MR-guided Periarterial Ethanol Injection for Renal Sympathetic Denervation: A Feasibility Study in Pigs

Abstract

MR-guided periarterial ethanol injection was feasible and efficient for renal sympathetic denervation in a swine model. This technique may be a promising alternative to the catheter-based approach in the treatment of resistant arterial hypertension.

Renal Sympathetic Denervation by CT-scan-Guided Periarterial Ethanol Injection in Sheep

“…Initial animal experiments and clinical studies (simplicity HTN-1 and 2 clinical trials) confirmed the effectiveness of this method [9,33,34]. However, endovascular RFA has several procedural limitations, including that not all hypertensives are suitable for this method and that patients must have a specific vascular anatomy [15,17]. Outcomes in controlling BP were also variable in several studies [9][10][11]36] with a recent clinical trial showing no significant difference in BP reduction between RFA and sham-treated patients after 6 months [37].…”

“…NE concentration in renal parenchyma was used to assess the effectiveness of the method, as follows: Immediately after removal, kidneys were frozen at -70°C. After thawing using a sonicator, NE measurement was performed using high performance liquid chromatography as previously described [17,26]. Serum Cr level was measured in all animals after the intervention.…”

“…Streitparth et al first discussed using ethanol for RSD [17]. Ethanol neurolysis has been used to treat many diseases, including chronic pain syndrome in patients with abdominal tumors/pancreatitis and in refractory peripheral arterial occlusive disease [18][19][20][21][22][23].…”

Effects of Renal Denervation from the Intima and the Adventitia of Renal Arteries on Renal Sympathetic Nerve Activity in Dogs: A Comparative Study

“…In a clinical study of catheter-based radiofrequency ablation the mean reduction in renal NE spillover was 47% [4] . MR-guided periarterial ethanol injection also found a significant reduction of NE concentration in the kidney parenchyma of 53% [30] . Circumferential adventitial delivery of 0.15, 0.30 and 0.60 ml of ethanol injection caused a mean renal NE reduction of 54, 78 and 88%, respectively [31] .…”

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

“…The sympathetic nervous system is tightly bundled within the perirenal space and is accessible under percutaneous needle guidance using MR imaging, CT, or US (69,70). Preliminary studies of RDN using image-guided, percutaneous instillation of sclerosants suggest similar results to endovascular ablation techniques (70).…”