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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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Bönner F, Haberkorn S, Behm P, Schnackenburg B, Krüger S, Weiss S, Meyer C, Kelm M, Neizel-Wittke M. Magnetic resonance guided renal denervation using active tracking: first in vivo experience in Swine. Int J Cardiovasc Imaging 2017; 34:431-439. [DOI: 10.1007/s10554-017-1244-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
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Shea J, de Bever J, Kholmovski E, Beal H, Hadley JR, Minalga E, Salama ME, Marrouche NF, Payne A. Effect of applied energy in renal sympathetic denervation with magnetic resonance guided focused ultrasound in a porcine model. J Ther Ultrasound 2017; 5:16. [PMID: 28616236 PMCID: PMC5467056 DOI: 10.1186/s40349-017-0094-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/27/2017] [Indexed: 11/30/2022] Open
Abstract
Background Past catheter-based and focused ultrasound renal denervation studies have indicated that procedure efficacy is related to the number of ablations performed or the amount of energy used for the ablation. This study extends those prior results and investigates energy level effects on the efficacy of MR guided focused ultrasound renal denervation performed in a porcine model. Methods Twenty-four normotensive pigs underwent unilateral denervation at three intensity levels. The applied intensity level was retrospectively de-rated to account for variability in animal size. Efficacy was assessed through evaluating the norepinephrine present in the kidney medulla and through histological analysis. The treatment was performed under MRI guidance including pre- and post-procedure T1-weighted and quantitative T1 and T2 imaging. During treatment, the temperature in the near field of the ultrasound beam was monitored in real time with MR temperature imaging. Energy delivery in the regions surrounding the renal artery was independently confirmed through an invasive fiberoptic temperature probe placed in the right renal artery. Results Animals that underwent denervation at a de-rated acoustic intensity of greater than 1.2 kW/cm2 had a significantly lower norepinephrine concentration in the kidney indicating successful denervation. Images obtained during the treatment indicated no tissue changes in the kidneys as a function of the procedure but there were significant T1 changes present in the right lumbar muscles, although only one animal had indication of muscle damage at the time of necropsy. Conclusions While MR guided focused ultrasound renal denervation was found to be safe and effective in this normotensive animal model, the results indicated the need to incorporate patient-specific details in the treatment planning of MRgFUS renal denervation procedure.
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Affiliation(s)
- Jill Shea
- Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Joshua de Bever
- Department of Radiology and Imaging Sciences, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108 USA
| | - Eugene Kholmovski
- Department of Radiology and Imaging Sciences, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108 USA
| | - Hannah Beal
- Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - J Rock Hadley
- Department of Radiology and Imaging Sciences, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108 USA
| | - Emilee Minalga
- Department of Radiology and Imaging Sciences, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108 USA
| | - Mohamed E Salama
- Department of Pathology, University of Utah, 15 North Medical Drive East Ste #1100, Salt Lake City, UT 84112 USA
| | - Nassir F Marrouche
- CARMA Center, Department of Cardiology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Allison Payne
- Department of Radiology and Imaging Sciences, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108 USA
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Ellens NPK, Partanen A. Preclinical MRI-Guided Focused Ultrasound: A Review of Systems and Current Practices. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2017; 64:291-305. [PMID: 27662675 DOI: 10.1109/tuffc.2016.2609238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Effective preclinical research is a vital component in the development of MRI-guided focused ultrasound (MRgFUS) and its translation to clinic. In this review, we seek to outline the challenges at hand for effective preclinical research, survey different solutions, and underline best practices. Furthermore, we summarize efforts to build and characterize dedicated preclinical MRgFUS equipment, including lab prototypes and available commercial products. Finally, we discuss constraints and considerations specific to using clinical MRgFUS equipment in preclinical research. Specifically, we examine additional hardware that has been used to adapt clinical MRgFUS equipment to better position, constrain, and image preclinical subjects, as well as software solutions that have been used to extend the potential and capabilities of clinical devices.
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Koopmann M, Shea J, Kholmovski E, de Bever J, Minalga E, Holbrook M, Merrill R, Hadley JR, Owan T, Salama ME, Marrouche NF, Payne A. Renal sympathetic denervation using MR-guided high-intensity focused ultrasound in a porcine model. J Ther Ultrasound 2016; 4:3. [PMID: 26848390 PMCID: PMC4741025 DOI: 10.1186/s40349-016-0048-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/27/2016] [Indexed: 12/15/2022] Open
Abstract
Background Initial catheter-based renal sympathetic denervation (RSD) studies demonstrated promising results in showing a significant reduction of blood pressure, while recent data were less successful. As an alternative approach, the objective of this study was to evaluate the feasibility of using magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) to perform RSD in a porcine model. Methods An intravascular fiber optic temperature probe was used to confirm energy delivery during MRgHIFU. This technique was evaluated both in a vascular phantom and in a normotensive pig model. Five animals underwent unilateral RSD using MRgHIFU, and both safety and efficacy were assessed. MRI was used to evaluate the acoustic window, target sonications, monitor the near-field treatment region using MR thermometry imaging, and assess the status of tissues post-procedure. An intravascular fiber optic temperature probe verified energy delivery. Animals were sacrificed 6 to 9 days post-treatment, and pathological analysis was performed. The norepinephrine present in the kidney medulla was assessed post-mortem. Results All animals tolerated the procedure well with no observed complications. The fiber optic temperature probe placed in the target renal artery confirmed energy delivery during MRgHIFU, measuring larger temperature rises when the MRgHIFU beam location was focused closer to the tip of the probe. Following ablation, a significant reduction (p = 0.04) of cross-sectional area of nerve bundles between the treated and untreated renal arteries was observed in all of the animals with treated nerves presenting increased cellular infiltrate and fibrosis. A reduction of norepinephrine (p = 0.14) in the kidney medulla tissue was also observed. There was no indication of tissue damage in arterial walls. Conclusions Performing renal denervation non-invasively with MRgHIFU was shown to be both safe and effective as determined by norepinephrine levels in a porcine model. This approach may be a promising alternative to catheter-based strategies.
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Affiliation(s)
- Matthias Koopmann
- CARMA Center, Department of Cardiology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jill Shea
- Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Eugene Kholmovski
- Department of Radiology, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108 USA
| | - Joshua de Bever
- Department of Radiology, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108 USA
| | - Emilee Minalga
- Department of Radiology, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108 USA
| | - Matthew Holbrook
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112 USA
| | - Robb Merrill
- Department of Radiology, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108 USA
| | - J Rock Hadley
- Department of Radiology, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108 USA
| | - Theophilus Owan
- Department of Cardiology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Mohamed E Salama
- Department of Pathology, University of Utah, 15 North Medical Drive East Ste #1100, Salt Lake City, UT 84112 USA
| | - Nassir F Marrouche
- CARMA Center, Department of Cardiology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Allison Payne
- Department of Radiology, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108 USA
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Kaye EA, Gutta NB, Monette S, Gulati A, Loh J, Srimathveeravalli G, Ezell PC, Erinjeri JP, Solomon SB, Maybody M. Feasibility Study on MR-Guided High-Intensity Focused Ultrasound Ablation of Sciatic Nerve in a Swine Model: Preliminary Results. Cardiovasc Intervent Radiol 2015; 38:985-92. [PMID: 26040256 DOI: 10.1007/s00270-015-1141-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/21/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Spastic patients often seek neurolysis, the permanent destruction of the sciatic nerve, for better pain management. MRI-guided high-intensity focused ultrasound (MRgHIFU) may serve as a noninvasive alternative to the prevailing, more intrusive techniques. This in vivo acute study is aimed at performing sciatic nerve neurolysis using a clinical MRgHIFU system. METHODS The HIFU ablation of sciatic nerves was performed in swine (n = 5) using a HIFU system integrated with a 3 T MRI scanner. Acute lesions were confirmed using T1-weighted contrast-enhanced (CE) MRI and histopathology using hematoxylin and eosin staining. The animals were euthanized immediately following post-ablation imaging. RESULTS Reddening and mild thickening of the nerve and pallor of the adjacent muscle were seen in all animals. The HIFU-treated sections of the nerves displayed nuclear pyknosis of Schwann cells, vascular hyperemia, perineural edema, hyalinization of the collagenous stroma of the nerve, myelin sheet swelling, and loss of axons. Ablations were visible on CE MRI. Non-perfused volume of the lesions (5.8-64.6 cc) linearly correlated with estimated lethal thermal dose volume (4.7-34.2 cc). Skin burn adjacent to the largest ablated zone was observed in the first animal. Bilateral treatment time ranged from 55 to 138 min, and preparation time required 2 h on average. CONCLUSION The acute pilot study in swine demonstrated the feasibility of a noninvasive neurolysis of the sciatic nerve using a clinical MRgHIFU system. Results revealed that acute HIFU nerve lesions were detectable on CE MRI, gross pathology, and histology.
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Affiliation(s)
- Elena A Kaye
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA,
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