Arterial microanatomy determines the success of energy-based renal denervation in controlling hypertension
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Author(s)
Tzafriri, Abraham R.
Keating, John H.
Markham, Peter M.
Spognardi, Anna-Maria
Stanley, James R. L.
Wong, Gee
Zani, Brett G.
Grunewald, Debby
O'Fallon, Patrick
Fuimaono, Kristine
Date Issued
April 2015
Journal
Science Translational Medicine
Publisher
American Association for the Advancement of Science (AAAS)
Citation
Tzafriri, Abraham R., John H. Keating, Peter M. Markham, Anna-Maria Spognardi, James R. L. Stanley, Gee Wong, Brett G. Zani, Debby Highsmith, Patrick O’Fallon, Kristine Fuimaono, Felix Mahfoud, and Elazer R. Edelman. “Arterial Microanatomy Determines the Success of Energy-Based Renal Denervation in Controlling Hypertension.” Science Translational Medicine 7, no. 285 (April 29, 2015): 285ra65–285ra65.
Version
Author's final manuscript
Abstract
Renal denervation (RDN) is a treatment option for patients with hypertension resistant to conventional therapy. Clinical trials have demonstrated variable benefit. To understand the determinants of successful clinical response to this treatment, we integrated porcine and computational models of intravascular radiofrequency RDN. Controlled single-electrode denervation resulted in ablation zone geometries that varied in arc, area, and depth, depending on the composition of the adjacent tissue substructure. Computational simulations predicted that delivered power density was influenced by tissue substructure, and peaked at the conductivity discontinuities between soft fatty adventitia and water-rich tissues (media, lymph nodes, etc.), not at the electrode-tissue interface. Electrode irrigation protected arterial wall tissue adjacent to the electrode by clearing heat that diffuses from within the tissue, without altering periarterial ablation. Seven days after multielectrode treatments, renal norepinephrine and blood pressure were reduced. Blood pressure reductions were correlated with the size-weighted number of degenerative nerves, implying that the effectiveness of the treatment in decreasing hypertension depends on the extent of nerve injury and ablation, which in turn are determined by the tissue microanatomy at the electrode site. These results may explain the variable patient response to RDN and suggest a path to more robust outcomes.
MIT Department
Massachusetts Institute of Technology. Institute for Medical Engineering & Science
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Article is made available in accordance with the publisher's policy and may be subject to US copyright law. Please refer to the publisher's site for terms of use.
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DOI of Published Version
https://doi.org/10.1126/scitranslmed.aaa3236
