Impact of Lesion Placement on Efficacy and Safety of Catheter-Based Radiofrequency Renal Denervation.
نویسندگان
چکیده
BACKGROUND Insufficient procedural efficacy has been proposed to explain nonresponse to renal denervation (RDN). OBJECTIVES The aim of this study was to examine the impact of different patterns of lesion placements on the efficacy and consistency of catheter-based radiofrequency RDN in pigs. METHODS The impact of increasing number of lesions versus location of RDN was investigated in a porcine model (Group 1; n = 51). The effect of treating the main artery, the branches, and the 2 combined was compared in Group 2 (n = 48). The durability of response and safety of combined treatment of the main artery plus branches was examined in Group 3 (n = 16). Renal norepinephrine (NE) tissue content and renal cortical axon density were assessed. RESULTS Increasing the number of RF lesions (4, 8, and 12) in the main renal artery was not sufficient to yield a clear dose-response relationship on NE content and axon density. In contrast, targeted treatment of the renal artery branches or distal segment of the main renal artery resulted in markedly less variability of response and significantly greater reduction of both NE and axon density than conventional treatment of only the main renal artery. Combination treatment (main artery plus branches) produced the greatest change in renal NE and axon density with the least heterogeneity. The changes were durable through 28 days post-treatment. CONCLUSIONS These data provide the rationale for investigation of an optimized approach for RDN in future clinical studies. This may have profound implications for the clinical application of RDN, as this approach may not only achieve greater reductions in sympathetic activity but also reduce treatment effect variability.
منابع مشابه
Letter by Wang regarding article, "efficacy and safety of catheter-based radiofrequency renal denervation in stented renal arteries".
متن کامل
Safety and feasibility of transcatheter renal sympathetic denervation using different types of catheter and various radiofrequency settings
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متن کاملEfficacy and safety of catheter-based radiofrequency renal denervation in stented renal arteries.
BACKGROUND In selected patients with hypertension, renal artery (RA) stenting is used to treat significant atherosclerotic stenoses. However, blood pressure often remains uncontrolled after the procedure. Although catheter-based renal denervation (RDN) can reduce blood pressure in certain patients with resistant hypertension, there are no data on the feasibility and safety of RDN in stented RA....
متن کاملSafety and efficacy of a multi-electrode renal sympathetic denervation system in resistant hypertension: the EnligHTN I trial
AIMS Catheter-based renal artery sympathetic denervation has emerged as a novel therapy for treatment of patients with drug-resistant hypertension. Initial studies were performed using a single electrode radiofrequency catheter, but recent advances in catheter design have allowed the development of multi-electrode systems that can deliver lesions with a pre-determined pattern. This study was de...
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ورودعنوان ژورنال:
- Journal of the American College of Cardiology
دوره 66 16 شماره
صفحات -
تاریخ انتشار 2015