denervation is a novel treatment approach for patients with hypertension and initial unblinded trials have shown promising results. The Paradise™ Ultrasound Renal Denervation System (ReCor Medical, CA, USA) is an ultrasound-based catheter with a distal balloon that acts as a coolant to protect the renal arterial wall. This device received CE-mark in 2012. Randomized, sham-controlled trials and postmarket studies have shown promising efficacy and safety results. Currently, three additional ongoing randomized, sham-controlled trials are underway in the USA, Europe, Japan and Korea, and the results will be pivotal in device approval in some of these countries. These studies with larger numbers of patients and longer duration of follow-up are needed to further confirm the safety and efficacy of this device.
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Affiliation(s)
- Yu Sato
- CVPath Institute, Inc., Gaithersburg, MD, USA
| | | | | | | | | | - Kenji Kawai
- CVPath Institute, Inc., Gaithersburg, MD, USA
| | - Liang Guo
- CVPath Institute, Inc., Gaithersburg, MD, USA
| | | | | | | | - Aloke V Finn
- CVPath Institute, Inc., Gaithersburg, MD, USA.,University of Maryland, Baltimore, MD, USA
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16
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Neurohormonal Modulation as a Therapeutic Target in Pulmonary Hypertension. Cells 2020; 9:cells9112521. [PMID: 33266371 PMCID: PMC7700466 DOI: 10.3390/cells9112521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/14/2022] Open
Abstract
The autonomic nervous system (ANS) and renin-angiotensin-aldosterone system (RAAS) are involved in many cardiovascular disorders, including pulmonary hypertension (PH). The current review focuses on the role of the ANS and RAAS activation in PH and updated evidence of potential therapies targeting both systems in this condition, particularly in Groups 1 and 2. State of the art knowledge in preclinical and clinical use of pharmacologic drugs (beta-blockers, beta-three adrenoceptor agonists, or renin-angiotensin-aldosterone signaling drugs) and invasive procedures, such as pulmonary artery denervation, is provided.
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17
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Schmieder RE. Renal denervation: where do we stand and what is the relevance to the nephrologist? Nephrol Dial Transplant 2020; 37:638-644. [DOI: 10.1093/ndt/gfaa237] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Indexed: 01/21/2023] Open
Abstract
Abstract
Catheter-based renal denervation to reduce high blood pressure (BP) has received well-deserved attention after a recent series of sham-controlled trials reported significant antihypertensive efficacy and very favourable tolerability and safety of the intervention. This emerging treatment option is of high relevance to nephrologists. Patients with chronic kidney disease (CKD) are at elevated risk of cardiovascular adverse events and often present with hypertension, which is very difficult to control with medication. Renal denervation promises a new tool to reduce BP and to prevent loss of renal function in this population. The current review considers the role of the kidney and neurohormonal activation in the development of hypertension and the rationale for renal denervation. The current state of the evidence for the effectiveness and tolerability of the procedure is considered from the nephrologists’ perspective, with a focus on the potential future role of renal denervation in the management of CKD patients with hypertension.
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Affiliation(s)
- Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany
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18
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Laparoscopic-based perivascular renal sympathetic nerve denervation: a feasibility study in a porcine model. Eur J Med Res 2020; 25:22. [PMID: 32552871 PMCID: PMC7301974 DOI: 10.1186/s40001-020-00422-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study aims to evaluate the effects and safety of laparoscopic-based perivascular renal sympathetic nerve denervation (RDN) in a porcine model fed a high-fat diet. Method Thirty-six high-fat diet-fed Bama minipigs were randomly divided into an RDN group (n = 18), in which minipigs received laparoscopic-based perivascular RDN, and a sham group (n = 18). All pigs were fed the high-fat diet after the operation to establish a model of obesity-induced hypertension. Bama pigs in the RDN and sham groups were killed at 3 time points [2 days after RDN (n = 6), day 90 (n = 6) and day 180 (n = 6)]. Result The systolic blood pressure (SBP) and noradrenaline (NE) concentration in the kidney tissue were significantly lower in the RDN group than in the sham group at 2 days (113.83 ± 3.26 mmHg vs 129.67 ± 3.32 mmHg, P = 0.011, and 112.02 ± 17.34 ng/g vs 268.48 ± 20.61 ng/g, P < 0.001, respectively), 90 days (116.83 ± 3.88 mmHg vs 145.00 ± 4.22 mmHg, P = 0.001, respectively) and 180 days (129.33 ± 2.87 mmHg vs 168.57 ± 2.86 mmHg, P < 0.001, and 152.15 ± 16.61 ng/g vs 318.97 ± 24.84 ng/g, P < 0.001, respectively) after the operation. The diastolic blood pressure (DBP) was significantly lower in the RDN group than in sham group at 90 and 180 days after the operation (72.17 ± 2.7 mmHg vs 81.50 ± 2.22 mmHg, P = 0.037, and 76.83 ± 2.75 mmHg vs 86.33 ± 2.22 mmHg P = 0.021, respectively). Based on the pathological evaluation, the renal sympathetic nerve fascicles were successfully disrupted by radiofrequency energy after laparoscopic-based perivascular RDN, but the intima was intact. Tyrosine hydroxylase (TH) expression was decreased, while the expression of the S100 protein was increased in treated renal arteries after RDN. Conclusions Laparoscopic-based perivascular RDN prevented the occurrence and development of hypertension, and thus it may be an efficient and safe method for controlling blood pressure in an experimental model.
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Cai X, Yang Y, Shen Y, Wang W, Qian L, Cai J, Chi R, Fei Y, Yu S, Wei L, Hou J, Wang Q, Zhang J, Wang D, Jiang M, Li YG. Noninvasive Stereotactic Radiotherapy for Renal Denervation in a Swine Model. J Am Coll Cardiol 2020; 74:1697-1709. [PMID: 31558254 DOI: 10.1016/j.jacc.2019.07.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/19/2019] [Accepted: 07/08/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Catheter-based renal denervation (RDN) has achieved promising outcomes to treat hypertension in recent randomized controlled trials. OBJECTIVES The purpose of this study was to assess the feasibility, efficacy, and safety of noninvasive stereotactic body radiotherapy (SBRT) as an approach for RDN. METHODS SBRT was performed in 24 renal arteries from 12 normotensive swine at doses of 25, 35, and 45 Gy (n = 4 each), and an additional 4 swine served as controls. Blood pressure (BP), renal function, and serum norepinephrine (NE) values were obtained at baseline and at 7 days, 1 month, and 3 months after SBRT. Abdominal contrast-enhanced computed tomography (CT) was performed after 3 months before euthanasia. Renal NE concentration was determined, and histological analysis and immunohistochemistry against tyrosine hydroxylase were performed. RESULTS SBRT procedure was successful in all 12 swine. BP was comparable among groups. Serum and renal NE levels at 3 months were significantly lower in treatment groups compared with control group. Furthermore, SBRT resulted in significantly greater nerve injury score and lower tyrosine hydroxylase score compared with control subjects, whereas there were no statistical differences between SBRT groups. Circumferential lesions created with 35 and 45 Gy were significantly greater than with 25 Gy. CT and histology analysis revealed that animals receiving 35 and 45 Gy experienced more collateral damage, which was minimal in the 25-Gy group. CONCLUSIONS Noninvasive SBRT was feasible and effective for complete, circumferential RDN in a swine model, with dosage at 25 Gy providing the safest short-term profile.
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Affiliation(s)
- Xingxing Cai
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuli Yang
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yichen Shen
- Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li Qian
- Department of Pathology, Affiliated Hospital of Nantong University, Nantong, China
| | - Jing Cai
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Runmin Chi
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yudong Fei
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shunxuan Yu
- Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Le Wei
- Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianwen Hou
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qian Wang
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianguo Zhang
- Department of Pathology, Affiliated Hospital of Nantong University, Nantong, China
| | - Dengbin Wang
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mawei Jiang
- Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Townsend RR, Walton A, Hettrick DA, Hickey GL, Weil J, Sharp AS, Blankenstijn PJ, Böhm M, Mancia G. Review and meta-analysis of renal artery damage following percutaneous renal denervation with radiofrequency renal artery ablation. EUROINTERVENTION 2020; 16:89-96. [DOI: 10.4244/eij-d-19-00902] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Su E, Zhao L, Yang X, Zhu B, Liu Y, Zhao W, Wang X, Qi D, Zhu L, Gao C. Aggravated endothelial endocrine dysfunction and intimal thickening of renal artery in high-fat diet-induced obese pigs following renal denervation. BMC Cardiovasc Disord 2020; 20:176. [PMID: 32295540 PMCID: PMC7161153 DOI: 10.1186/s12872-020-01472-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background Renal denervation (RDN) targeting the sympathetic nerves in the renal arterial adventitia as a treatment of resistant hypertension can cause endothelial injury and vascular wall injury. This study aims to evaluate the risk of atherosclerosis induced by RDN in renal arteries. Methods A total of 15 minipigs were randomly assigned to 3 groups: (1) control group, (2) sham group, and (3) RDN group (n = 5 per group). All pigs were fed a high-fat diet (HFD) for 6 months after appropriate treatment. The degree of intimal thickening of renal artery and the conversion of endothelin 1 (ET-1) receptors were evaluated by histological staining. Western blot was used to assess the expression of nitric oxide (NO) synthesis signaling pathway, ET-1 and its receptors, NADPH oxidase 2 (NOX2) and 4-hydroxynonenal (4-HNE) proteins, and the activation of NF-kappa B (NF-κB). Results The histological staining results suggested that compared to the sham treatment, RDN led to significant intimal thickening and significantly promoted the production of endothelin B receptor (ETBR) in vascular smooth muscle cells (VSMCs). Western blotting analysis indicated that RDN significantly suppressed the expression of AMPK/Akt/eNOS signaling pathway proteins, and decreased the production of NO, and increased the expression of endothelin system proteins including endothelin-1 (ET-1), endothelin converting enzyme 1 (ECE1), endothelin A receptor (ETAR) and ETBR; and upregulated the expression of NOX2 and 4-HNE proteins and enhanced the activation of NF-kappa B (NF-κB) when compared with the sham treatment (all p < 0.05). There were no significant differences between the control and sham groups (all p > 0.05). Conclusions RDN aggravated endothelial endocrine dysfunction and intimal thickening, and increased the risk of atherosclerosis in renal arteries of HFD-fed pigs.
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Affiliation(s)
- Enyong Su
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, Henan, China.,Department of Cardiology, Huazhong Fuwai Hospital, Zhengzhou, 451464, Henan, China
| | - Linwei Zhao
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, Henan, China.,Department of Cardiology, Huazhong Fuwai Hospital, Zhengzhou, 451464, Henan, China
| | - Xiaohang Yang
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Binbin Zhu
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, Henan, China.,Department of Cardiology, Huazhong Fuwai Hospital, Zhengzhou, 451464, Henan, China
| | - Yahui Liu
- Department of Cardiology, Huazhong Fuwai Hospital, Zhengzhou, 451464, Henan, China
| | - Wen Zhao
- Zhengzhou University School of Pharmaceutical Sciences, Zhengzhou, 450001, Henan, China
| | - Xianpei Wang
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, Henan, China.,Department of Cardiology, Huazhong Fuwai Hospital, Zhengzhou, 451464, Henan, China
| | - Datun Qi
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, Henan, China.,Department of Cardiology, Huazhong Fuwai Hospital, Zhengzhou, 451464, Henan, China
| | - Lijie Zhu
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, Henan, China.,Department of Cardiology, Huazhong Fuwai Hospital, Zhengzhou, 451464, Henan, China
| | - Chuanyu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, Henan, China. .,Department of Cardiology, Huazhong Fuwai Hospital, Zhengzhou, 451464, Henan, China.
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22
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Transcatheter microwave ablation can deliver deep and circumferential perivascular nerve injury without significant arterial injury to provide effective renal denervation. J Hypertens 2019; 37:2083-2092. [DOI: 10.1097/hjh.0000000000002104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sakaoka A, Terao H, Nakamura S, Hagiwara H, Furukawa T, Matsumura K, Sakakura K. Accurate Depth of Radiofrequency-Induced Lesions in Renal Sympathetic Denervation Based on a Fine Histological Sectioning Approach in a Porcine Model. Circ Cardiovasc Interv 2019; 11:e005779. [PMID: 29440276 PMCID: PMC5828376 DOI: 10.1161/circinterventions.117.005779] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/08/2018] [Indexed: 11/16/2022]
Abstract
Background— Ablation lesion depth caused by radiofrequency-based renal denervation (RDN) was limited to <4 mm in previous animal studies, suggesting that radiofrequency-RDN cannot ablate a substantial percentage of renal sympathetic nerves. We aimed to define the true lesion depth achieved with radiofrequency-RDN using a fine sectioning method and to investigate biophysical parameters that could predict lesion depth. Methods and Results— Radiofrequency was delivered to 87 sites in 14 renal arteries from 9 farm pigs at various ablation settings: 2, 4, 6, and 9 W for 60 seconds and 6 W for 120 seconds. Electric impedance and electrode temperature were recorded during ablation. At 7 days, 2470 histological sections were obtained from the treated arteries. Maximum lesion depth increased at 2 to 6 W, peaking at 6.53 (95% confidence interval, 4.27–8.78) mm under the 6 W/60 s condition. It was not augmented by greater power (9 W) or longer duration (120 seconds). There were statistically significant tendencies at 6 and 9 W, with higher injury scores in the media, nerves, arterioles, and fat. Maximum lesion depth was positively correlated with impedance reduction and peak electrode temperature (Pearson correlation coefficients were 0.59 and 0.53, respectively). Conclusions— Lesion depth was 6.5 mm for radiofrequency-RDN at 6 W/60 s. The impedance reduction and peak electrode temperature during ablation were closely associated with lesion depth. Hence, these biophysical parameters could provide prompt feedback during radiofrequency-RDN procedures in the clinical setting.
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Affiliation(s)
- Atsushi Sakaoka
- From Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, Kanagawa, Japan (A.S., H.T., S.N., H.H.); Graduate School of Engineering, Osaka Institute of Technology, Japan (A.S., K.M.); Biostatistical Research Co, Ltd, Tokyo, Japan (T.F.); and Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S.).
| | - Hisako Terao
- From Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, Kanagawa, Japan (A.S., H.T., S.N., H.H.); Graduate School of Engineering, Osaka Institute of Technology, Japan (A.S., K.M.); Biostatistical Research Co, Ltd, Tokyo, Japan (T.F.); and Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S.)
| | - Shintaro Nakamura
- From Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, Kanagawa, Japan (A.S., H.T., S.N., H.H.); Graduate School of Engineering, Osaka Institute of Technology, Japan (A.S., K.M.); Biostatistical Research Co, Ltd, Tokyo, Japan (T.F.); and Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S.)
| | - Hitomi Hagiwara
- From Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, Kanagawa, Japan (A.S., H.T., S.N., H.H.); Graduate School of Engineering, Osaka Institute of Technology, Japan (A.S., K.M.); Biostatistical Research Co, Ltd, Tokyo, Japan (T.F.); and Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S.)
| | - Toshihito Furukawa
- From Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, Kanagawa, Japan (A.S., H.T., S.N., H.H.); Graduate School of Engineering, Osaka Institute of Technology, Japan (A.S., K.M.); Biostatistical Research Co, Ltd, Tokyo, Japan (T.F.); and Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S.)
| | - Kiyoshi Matsumura
- From Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, Kanagawa, Japan (A.S., H.T., S.N., H.H.); Graduate School of Engineering, Osaka Institute of Technology, Japan (A.S., K.M.); Biostatistical Research Co, Ltd, Tokyo, Japan (T.F.); and Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S.)
| | - Kenichi Sakakura
- From Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, Kanagawa, Japan (A.S., H.T., S.N., H.H.); Graduate School of Engineering, Osaka Institute of Technology, Japan (A.S., K.M.); Biostatistical Research Co, Ltd, Tokyo, Japan (T.F.); and Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S.)
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Su E, Zhao L, Gao C, Zhao W, Wang X, Qi D, Zhu L, Yang X, Zhu B, Liu Y. Acute changes in morphology and renal vascular relaxation function after renal denervation using temperature-controlled radiofrequency catheter. BMC Cardiovasc Disord 2019; 19:67. [PMID: 30902047 PMCID: PMC6431051 DOI: 10.1186/s12872-019-1053-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Resistant hypertension and renal sympathetic hyperactivity are closely linked, and catheter-based renal denervation (RDN) is regarded as a new treatment strategy. However, the acute changes in vascular morphology and relaxation function have yet to be evaluated, and these may be important for the efficacy and safety of the procedure. In this study, we explored these questions by conventional temperature-controlled cardiac radiofrequency catheter-based RDN in a pig model. METHODS Six mini-pigs were randomly divided into the renal denervation (RDN) group (n = 3) and the Sham-RDN group (n = 3). Animals in the RDN group underwent unilateral radiofrequency ablation, and those in the Sham-RDN group underwent the same procedure except for the ablation. The pigs were examined by angiography pre- and post-RDN and were euthanized immediately thereafter. Renal arteries were processed for histological and molecular biology analyses as well as for in vitro vascular tension testing. RESULTS Compared with the Sham-RDN group, the RDN caused vascular intima and media injury, renal nerve vacuolization, mild collagen fiber hyperplasia and elastic fiber cleavage (all p < 0.05). The RDN group also significantly exhibited nitric oxide synthase pathway inhibition and decreased endothelium-independent vascular relaxation function Compared to the Sham-RDN group (all p < 0.05). CONCLUSIONS In this porcine model, renal artery denervation led to vascular wall injury and endothelial dysfunction in the acute phase, which negatively affected vascular relaxation function. Thus, this process may be detrimental to the prognosis and progress of hypertension patients.
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Affiliation(s)
- Enyong Su
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Linwei Zhao
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Chuanyu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China.
| | - Wen Zhao
- Zhengzhou University School of Pharmaceutical Sciences, Zhengzhou, 450003, Henan, China
| | - Xianpei Wang
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Datun Qi
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Lijie Zhu
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Xiaohang Yang
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Binbin Zhu
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
| | - Yahui Liu
- Department of Cardiology, Zhengzhou University People's Hospital, No.7 Weiwu road, Jinshui District, Zhengzhou, 450003, China
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Rousselle SD, Wicks JR, Tabb BC, Tellez A, O’Brien M. Histology Strategies for Medical Implants and Interventional Device Studies. Toxicol Pathol 2019; 47:235-249. [DOI: 10.1177/0192623319827288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Histology of medical devices poses a variety of unique challenges. Comprehensive histologic assessment of medical devices often requires spatial context and high-quality retention of the device–tissue interface. However, the composition of many medical devices is often not amenable to traditional paraffin embedding and thus alternative specialized methodologies such as hard resin embedding must be used. Hard resin embedding requires specialized laboratory technical expertise and equipment, and the fixation techniques and resin composition used markedly impact the feasibility of immunohistochemistry. For the continuity of spatial context during histologic evaluation, additional imaging methods such as macrophotography, radiography, micro-Computerized Tomography (microCT), or magnetic resonance imaging (MRI) can be used to guide sectioning and to complement histologic findings. Although standardized approaches are scarce for medical devices, important considerations specific to medical device histology are discussed, including general specimen preparation, special considerations for devices by organ system, and the challenges of immunohistochemistry. Histologic preparation of medical devices must be thoughtful, thorough, and tailored to achieve optimal histologic outcomes for complex, valuable, and often limited implant specimens.
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Affiliation(s)
| | | | | | - Armando Tellez
- Alizée Pathology, Thurmont, Maryland, USA
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
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26
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Táborský M, Richter D, Tonar Z, Kubíková T, Herman A, Peregrin J, Husková Z, Kopkan L. Evaluation of later morphologic alterations in renal artery wall and renal nerves in response to catheter-based renal denervation in sheep: comparison of the single-point and multiple-point ablation catheters. Physiol Res 2018; 67:891-901. [PMID: 30204473 DOI: 10.33549/physiolres.933903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study evaluated the subacute morphologic alterations in renal artery wall and renal nerves in response to catheter-based renal denervation (RDN) in sheep and also compared the efficiency of single-point and multiple-point ablation catheters. Effect of each ablation catheter approved for the clinical use (Symplicity Flex(TM), Medtronic, Inc., or EnligHTN(TM), St. Jude Medical, INC.) was compared to intact contralateral renal artery in 12 sheep by histopathology and immunohistochemistry evaluation after a 10-day period post-RDN procedure. The safety was verified by extensive evaluation of kidney morphology. Vascular wall lesions and nerve injuries were more pronounced in those animals treated with multi-point EnligHTN catheter when compared with animals treated with single-point Symplicity Flex catheter. However, neither RDN procedure led to complete renal nerve ablation. Both systems, tested in the present study, provided only incomplete renal nerve ablation in sheep. Moreover, no appreciable progression of the nerve disintegration in subacute phase post-RDN procedure was observed. This study further supports the notion that the effectiveness remains fully dependent on anatomical inter-individual variability of the sympathetic nerve plexus accompanying the renal artery. Therefore, new systems providing deeper penetrance to targeted perivascular structure would be more efficient.
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Affiliation(s)
- M Táborský
- Department of Internal Medicine I, Cardiology, University Hospital Olomouc and Palacký University, Olomouc, Czech Republic.
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27
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Sakaoka A, Rousselle SD, Hagiwara H, Tellez A, Hubbard B, Sakakura K. Safety of catheter-based radiofrequency renal denervation on branch renal arteries in a porcine model. Catheter Cardiovasc Interv 2018; 93:494-502. [PMID: 30407718 PMCID: PMC6587466 DOI: 10.1002/ccd.27953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/22/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We aimed to investigate the safety of radiofrequency (RF)-renal denervation (RDN) on branch renal arteries (RAs) in a porcine model. BACKGROUND The efficacy of RF-RDN was enhanced by treatment of the branch RA, in addition to the main RA. However, there are concerns regarding the safety of RF-RDN on branch RA because of their smaller diameter and proximity to the kidney. METHODS RF was delivered to 24 RA from 12 swine. A total of 8 RA from 4 swine were untreated. Treated RA were examined by angiography and histopathology at 7, 30, and 90 days. Serum creatinine concentration, biophysical parameters during RF delivery, and renal norepinephrine concentration were also assessed. RESULTS Angiography revealed minimal late lumen loss and diameter stenosis in the main and branch RA at any time point. There was no change in serum creatinine after RF-RDN. Histopathologically, no augmentation of medial damage or neointimal formation was found in branch RA compared with main RA. No or minimal damage to surrounding tissues including the kidneys, ureters, lymph nodes, and muscles was observed at any time point in both the main and branch RA. Equivalent electrode temperature in the main and branch RA was achieved by automatic adjustment of output power by the generator. The renal norepinephrine concentration was significantly lower in the treated group compared with the untreated group. CONCLUSIONS RF-RDN on branch RA was safe in a porcine model, with stenosis-free healing of treated arteries and negligible kidney damage at 7, 30, and 90 days.
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Affiliation(s)
- Atsushi Sakaoka
- Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, Kanagawa, Japan
| | | | - Hitomi Hagiwara
- Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, Kanagawa, Japan
| | - Armando Tellez
- Alizée Pathology, LLC, Thurmont, Maryland.,Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | | | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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28
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MRI-based detection of renal artery abnormalities related to renal denervation by catheter-based radiofrequency ablation in drug resistant hypertensive patients. Eur Radiol 2018; 28:3355-3361. [DOI: 10.1007/s00330-017-5272-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/08/2017] [Accepted: 12/21/2017] [Indexed: 01/07/2023]
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Sakaoka A, Koshimizu M, Nakamura S, Matsumura K. Quantitative angiographic anatomy of the renal arteries and adjacent aorta in the swine for preclinical studies of intravascular catheterization devices. Exp Anim 2018; 67:291-299. [PMID: 29353822 PMCID: PMC5955760 DOI: 10.1538/expanim.17-0125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Swine are the most common animal model in preclinical studies of cardiovascular devices. Because of the recent trend for development of new devices for percutaneous catheterization, especially for the renal arteries (RAs), we examined the quantitative anatomical dimensions of the RAs and adjacent aorta in swine. Angiographic images were analyzed in 66 female Yorkshire/Landrace crossbred swine. The diameter of both the right and left main RA was 5.4 ± 0.6 mm. The length of the right main RA was significantly longer than that of the left (29.8 ± 7.5 mm vs. 20.6 ± 5.4 mm, respectively; P<0.001). The diameter of both the right and left branch RA with diameters ≥3 mm (the target vessel diameter of recently developed devices) was 3.8 ± 0.5 mm. The right branch RA was significantly longer than that of the left (18.9 ± 7.8 mm vs. 16.4 ± 7.4 mm, respectively; P<0.05). The branching angle of the right RA from the aorta was significantly smaller than that of the left (91 ± 12° vs. 103 ± 15°, respectively; P<0.001). The diameters of the suprarenal and infrarenal aorta were 10.6 ± 1.1 mm and 9.7 ± 0.9 mm, respectively. In conclusion, because of their similar dimensions to human, swine are an appropriate animal model for assessing the safety of, and determining optimal design of, catheter devices for RAs in simulated clinical use. However, there were species differences in the branching angle and adjacent aorta diameter, suggesting that swine models alone are inadequate to assess the delivery performance of catheter devices for RAs.
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Affiliation(s)
- Atsushi Sakaoka
- Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, 1500 Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa 259-0151, Japan.,Graduate School of Engineering, Osaka Institute of Technology, 5-16-1 Omiya, Asahi-ku, Osaka 535-8585, Japan
| | - Masafumi Koshimizu
- Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, 1500 Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa 259-0151, Japan
| | - Shintaro Nakamura
- Evaluation Center, R&D Administration and Promotion Department, Terumo Corporation, 1500 Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa 259-0151, Japan
| | - Kiyoshi Matsumura
- Graduate School of Engineering, Osaka Institute of Technology, 5-16-1 Omiya, Asahi-ku, Osaka 535-8585, Japan
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30
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Sakaoka A, Takami A, Onimura Y, Hagiwara H, Terao H, Kumagai F, Matsumura K. Acute changes in histopathology and intravascular imaging after catheter-based renal denervation in a porcine model. Catheter Cardiovasc Interv 2017. [PMID: 28639746 PMCID: PMC6585757 DOI: 10.1002/ccd.27158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We first aimed to identify the histopathological changes occurring immediately after renal denervation (RDN) with radiofrequency energy, and then to assess the feasibility of determining procedural success using currently available clinical intravascular imaging techniques. BACKGROUND Catheter-based RDN has been used as an alternative therapy for hypertension. However, no practical endpoint to determine procedural success during treatment has been established. METHODS A total of 39 ablation lesions were induced in vivo in eight porcine renal arteries and a total of 15 ablation lesions were induced ex vivo in five excised porcine renal arteries with a radiofrequency delivery device. Acute histological changes and appearance on intravascular imaging of the lesions were investigated with light microscopy, transmission electron microscopy, intravascular ultrasound (IVUS), and optical frequency domain imaging (OFDI). RESULTS Marked changes were noted in media, adventitia, and perirenal-arterial nerves immediately after in vivo ablation. Changes visualized on IVUS were characterized by focal adventitial thickening comprising a relatively echogenic layer around a heterogeneously hypoechoic interior region, and on OFDI as disappearance of the external elastic membrane signals with high scattering of signals in the surface layer. The changes after ex vivo ablation were histopathologically identical to those from in vivo ablation. There were statistically significant positive correlations in measured dimensions (area, depth, width, and diameter) of ablation lesions between histopathology and IVUS/OFDI findings (Pearson correlation coefficients = 0.69-0.77). CONCLUSIONS These findings suggest that observation of treated renal arteries by IVUS or OFDI immediately after RDN improves the success rate of RDN.
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Affiliation(s)
- Atsushi Sakaoka
- R&D Headquarters, Terumo Corporation, Tokyo, Japan.,Graduate School of Engineering, Osaka Institute of Technology, Osaka, Japan
| | - Akiyuki Takami
- Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yuji Onimura
- R&D Headquarters, Terumo Corporation, Tokyo, Japan
| | | | - Hisako Terao
- R&D Headquarters, Terumo Corporation, Tokyo, Japan
| | - Fumiaki Kumagai
- Laboratory of Safety Evaluation, Division of Safety, Hatano Research Institute, Food and Drug Safety Center, Kanagawa, Japan
| | - Kiyoshi Matsumura
- Graduate School of Engineering, Osaka Institute of Technology, Osaka, Japan
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Laffin LJ, Bakris GL. Catheter-Based Renal Denervation for Resistant Hypertension: Will It Ever Be Ready for "Prime Time"? Am J Hypertens 2017; 30:841-846. [PMID: 27838622 DOI: 10.1093/ajh/hpw123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/08/2016] [Indexed: 12/30/2022] Open
Abstract
The year 2014 was a turning point for the field of renal denervation (RDN) and its potential use to treat resistant hypertension. Tremendous enthusiasm shifted to sober reflection on the efficacy of a technology once touted as the cure to resistant hypertension. The following review highlights 2 major questions: First, does catheter-based RDN lower blood pressure and, second, will RDN using catheter-directed therapy for the treatment of resistant hypertension ever become more than an investigational technology.
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Affiliation(s)
- Luke J Laffin
- Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - George L Bakris
- Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
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Táborský M, Richter D, Tonar Z, Kubíková T, Herman A, Peregrin J, Červenková L, Husková Z, Kopkan L. Early morphologic alterations in renal artery wall and renal nerves in response to catheter-based renal denervation procedure in sheep: difference between single-point and multiple-point ablation catheters. Physiol Res 2017; 66:601-614. [PMID: 28406699 DOI: 10.33549/physiolres.933503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Renal sympathetic hyperactivity is critically involved in hypertension pathophysiology; renal denervation (RDN) presents a novel strategy for treatment of resistant hypertension cases. This study assessed effects of two RDN systems to detect acute intravascular, vascular and peri-vascular changes in the renal artery, and renal nerve alterations, in the sheep. The procedures using a single-point or multi-point ablation catheters, Symplicity Flex(TM), Medtronic versus EnligHTN(TM), St. Jude Medical were compared; the intact contralateral kidneys served as controls. Histopathological and immunohistochemical assessments were performed 48 h after RDN procedures; the kidney and suprarenal gland morphology was also evaluated. Special staining methods were applied for histologic analysis, to adequately score the injury of renal artery and adjacent renal nerves. These were more pronounced in the animals treated with the multi-point compared with the single-point catheter. However, neither RDN procedure led to complete renal nerve ablation. Forty-eight hours after the procedure no significant changes in plasma and renal tissue catecholamines were detected. The morphologic changes elicited by application of both RDN systems appeared to be dependent on individual anatomical variability of renal nerves in the sheep. Similar variability in humans may limit the therapeutic effectiveness of RDN procedures used in patients with resistant hypertension.
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Affiliation(s)
- M Táborský
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Palacký University, Olomouc, Czech Republic.
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33
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Procedural Reassessment of Radiofrequency Renal Denervation in Resistant Hypertensive Patients. High Blood Press Cardiovasc Prev 2017; 24:187-192. [PMID: 28374154 DOI: 10.1007/s40292-017-0197-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Recent anatomical and clinical studies have led to the hypothesis that in several cases of failure of response to renal denervation (RDN), the procedure has not been technically correct. AIM To perform procedural reassessment in patients with true resistant hypertension who underwent RDN. METHODS We retrospectively reassessed the procedural technique of RDN in 10 true resistant hypertensive patients, comparing the sites of renal ablations with the knowledge of animal and human post mortem evidences. Procedural ablation technique was assessed in terms of number of ablations for each renal artery and site of ablation (quadrant and distance from renal ostium) by using the radiologic images of each RDN and the number of radiofrequency ablation attempts documented in the reports of each denervation session. RESULTS 10 patients were studied, 9 denervated with Simplicity monoelectrode catheter, 1 with multielectrode balloon technique. Responders to the procedure underwent more ablations and particularly at least a quadrant ablation in one of the kidney arteries, >2 ablations in Dorsal plus Ventral quadrants and in 67% of then >10 ablations were done in superior inferior and ventral quadrants. CONCLUSION This study confirms the importance of a well knowledge of renal artery anatomy and underlines the relevance of the choice of ablation sites in order to obtain a successful RDN procedure.
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Qian P, Barry M, Al-Raisi S, Kovoor P, Pouliopoulos J, Nalliah C, Bhaskaran A, Chik W, Kurup R, James V, Varikatt W, McEwan A, Thiagalingam A, Thomas S. Transcatheter non-contact microwave ablation may enable circumferential renal artery denervation while sparing the vessel intima and media. EUROINTERVENTION 2017; 12:e1907-e1915. [DOI: 10.4244/eij-d-16-00509] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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35
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Schlaich MP. What we need to know about renal nerve ablation for treatment of hypertension and other states of sympathetic overactivity. Am J Physiol Renal Physiol 2016; 311:F1267-F1270. [PMID: 27630063 DOI: 10.1152/ajprenal.00058.2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 09/12/2016] [Indexed: 01/18/2023] Open
Abstract
Renal nerves are key players in the regulation of kidney function and blood pressure control. Targeting the neurogenic mechanisms underlying hypertension and cardiac and renal disease has been attempted by means of surgical and pharmacologic approaches and most recently by catheter-based interventions aimed at disrupting renal sympathetic nerve traffic. The recent developments in the area and the relevant questions that need to be addressed to advance the field further are briefly reviewed in this article.
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Affiliation(s)
- Markus P Schlaich
- School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Perth, Western Australia, Australia; .,Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; and.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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36
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Burchell AE, Chan K, Ratcliffe LEK, Hart EC, Saxena M, Collier DJ, Jain AK, Mathur A, Knight CJ, Caulfield MJ, Paton JFR, Nightingale AK, Lobo MD, Baumbach A. Controversies Surrounding Renal Denervation: Lessons Learned From Real-World Experience in Two United Kingdom Centers. J Clin Hypertens (Greenwich) 2016; 18:585-92. [PMID: 26857092 DOI: 10.1111/jch.12789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/18/2015] [Accepted: 12/20/2015] [Indexed: 11/27/2022]
Abstract
Renal denervation (RDN) is a therapy that targets treatment-resistant hypertension (TRH). The Renal Denervation in Patients With Uncontrolled Hypertension (Symplicity) HTN-1 and Symplicity HTN-2 trials reported response rates of >80%; however, sham-controlled Symplicity HTN-3 failed to reach its primary blood pressure (BP) outcome. The authors address the current controversies surrounding RDN, illustrated with real-world data from two centers in the United Kingdom. In this cohort, 52% of patients responded to RDN, with a 13±32 mm Hg reduction in office systolic BP (SBP) at 6 months (n=29, P=.03). Baseline office SBP and number of ablations correlated with office SBP reduction (R=-0.47, P=.01; R=-0.56, P=.002). RDN appears to be an effective treatment for some patients with TRH; however, individual responses are highly variable. Selecting patients for RDN is challenging, with only 10% (33 of 321) of the screened patients eligible for the study. Medication alterations and nonadherence confound outcomes. Adequate ablation is critical and should impact future catheter design/training. Markers of procedural success and improved patient selection parameters remain key research aims.
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Affiliation(s)
- Amy E Burchell
- CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Kenneth Chan
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Barts Blood Pressure Clinic, Barts Health NHS Trust, London, UK
| | - Laura E K Ratcliffe
- CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.,School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Emma C Hart
- CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.,School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Manish Saxena
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Barts Blood Pressure Clinic, Barts Health NHS Trust, London, UK
| | - David J Collier
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Ajay K Jain
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - Charles J Knight
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - Mark J Caulfield
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Barts Blood Pressure Clinic, Barts Health NHS Trust, London, UK
| | - Julian F R Paton
- CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.,School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Angus K Nightingale
- CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Melvin D Lobo
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK.,Barts Blood Pressure Clinic, Barts Health NHS Trust, London, UK
| | - Andreas Baumbach
- CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK
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Renal Denervation for Treatment of Hypertension: a Second Start and New Challenges. Curr Hypertens Rep 2016; 18:6. [DOI: 10.1007/s11906-015-0610-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Patel HC, Hayward C, Vassiliou V, Patel K, Howard JP, Di Mario C. Renal denervation for the management of resistant hypertension. Integr Blood Press Control 2015; 8:57-69. [PMID: 26672761 PMCID: PMC4675644 DOI: 10.2147/ibpc.s65632] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Renal sympathetic denervation (RSD) as a therapy for patients with resistant hypertension has attracted great interest. The majority of studies in this field have demonstrated impressive reductions in blood pressure (BP). However, these trials were not randomized or sham-controlled and hence, the findings may have been overinflated due to trial biases. SYMPLICITY HTN-3 was the first randomized controlled trial to use a blinded sham-control and ambulatory BP monitoring. A surprise to many was that this study was neutral. Possible reasons for this neutrality include the fact that RSD may not be effective at lowering BP in man, RSD was not performed adequately due to limited operator experience, patients’ adherence with their anti-hypertensive drugs may have changed during the trial period, and perhaps the intervention only works in certain subgroups that are yet to be identified. Future studies seeking to demonstrate efficacy of RSD should be designed as randomized blinded sham-controlled trials. The efficacy of RSD is in doubt, but many feel that its safety has been established through the thousands of patients in whom the procedure has been performed. Over 90% of these data, however, are for the Symplicity™ system and rarely extend beyond 12 months of follow-up. Long-term safety cannot be assumed with RSD and nor should it be assumed that if one catheter system is safe then all are. We hope that in the near future, with the benefit of well-designed clinical trials, the role of renal denervation in the management of hypertension will be established.
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Affiliation(s)
- Hitesh C Patel
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Carl Hayward
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Vassilis Vassiliou
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Ketna Patel
- Department of Cardiology, Royal Free Hospital, London, UK
| | - James P Howard
- National Heart and Lung Institute, Imperial College, London, UK
| | - Carlo Di Mario
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
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Patel HC, Otero S, Moser JB, Hayward C, Rosen SD, Lyon AR, Mohiaddin R, di Mario C, Padley S. A cross-sectional imaging study to identify organs at risk of thermal injury during renal artery sympathetic denervation. Int J Cardiol 2015; 197:235-40. [DOI: 10.1016/j.ijcard.2015.06.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/15/2015] [Accepted: 06/19/2015] [Indexed: 11/26/2022]
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40
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Sawlani NN, Bhatt DL. Distal and Tributary Targets. J Am Coll Cardiol 2015; 66:1776-1778. [DOI: 10.1016/j.jacc.2015.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/09/2015] [Indexed: 11/25/2022]
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41
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Schmid A, Schmieder R, Lell M, Janka R, Veelken R, Schmieder RE, Uder M, Ott C. Mid-Term Vascular Safety of Renal Denervation Assessed by Follow-up MR Imaging. Cardiovasc Intervent Radiol 2015; 39:426-32. [DOI: 10.1007/s00270-015-1192-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/18/2015] [Indexed: 11/29/2022]
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42
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Iliescu R, Lohmeier TE, Tudorancea I, Laffin L, Bakris GL. Renal denervation for the treatment of resistant hypertension: review and clinical perspective. Am J Physiol Renal Physiol 2015. [PMID: 26224718 DOI: 10.1152/ajprenal.00246.2015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
When introduced clinically 6 years ago, renal denervation was thought to be the solution for all patients whose blood pressure could not be controlled by medication. The initial two studies, SYMPLICITY HTN-1 and HTN-2, demonstrated great magnitudes of blood pressure reduction within 6 mo of the procedure and were based on a number of assumptions that may not have been true, including strict adherence to medication and absence of white-coat hypertension. The SYMPLICITY HTN-3 trial controlled for all possible factors believed to influence the outcome, including the addition of a sham arm, and ultimately proved the demise of the initial overly optimistic expectations. This trial yielded a much lower blood pressure reduction compared with the previous SYMPLICITY trials. Since its publication in 2014, there have been many analyses to try and understand what accounted for the differences. Of all the variables examined that could influence blood pressure outcomes, the extent of the denervation procedure was determined to be inadequate. Beyond this, the physiological mechanisms that account for the heterogeneous fall in arterial pressure following renal denervation remain unclear, and experimental studies indicate dependence on more than simply reduced renal sympathetic activity. These and other related issues are discussed in this paper. Our perspective is that renal denervation works if done properly and used in the appropriate patient population. New studies with new approaches and catheters and appropriate controls will be starting later this year to reassess the efficacy and safety of renal denervation in humans.
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Affiliation(s)
- Radu Iliescu
- Department of Physiology, University of Medicine and Pharmacy, "Gr. T. Popa," Iasi, Romania
| | - Thomas E Lohmeier
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Ionut Tudorancea
- Department of Physiology, University of Medicine and Pharmacy, "Gr. T. Popa," Iasi, Romania
| | - Luke Laffin
- Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, Illinois
| | - George L Bakris
- Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, Illinois
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Fadl Elmula FEM, Jin Y, Yang WY, Thijs L, Lu YC, Larstorp AC, Persu A, Sapoval M, Rosa J, Widimský P, Jacobs L, Renkin J, Petrák O, Chatellier G, Shimada K, Widimský J, Kario K, Azizi M, Kjeldsen SE, Staessen JA. Meta-analysis of randomized controlled trials of renal denervation in treatment-resistant hypertension. Blood Press 2015; 24:263-74. [DOI: 10.3109/08037051.2015.1058595] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Fadl Elmula M. Fadl Elmula
- Departments of Cardiology, Internal Medicine and Medical Biochemistry, Oslo University Hospital, Ullevaal, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yu Jin
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Leuven, Belgium
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Leuven, Belgium
| | - Yi-Chao Lu
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Leuven, Belgium
| | - Anne C. Larstorp
- Departments of Cardiology, Internal Medicine and Medical Biochemistry, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Alexandre Persu
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Marc Sapoval
- Universit Paris-Descartes and H pital Europ en Georges Pompidou, Assistance Publique H pitaux de Paris, Paris, France
| | - Ján Rosa
- Centre for Hypertension, Third Department of Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
- Cardiocentre, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Widimský
- Cardiocentre, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lotte Jacobs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Leuven, Belgium
| | - Jean Renkin
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ondřej Petrák
- Centre for Hypertension, Third Department of Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Gilles Chatellier
- Universit Paris-Descartes and H pital Europ en Georges Pompidou, Assistance Publique H pitaux de Paris, Paris, France
- INSERM CIC1418, Paris, France
| | - Kazuyuki Shimada
- Department of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Jiři Widimský
- Centre for Hypertension, Third Department of Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Kazuomi Kario
- Department of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Michel Azizi
- Universit Paris-Descartes and H pital Europ en Georges Pompidou, Assistance Publique H pitaux de Paris, Paris, France
- INSERM CIC1418, Paris, France
| | - Sverre E. Kjeldsen
- Departments of Cardiology, Internal Medicine and Medical Biochemistry, Oslo University Hospital, Ullevaal, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan A. Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Leuven, Belgium
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
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44
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Santos-Gallego CG, Badimón JJ. Denervación renal por catéter como tratamiento para la hipertensión pulmonar: ¿esperanza o espejismo? Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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45
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Kiuchi MG, Chen S, Graciano ML, de Queiroz Carreira MAM, Kiuchi T, Andrea BR, Lugon JR. Acute effect of renal sympathetic denervation on blood pressure in refractory hypertensive patients with chronic kidney disease. Int J Cardiol 2015; 190:29-31. [DOI: 10.1016/j.ijcard.2015.04.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/05/2015] [Indexed: 11/15/2022]
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46
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Catheter-based Renal Denervation as a Treatment for Pulmonary Hypertension: Hope or Hype? ACTA ACUST UNITED AC 2015; 68:551-3. [PMID: 26032026 DOI: 10.1016/j.rec.2015.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/17/2015] [Indexed: 11/20/2022]
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