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Effect of applied energy in renal sympathetic denervation with magnetic resonance guided focused ultrasound in a porcine model

BACKGROUND: Past catheter-based and focused ultrasound renal denervation studies have indicated that procedure efficacy is related to the number of ablations performed or the amount of energy used for the ablation. This study extends those prior results and investigates energy level effects on the e...

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Autores principales: Shea, Jill, de Bever, Joshua, Kholmovski, Eugene, Beal, Hannah, Hadley, J. Rock, Minalga, Emilee, Salama, Mohamed E., Marrouche, Nassir F., Payne, Allison
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467056/
https://www.ncbi.nlm.nih.gov/pubmed/28616236
http://dx.doi.org/10.1186/s40349-017-0094-y
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author Shea, Jill
de Bever, Joshua
Kholmovski, Eugene
Beal, Hannah
Hadley, J. Rock
Minalga, Emilee
Salama, Mohamed E.
Marrouche, Nassir F.
Payne, Allison
author_facet Shea, Jill
de Bever, Joshua
Kholmovski, Eugene
Beal, Hannah
Hadley, J. Rock
Minalga, Emilee
Salama, Mohamed E.
Marrouche, Nassir F.
Payne, Allison
author_sort Shea, Jill
collection PubMed
description BACKGROUND: Past catheter-based and focused ultrasound renal denervation studies have indicated that procedure efficacy is related to the number of ablations performed or the amount of energy used for the ablation. This study extends those prior results and investigates energy level effects on the efficacy of MR guided focused ultrasound renal denervation performed in a porcine model. METHODS: Twenty-four normotensive pigs underwent unilateral denervation at three intensity levels. The applied intensity level was retrospectively de-rated to account for variability in animal size. Efficacy was assessed through evaluating the norepinephrine present in the kidney medulla and through histological analysis. The treatment was performed under MRI guidance including pre- and post-procedure T1-weighted and quantitative T1 and T2 imaging. During treatment, the temperature in the near field of the ultrasound beam was monitored in real time with MR temperature imaging. Energy delivery in the regions surrounding the renal artery was independently confirmed through an invasive fiberoptic temperature probe placed in the right renal artery. RESULTS: Animals that underwent denervation at a de-rated acoustic intensity of greater than 1.2 kW/cm(2) had a significantly lower norepinephrine concentration in the kidney indicating successful denervation. Images obtained during the treatment indicated no tissue changes in the kidneys as a function of the procedure but there were significant T1 changes present in the right lumbar muscles, although only one animal had indication of muscle damage at the time of necropsy. CONCLUSIONS: While MR guided focused ultrasound renal denervation was found to be safe and effective in this normotensive animal model, the results indicated the need to incorporate patient-specific details in the treatment planning of MRgFUS renal denervation procedure.
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spelling pubmed-54670562017-06-14 Effect of applied energy in renal sympathetic denervation with magnetic resonance guided focused ultrasound in a porcine model Shea, Jill de Bever, Joshua Kholmovski, Eugene Beal, Hannah Hadley, J. Rock Minalga, Emilee Salama, Mohamed E. Marrouche, Nassir F. Payne, Allison J Ther Ultrasound Research BACKGROUND: Past catheter-based and focused ultrasound renal denervation studies have indicated that procedure efficacy is related to the number of ablations performed or the amount of energy used for the ablation. This study extends those prior results and investigates energy level effects on the efficacy of MR guided focused ultrasound renal denervation performed in a porcine model. METHODS: Twenty-four normotensive pigs underwent unilateral denervation at three intensity levels. The applied intensity level was retrospectively de-rated to account for variability in animal size. Efficacy was assessed through evaluating the norepinephrine present in the kidney medulla and through histological analysis. The treatment was performed under MRI guidance including pre- and post-procedure T1-weighted and quantitative T1 and T2 imaging. During treatment, the temperature in the near field of the ultrasound beam was monitored in real time with MR temperature imaging. Energy delivery in the regions surrounding the renal artery was independently confirmed through an invasive fiberoptic temperature probe placed in the right renal artery. RESULTS: Animals that underwent denervation at a de-rated acoustic intensity of greater than 1.2 kW/cm(2) had a significantly lower norepinephrine concentration in the kidney indicating successful denervation. Images obtained during the treatment indicated no tissue changes in the kidneys as a function of the procedure but there were significant T1 changes present in the right lumbar muscles, although only one animal had indication of muscle damage at the time of necropsy. CONCLUSIONS: While MR guided focused ultrasound renal denervation was found to be safe and effective in this normotensive animal model, the results indicated the need to incorporate patient-specific details in the treatment planning of MRgFUS renal denervation procedure. BioMed Central 2017-06-12 /pmc/articles/PMC5467056/ /pubmed/28616236 http://dx.doi.org/10.1186/s40349-017-0094-y Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Shea, Jill
de Bever, Joshua
Kholmovski, Eugene
Beal, Hannah
Hadley, J. Rock
Minalga, Emilee
Salama, Mohamed E.
Marrouche, Nassir F.
Payne, Allison
Effect of applied energy in renal sympathetic denervation with magnetic resonance guided focused ultrasound in a porcine model
title Effect of applied energy in renal sympathetic denervation with magnetic resonance guided focused ultrasound in a porcine model
title_full Effect of applied energy in renal sympathetic denervation with magnetic resonance guided focused ultrasound in a porcine model
title_fullStr Effect of applied energy in renal sympathetic denervation with magnetic resonance guided focused ultrasound in a porcine model
title_full_unstemmed Effect of applied energy in renal sympathetic denervation with magnetic resonance guided focused ultrasound in a porcine model
title_short Effect of applied energy in renal sympathetic denervation with magnetic resonance guided focused ultrasound in a porcine model
title_sort effect of applied energy in renal sympathetic denervation with magnetic resonance guided focused ultrasound in a porcine model
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467056/
https://www.ncbi.nlm.nih.gov/pubmed/28616236
http://dx.doi.org/10.1186/s40349-017-0094-y
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