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Tsukamoto T, Fujita Y, Shimogami M, Kaneda K, Seto T, Mizukami K, Takei M, Isobe Y, Yasui H, Sato K. Inside-the-body light delivery system using endovascular therapy-based light illumination technology. EBioMedicine 2022; 85:104289. [PMID: 36208989 PMCID: PMC9669774 DOI: 10.1016/j.ebiom.2022.104289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022] Open
Abstract
Background Light-based therapies are promising for treating diseases including cancer, hereditary conditions, and protein-related disorders. However, systems, methods, and devices that deliver light deep inside the body are limited. This study aimed to develop an endovascular therapy-based light illumination technology (ET-BLIT), capable of providing deep light irradiation within the body. Methods The ET-BLIT system consists of a catheter with a single lumen as a guidewire and diffuser, with a transparent section at the distal end for thermocouple head attachment. The optical light diffuser alters the emission direction laterally, according to the optical fibre's nose-shape angle. If necessary, after delivering the catheter to the target position in the vessel, the diffuser is inserted into the catheter and placed in the transparent section in the direction of the target lesion. Findings ET-BLIT was tested in an animal model. The 690-nm near-infrared (NIR) light penetrated the walls of blood vessels to reach the liver and kidneys without causing temperature increase, vessel damage, or blood component alterations. NIR light transmittance from the diffuser to the detector within the organ or vessel was approximately 30% and 65% for the renal and hepatic arteries, respectively. Interpretation ET-BLIT can be potentially used in clinical photo-based medicine, as a far-out technology. ET-BLIT uses a familiar method that can access the whole body, as the basic procedure is comparable to that of endovascular therapy in terms of sequence and technique. Therefore, the use of the ET-BLIT system is promising for many light-based therapies that are currently in the research phase. Funding Supported by Programme for Developing Next-generation Researchers (Japan Science and Technology Agency); JSPS KAKENHI (18K15923, 21K07217); JST-CREST (JPMJCR19H2); JST-FOREST-Souhatsu (JPMJFR2017); The Uehara Memorial Foundation; Yasuda Memorial Medical Foundation; Mochida Memorial Foundation for Medical and Pharmaceutical Research; Takeda Science Foundation; The Japan Health Foundation; Takahashi Industrial and Economic Research Foundation; AICHI Health Promotion Foundation; and Princess Takamatsu Cancer Research Fund.
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Characterization of the mesenteric circulatory physiology during hemorrhagic shock in a swine model. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hansen-Estruch C, Porrett PM, Kumar V, Locke JE. The science of xenotransplantation for nephrologists. Curr Opin Nephrol Hypertens 2022; 31:387-393. [PMID: 35703221 DOI: 10.1097/mnh.0000000000000800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW The field of xenotransplantation has seen remarkable progress since its inception with recent preclinical trials in human recipients pushing kidney xenotransplantation one-step closer to clinical reality. In this review, we update practicing clinicians on recent advances in kidney xenotransplantation given the proximity of clinical trials in humans. RECENT FINDINGS Early studies in the field established the physiologic basis of xenotransplantation and suggested that the pig kidney will support human physiology. Genetic engineering of source pigs has greatly reduced the immunogenicity of kidney grafts, and studies in nonhuman primates have demonstrated the viability of kidney xenotransplants for months after transplantation. Finally, a recent study in a novel preclinical human model demonstrated that key findings in NHP experiments are generalizable to humans, namely, the absence of hyperacute rejection. SUMMARY Overall, it appears that critical physiologic, immunologic and technical barriers to implementation of clinical trials in humans have been overcome.
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Affiliation(s)
| | - Paige M Porrett
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vineeta Kumar
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jayme E Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Hernández D, Cuevas JL, Gramegna LL, Requena M, Piñana C, de Dios M, Coscojuela P, Esteves M, Li J, Gil A, Ribó M, Tomasello A. Increased Number of Passes and Double Stent Retriever Technique Induces Cumulative Injury on Arterial Wall After Mechanical Thrombectomy in a Swine Model. Transl Stroke Res 2022; 14:425-433. [PMID: 35672562 DOI: 10.1007/s12975-022-01044-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 11/27/2022]
Abstract
The number of stentriever passes during endovascular thrombectomy impacts clinical outcomes in acute ischemic stroke. Previous studies suggest that the simultaneous double stent retriever technique (DSRT) could improve the efficacy and reduce the number of passes. We aim to analyze the degree of vessel wall injury according to the number of passes and technique (single vs. simultaneous devices). Histological changes were evaluated in renal arteries (RAs) of swine models after thrombectomy (1, 2, or 3 passes) with single stent (SSRT) and DSRT. Thrombectomy passes were performed in 12 RA: 3 samples from each artery were studied by optical microscopy to assess a vascular damage score. All thirty-six samples showed endothelial denudation and different degrees of damage in the deepest layers of the arterial wall; however, all arteries remained patent by the time of assessment. In all cases, the degree of vascular injury increased with the number of passes. Compared with a SSRT, DSRT showed a higher severity of histological damage corresponding to the damage caused by 1.4 SSRT passes. However, in distal arteries, vascular damage was relatively similar when comparing SSRT with multiple passes and DSRT with one pass. The degree of vessel injury increases with the number of passes. Even though histological damage per pass was 1.4 higher with DSRT than SSRT, short-term vessel patency was not compromised after up to 3 DSRT passes. Further studies are needed to characterize the risk-benefit ratio of the DSRT in routine clinical practice.
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Affiliation(s)
- David Hernández
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - José Luis Cuevas
- Neurosurgery and Interventional Neuroradiology, Hospital de Puerto Montt, Puerto Montt, Chile
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Ludovica Gramegna
- Department of Biomedical and Motor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Manuel Requena
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Stroke Unit, Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Piñana
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marta de Dios
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Pilar Coscojuela
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marielle Esteves
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jiahui Li
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
- Stroke Unit, Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alberto Gil
- Interventional Neuroradiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Marc Ribó
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
- Stroke Unit, Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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Hansen-Estruch C, Cooper DK, Judd E. Physiological aspects of pig kidney xenotransplantation and implications for management following transplant. Xenotransplantation 2022; 29:e12743. [PMID: 35297098 PMCID: PMC9232961 DOI: 10.1111/xen.12743] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 02/19/2022] [Accepted: 03/03/2022] [Indexed: 12/16/2022]
Abstract
Successful organ transplantation between species is now possible, using genetic modifications. This article aims to provide a comprehensive overview of the differences and similarities in kidney function between humans, primates, and pigs, in preparation for pig-allograft to human xenotransplantation. The kidney, as the principal defender of body homeostasis, acts as a sensor, effector, and regulator of physiologic feedback systems. Considerations are made for anticipated effects on each system when a pig kidney is placed into a human recipient. Discussion topics include anatomy, global kidney function, sodium and water handling, kidney hormone production and response to circulating hormones, acid-base balance, and calcium and phosphorus handling. Based on available data, pig kidneys are anticipated to be compatible with human physiology, despite a few barriers.
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Affiliation(s)
- Christophe Hansen-Estruch
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David K.C. Cooper
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eric Judd
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Cheng Y, Liu H, Tian Z, Zhang M, Liu Y, Nan Q. Evaluating the thermal performance of a balloon-based renal sympathetic denervation system with array electrodes: a finite element study. Electromagn Biol Med 2021; 40:488-501. [PMID: 34352188 DOI: 10.1080/15368378.2021.1961266] [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: 10/20/2022]
Abstract
Renal denervation transmits radiofrequency (RF) energy through an electrode to treat resistant hypertension (RH), applying ablation in the renal artery. Several experimental studies have shown that this treatment has been used effectively to treat RH. The aim of this paper is to investigate the effect of ablation parameters (i.e., electrode length, applied voltage, ablation time, and blood flow) on the temperature distribution using a balloon-based array electrodes system. A simplified three-dimensional model including four electrodes and a balloon was established. The balloon diameter was 3 mm and placed in a 5 mm diameter renal artery for forming intra-arterial occlusion. Four electrodes were mounted on the balloon and distributed in the same plane to mimic circumferential RF ablation. Computer simulations were conducted to investigate the thermal performances of the device by setting different electrode configurations, treatment protocols, and physiological factors. The thermal performances including the thermal distribution, maximum lesion depth, length, and area were analyzed. The lesion shape of the array RF electrodes was approximately a sphere with a 100% circumference coverage rate of the renal artery. The lesion depth and length increase with each factor except for blood velocity. Increasing the electrode length from 2 to 4 mm or 2 to 6 mm, the lesion depth increases by 1.15 mm and 0.54 mm at 60 s. The corresponding lesion length increases by 2.65 mm and 2.34 mm, respectively. The range of effective lesion depth is 1.90-4.90 mm, at a voltage of 15-30 V. But the peak temperature at the arterial outer wall exceeded 100 °C when the voltage is above 25 V. In tissue, the degree of thermal injury in the 2 mm area reached 100%, but in blood was not more than 5%. There was no significant difference at different flow conditions because the difference value in lesion depth was not exceeded 0.5 mm. The results showed that the balloon-based four electrodes system is expected to overcome the difficulty of incomplete ablation. In clinical application, 2 mm-electrode is recommended to avoid long wall damage as much as possible and control the voltage below 25 V. This treatment has little thermal injury on the blood, which means it may avoid coagulation formation. Moreover, the application of this device does not need to consider the difference in individual blood velocity.
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Affiliation(s)
- Yanyan Cheng
- College of Life Science and Chemistry, The Faculty of Environment and Life ScienceBeijing University of Technology, Beijing, China
| | - Hongxing Liu
- College of Life Science and Chemistry, The Faculty of Environment and Life ScienceBeijing University of Technology, Beijing, China
| | - Zhen Tian
- College of Life Science and Chemistry, The Faculty of Environment and Life ScienceBeijing University of Technology, Beijing, China
| | - Meng Zhang
- College of Life Science and Chemistry, The Faculty of Environment and Life ScienceBeijing University of Technology, Beijing, China
| | - Youjun Liu
- College of Life Science and Chemistry, The Faculty of Environment and Life ScienceBeijing University of Technology, Beijing, China
| | - Qun Nan
- College of Life Science and Chemistry, The Faculty of Environment and Life ScienceBeijing University of Technology, Beijing, China
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Góes AMDO, Chaves RHDF, Furlaneto IP, Rodrigues EDM, de Albuquerque FBA, Smit JHA, de Oliveira CP, Abib SDCV. Comparative angiotomographic study of swine vascular anatomy: contributions to research and training models in vascular and endovascular surgery. J Vasc Bras 2021; 20:e20200086. [PMID: 34093675 PMCID: PMC8147709 DOI: 10.1590/1677-5449.200086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Medium and large animal models allow researchers to evaluate the efficacy and safety of cardiovascular procedures in systems that resemble human anatomy and can be used to simulate scenarios for training purposes. Although porcine models have been used extensively, many physiological and anatomical features remain unknown or only superficially described. Objectives To describe the normal porcine vascular anatomy on computed tomography scans, compare it to human vascular anatomy, and discuss the application of porcine models for open and endovascular procedures. Methods Three male Landrace pigs underwent computed tomography. The vascular anatomy of the neck, thorax, abdomen, and limbs was analyzed and described; relevant similarities and differences between porcine and human vascular anatomies and the implications for vascular procedures in pigs are highlighted. Results The carotid territory, aortic arch, and terminal aorta branches all show marked differences in pigs compared to their human counterparts. Compressions of both left renal and common iliac veins were detected, analogous to those seen in human Nutcracker and May-Thurner syndromes. Vascular measurements (diameters, lengths, and angles) of several different porcine territories are presented. Conclusions The data presented should be useful for planning preclinical trials and basic research and for refining surgical training using porcine models in vascular fields.
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Affiliation(s)
- Adenauer Marinho de Oliveira Góes
- Centro Universitário do Estado do Pará - CESUPA, Curso de Medicina, Belém, PA, Brasil.,Universidade Federal de São Paulo - UNIFESP, Programa de Ciência Cirúrgica Interdisciplinar, São Paulo, SP, Brasil
| | | | | | | | | | | | | | - Simone de Campos Vieira Abib
- Universidade Federal de São Paulo - UNIFESP, Programa de Ciência Cirúrgica Interdisciplinar, São Paulo, SP, Brasil
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Smit JHA, Leonardi EP, Chaves RHDF, Furlaneto IP, da Silva CMS, Abib SDCV, Góes AMDO. Image-guided study of swine anatomy as a tool for urologic surgery research and training. Acta Cir Bras 2021; 35:e351208. [PMID: 33503221 PMCID: PMC7819699 DOI: 10.1590/acb351208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/10/2020] [Accepted: 11/11/2020] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To describe the anatomy of the swine urinary system using computed tomography and to discuss the role of this animal as an experimental model for urological procedures. METHODS Three male Landrace pigs underwent computed tomography and the anatomy of the urinary system and renal circulation was analyzed and described. RESULTS In all animals, 2 kidneys, 2 ureters and one bladder were identified. Each kidney presented a single renal artery vascularization, with a mean diameter on the right of 4.45 and 5.31 mm on the left (p < 0.0001) and single renal vein drainage, with a mean diameter on the right of 5.78 and 5.82 mm on the left (p = 0.0336). The average renal length was 9.85 cm on the right and 10.30 cm on the left (p < 0.0001). The average renal volume was 113.70 cm3 on the right and 109.70 cm3 on the left (p < 0.0001). The average length of the ureter was 19.78 cm on the right and 22.08 cm on the left (p < 0.0001). The average bladder volume was 423.70 cm3. CONCLUSIONS The data obtained show similarities with human anatomy, suggesting the viability of the swine model for planning preclinical trials, basic research, refinement in experimental surgery and surgical training for urological procedures.
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Affiliation(s)
| | - Eduardo Piotto Leonardi
- MSc, Associate Professor, Department of Urology, School of
Medicine, Centro Universitário do Estado do Pará, Belém-PA, Brazil
| | | | - Ismari Perini Furlaneto
- PhD, Grupo de Pesquisa Experimental, Centro Universitário do Estado
do Pará, Belém-PA, Brazil
| | - Cezar Massoud Salame da Silva
- MSc, Associate Professor, Department of Radiology, School of
Medicine, Centro Universitário do Estado do Pará, Belém-PA, Brazil
| | | | - Adenauer Marinho de Oliveira Góes
- PhD, Full Professor, Department of Vascular Surgery, Grupo de
Pesquisa Experimental, Centro Universitário do Estado do Pará, Belém-PA,
Brazil
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Yim D, Baik J, Lee S, Yang S, Jeong CW, Park SM. Development of a nitinol-actuated surgical instrument for laparoscopic renal denervation: feasibility test in a swine survival model. Int J Hyperthermia 2020; 37:573-584. [PMID: 32552042 DOI: 10.1080/02656736.2020.1767806] [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: 10/24/2022] Open
Abstract
Purpose: In this study, we developed a novel nitinol-actuated surgical instrument to conduct laparoscopic renal denervation for the treatment of resistant hypertension. We investigated whether shape and temperature settings of nitinol specimens fit well into the design goals. Furthermore, we conducted a pilot study to validate the mechanical and physiological performance of nerve ablation without damaging the renal artery.Method: Tensile tests were performed to observe temperature-dependent thermomechanical properties and the original shape of nitinol specimens was set considering our design goal. We performed strain gage experiments to measure bending strain. We developed surgical instrument and operated laparoscopic renal denervation in a swine model. Subsequent impedance spectroscopy experiments were conducted to measure changes in impedance magnitudes during the operation and histological analyses were performed to visualize thermogenic damage to arteries and nerves.Results: Tensile testing showed that the shape memory effect begins above 37 °C. Measured strains on nitinol surfaces were 2.10% ± 0.769%, below the strain limit of 8%. Impedance spectroscopy experiments showed decreases in magnitude in all six trials. After operation of laparoscopic renal denervation following the protocol, renal arteries and nerves were harvested and thermogenic damage was observed in nerves but not arteries.Conclusion: We developed a novel nitinol-actuated surgical instrument with which to perform laparoscopic renal denervation. The feasibility of our device was verified using thermomechanical analyses of nitinol, and assessments of mechanical and physiological performance. Our device could be used in other laparoscopic procedures that require large degrees of freedom while restricting to trocar size.
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Affiliation(s)
- Donghyun Yim
- Department of Creative IT Engineering, POSTECH, Pohang, Republic of Korea
| | - Jinhwan Baik
- Department of Creative IT Engineering, POSTECH, Pohang, Republic of Korea
| | - Sangyong Lee
- Department of Prototype Production, Osong Medical Innovation Foundation, Chungbuk, Republic of Korea
| | - Sunchoel Yang
- Department of Prototype Production, Osong Medical Innovation Foundation, Chungbuk, Republic of Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung-Min Park
- Department of Creative IT Engineering, POSTECH, Pohang, Republic of Korea
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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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