Author + information
- Armando Telleza,b,
- Michael Gertnera,b,
- Krista N. Dillona,b,
- Don Christophera,b,
- Dane Bradya,b and
- Serge Roussellea,b
Background: Although controversial, RDN has been proposed as an alternative therapy for resistant hypertensive patients. We aim to evaluate the acute and subchronic safety and deliverability of a novel extracorporeal, ultrasound-based RDN system in a large animal model.
Methods: 7 swine were treated bilaterally with the Kona Medical surround system. 14 days following RDN treatment renal arteries were harvested for histopathological evaluation. Each artery (n=13) was sectioned equidistantly from the ostium to the renal cortex, passed the distal bifurcation (n=12 sections). Sections were processed for light microscopy evaluation. A semiquantitative scoring system standard for RDN was employed to evaluate the presence and severity of arterial, nerve and periarterial tissue ablation effects.
Results: The sonic-induced changes portrayed characteristic features of thermal injury with healing patterns concordant with 14 day follow up (i.e. residual necrotic fat, healing necrotic muscle, kidney, nerves, ureter and or vessel wall). As expected, due to the type of delivery, the ablation areas did not necessarily follow an arterial-based pattern; however, most lesions were found at or close the renal bifurcation. The extent of lesion extended to up to 30 mm in length. The average distance of sonic treatment from arterial lumen was 8.7mm and achieved a circumference of 20% with the maximum reaching up to 50%. When the nerves were reached by the sonic lesion they demonstrated vacuolation of the nerve fibers, endoneurium, perineurial and early endoneurial fibrosis with low severity of necrosis and instances of distal nerve atrophy. There were no adverse vascular changes or major adverse collateral damage observed.
Conclusions: No adverse histopathological features were observed after delivery of ultrasound renal denervation therapy. The character and distribution of the treatment-induced lesion, while different than standard catheter-based technologies, achieves nerve ablation, distal nerve atrophy, and periarterial involvement. Extracorporeal delivery of ultrasound therapy for resistant hypertension emerges as a potential alternative for RDN.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Interventional Cardiology: Translation and Pre-Clinical Research
Abstract Category: 25. Interventional Cardiology: Translation and Pre-clinical Research
Presentation Number: 1116-192
- 2017 American College of Cardiology Foundation