Morphological assessment of renal arteries after radiofrequency catheter-based sympathetic denervation in a porcine model

Steigerwald, Kristin; Titova, Anna; Malle, Caroline; Kennerknecht, Elisabeth; Jilek, Clemens; Hausleiter, Jörg; Nährig, Jörg; Laugwitz, Karl‐Ludwig; Joner, Michael

doi:10.1097/hjh.0b013e32835821e5

Cited by 92 publications

(67 citation statements)

References 18 publications

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“…Although angiography results showed there were slight vessel irregularities caused by radiofrequency energy delivery, the lesions disappeared at first month of follow-up. Our angiography results were similar to those of the study by Steigerwald et al 31 which conducted RDN using the Symplicity Catheter System. In Simplicity trials, renal artery aneurysm or stenosis was seldom seen as judged by computed tomography (CT) or magnetic resonance imaging (MRI) angiography.…”

Section: Renal Angiogramsupporting

confidence: 90%

Effects of renal sympathetic denervation using saline-irrigated radiofrequency ablation catheter on the activity of the renin-angiotensin system and endothelin-1

Ling

Chen

et al. 2014

J Renin Angiotensin Aldosterone Syst

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Introduction: Excessive activation of the sympathetic nervous system (SNS) and the renin-angiotensin system (RAS) are crucial and interacted closely in the pathogenesis of chronic cardiovascular diseases. This study investigated the effects of renal denervation (RDN) on the RAS. Materials and methods: Eight Chinese Kunming dogs underwent bilateral RDN utilizing saline-irrigated radiofrequency ablation catheter. Blood pressure (BP) measurements, blood sampling assays and renal angiography were performed at baseline, 30 min, one month and three months after ablation. Results: During three months of follow-up, RDN caused a significant and uniform reduction in plasma level of renin, angiotensin II, and endothelin-1(ET-1), with the reduction of -5.7±6.8 (p=0.049), -19.4±19.3 (p=0.025), and -22.4±21 pg/ml (p=0.02) for plasma renin, -10.6±7.2 (p=0.004), -15.9±8.8 (p=0.001), and -15.2±9.6 pg/ml (p=0.003) for plasma angiotensin II, as well as -3.9±3 (p=0.007), -10.8±5 (p<0.001), and -14.6±6.1 pg/ml (p<0.001) for plasma ET-1. RDN utilizing a saline-irrigated catheter also caused a progressive and substantial BP reduction of -19±22/-8±13, -30±13/-13±14, and -36±20/-16±14 mm Hg (p=0.045, p<0.001, and p<0.002 for systolic BP; p=0.14, p=0.036, and p=0.014 for diastolic BP) without ablation-related complications. Conclusion: RDN substantially decreased BP and also significantly decreased the plasma levels of RAS and ET-1, which might be implicated in the mechanism of BP reduction by RDN.

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Section: Renal Angiogramsupporting

confidence: 90%

Effects of renal sympathetic denervation using saline-irrigated radiofrequency ablation catheter on the activity of the renin-angiotensin system and endothelin-1

Ling

Chen

et al. 2014

J Renin Angiotensin Aldosterone Syst

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“…18 It is not surprising that there was absence of arterial endothelial damage at 7 days after treatment in the current study because re-endothelialization has previously been reported to be complete within 10 days in other preclinical RDN studies. 11 Although recent optical coherence tomography imaging studies observed occasional small nonocclusive mural thrombi in the renal arteries after RDN procedures, 19 it is clear from the HTN-3 study 9 that the RDN procedure was safe. On a morphological level, the current study showed that nerve regeneration was observed within the region of radiofrequency ablation and yet, complete neuronal restoration was absent at 180 days.…”

Section: Discussionmentioning

confidence: 99%

“…Although local loss of the endothelium was observed in the hyperacute phase, arterial media injury and nerve degeneration such as vacuolization and perineural fibrosis were only observed in the subacute phase. 11 Rippy et al 10 only investigated the histopathologic findings after radiofrequency RDN at 6 months (chronic phase) in the swine model using the Symplicity RDN system. Renal nerve injury was characterized as healing fibrosis causing a thickening of the surrounding perineurium in affected nerves.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Histopathologic Analysis Following Renal Sympathetic Denervation Over Multiple Time Points

Sakakura

Tunev

Yahagi

et al. 2015

Circ: Cardiovascular Interventions

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Background-The pathology of radiofrequency-derived sympathetic renal denervation has not been studied over time and may provide important understanding of the mechanisms resulting in sustained blood pressure reduction. The purpose of this study was to investigate chronological changes after radiofrequency-renal denervation in the swine model. Methods and Results-A total of 49 renal arteries from 28 animals with 4 different time points (7, 30, 60, and 180 days) were examined. Semiquantitative histological assessment of arteries and associated tissue was performed to characterize the chronological progression of the radiofrequency lesions. Arterial medial circumferential injury (%) was greatest at 7 days (38±13%), followed by 30 days (31±6%) and 60 days (31±15%), and least at 180 days (21±12%) (P=0.046). Nerve injury score was significantly greater (P<0.001) at 7 days (3.9±0.4) compared with 30 days (2.5±0.5), 60 days (2.6±0.5), and 180 days (1.9±0.9). Tyrosine hydroxylase score, which assesses functional nerve damage, was significantly less after 7 (1±1) and 30 days (0.7±0.6) compared with 60 (2.7±0.6) and 180 days (2.7±0.6; P=0.01). Focal nerve regeneration at the sites of radiofrequency ablation was observed in 17% of renal arteries at 60 days and 71% of 180 days. Conclusions-Nerve injury after radiofrequency ablation was greatest at 7 days, with maximum functional nerve damage sustained ≤30 days. Focal terminal nerve regeneration was observed only at the sites of ablation as early as 60 days and continued to 180 days. Renal artery and peri-arterial soft tissue injury is greatest in the subacute phase, and least in the chronic phase, suggesting gradual recovery of the renal arterial wall and surrounding tissue. (Circ Cardiovasc Interv. 2015;8:e001813.

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“…This protocol is unlikely to change as long as the experimental treatment is delivered via a transarterial, catheterbased platform. Ultrasound (US), computed tomography (CT) angiography, and magnetic resonance (MR) angiography all may be useful for screening and planning before RDN, but the relative benefit of these noninvasive imaging modalities needs to be evaluated further and validated (47,48).…”

Section: Rdn In the Presence Of Renal Artery Stenosismentioning

confidence: 99%

Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel on Renal Sympathetic Denervation

Angle

Prince

Matsumoto

et al. 2014

Journal of Vascular and Interventional Radiology

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ABBREVIATIONSBP = blood pressure, CHF = congestive heart failure, HTN = hypertension, MSNA = muscle sympathetic nerve activity, NE = norepinephrine, LV = left ventricular, OSA = obstructive sleep apnea, PET = positron emission tomography, PAREPET = prediction of arrhythmic events with positron emission tomography, RCP = research consensus panel, RDN = renal denervation, RSNA = renal sympathetic nerve activity

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Morphological assessment of renal arteries after radiofrequency catheter-based sympathetic denervation in a porcine model

Abstract: Catheter-based application of radiofrequency energy resulted in circumscribed transmural injury within the arterial wall affecting autonomic nerve fascicles delayed to treatment. Acute loss of endothelialization resulted in thrombus formation leaving kidney perfusion apparently unimpaired.

Cited by 92 publications

References 18 publications

Effects of renal sympathetic denervation using saline-irrigated radiofrequency ablation catheter on the activity of the renin-angiotensin system and endothelin-1

Effects of renal sympathetic denervation using saline-irrigated radiofrequency ablation catheter on the activity of the renin-angiotensin system and endothelin-1

Comparison of Histopathologic Analysis Following Renal Sympathetic Denervation Over Multiple Time Points

Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel on Renal Sympathetic Denervation

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