Cargando…
Histological evidence supporting the durability of successful radiofrequency renal denervation in a normotensive porcine model
BACKGROUND: Sustained blood pressure reductions after radiofrequency (RF) renal denervation (RDN) have been reported to 3 years in patients with uncontrolled hypertension. However, mechanistic data to support procedural durability are lacking. We aimed to quantify the long-term nerve anatomic and fu...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9451943/ https://www.ncbi.nlm.nih.gov/pubmed/35866489 http://dx.doi.org/10.1097/HJH.0000000000003236 |
_version_ | 1784784834216853504 |
---|---|
author | Sharp, Andrew S.P. Tunev, Stefan Schlaich, Markus Lee, David P. Finn, Aloke V. Trudel, Julie Hettrick, Douglas A. Mahfoud, Felix Kandzari, David E. |
author_facet | Sharp, Andrew S.P. Tunev, Stefan Schlaich, Markus Lee, David P. Finn, Aloke V. Trudel, Julie Hettrick, Douglas A. Mahfoud, Felix Kandzari, David E. |
author_sort | Sharp, Andrew S.P. |
collection | PubMed |
description | BACKGROUND: Sustained blood pressure reductions after radiofrequency (RF) renal denervation (RDN) have been reported to 3 years in patients with uncontrolled hypertension. However, mechanistic data to support procedural durability are lacking. We aimed to quantify the long-term nerve anatomic and functional effects of RF RDN in a preclinical model. METHODS: Bilateral RF RDN was performed in 20 normotensive swine. Renal tissue samples were obtained in the RDN-treated groups at 7 (n = 6), 28 (n = 6), and 180 days (n = 8) postprocedure for quantification of cortical norepinephrine (NE) levels and renal cortical axon density. Tissue fibrosis, necrosis and downstream nerve fiber atrophy (axonal loss) were also scored for each sample. Three additional untreated groups (n = 6, n = 6 and n = 8, respectively) served as control. RESULTS: Pathologic nerve changes were characterized by necrosis in the ablated region at 7 days that partially resolved by 28 days and fully resolved at 180 days. Axonal loss was apparent within and downstream to the ablation regions and was evident at 7, 28 and 180 days in the main vessel and branch vessels. Consequently, renal cortical axon density and corresponding cortical NE levels were significantly reduced at 7 days in the RDN vs. control group and remained suppressed at 180 days. CONCLUSIONS: Reductions in renal NE, cortical axon density and downstream axonal loss caused by axonal destruction persisted through 180 days post-RDN in a normotensive swine model. These results suggest functional nerve regrowth after RF RDN is unlikely and support published clinical evidence that the procedure results in durable blood pressure reduction. |
format | Online Article Text |
id | pubmed-9451943 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-94519432022-09-13 Histological evidence supporting the durability of successful radiofrequency renal denervation in a normotensive porcine model Sharp, Andrew S.P. Tunev, Stefan Schlaich, Markus Lee, David P. Finn, Aloke V. Trudel, Julie Hettrick, Douglas A. Mahfoud, Felix Kandzari, David E. J Hypertens Original Articles BACKGROUND: Sustained blood pressure reductions after radiofrequency (RF) renal denervation (RDN) have been reported to 3 years in patients with uncontrolled hypertension. However, mechanistic data to support procedural durability are lacking. We aimed to quantify the long-term nerve anatomic and functional effects of RF RDN in a preclinical model. METHODS: Bilateral RF RDN was performed in 20 normotensive swine. Renal tissue samples were obtained in the RDN-treated groups at 7 (n = 6), 28 (n = 6), and 180 days (n = 8) postprocedure for quantification of cortical norepinephrine (NE) levels and renal cortical axon density. Tissue fibrosis, necrosis and downstream nerve fiber atrophy (axonal loss) were also scored for each sample. Three additional untreated groups (n = 6, n = 6 and n = 8, respectively) served as control. RESULTS: Pathologic nerve changes were characterized by necrosis in the ablated region at 7 days that partially resolved by 28 days and fully resolved at 180 days. Axonal loss was apparent within and downstream to the ablation regions and was evident at 7, 28 and 180 days in the main vessel and branch vessels. Consequently, renal cortical axon density and corresponding cortical NE levels were significantly reduced at 7 days in the RDN vs. control group and remained suppressed at 180 days. CONCLUSIONS: Reductions in renal NE, cortical axon density and downstream axonal loss caused by axonal destruction persisted through 180 days post-RDN in a normotensive swine model. These results suggest functional nerve regrowth after RF RDN is unlikely and support published clinical evidence that the procedure results in durable blood pressure reduction. Lippincott Williams & Wilkins 2022-10 2022-07-18 /pmc/articles/PMC9451943/ /pubmed/35866489 http://dx.doi.org/10.1097/HJH.0000000000003236 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) |
spellingShingle | Original Articles Sharp, Andrew S.P. Tunev, Stefan Schlaich, Markus Lee, David P. Finn, Aloke V. Trudel, Julie Hettrick, Douglas A. Mahfoud, Felix Kandzari, David E. Histological evidence supporting the durability of successful radiofrequency renal denervation in a normotensive porcine model |
title | Histological evidence supporting the durability of successful radiofrequency renal denervation in a normotensive porcine model |
title_full | Histological evidence supporting the durability of successful radiofrequency renal denervation in a normotensive porcine model |
title_fullStr | Histological evidence supporting the durability of successful radiofrequency renal denervation in a normotensive porcine model |
title_full_unstemmed | Histological evidence supporting the durability of successful radiofrequency renal denervation in a normotensive porcine model |
title_short | Histological evidence supporting the durability of successful radiofrequency renal denervation in a normotensive porcine model |
title_sort | histological evidence supporting the durability of successful radiofrequency renal denervation in a normotensive porcine model |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9451943/ https://www.ncbi.nlm.nih.gov/pubmed/35866489 http://dx.doi.org/10.1097/HJH.0000000000003236 |
work_keys_str_mv | AT sharpandrewsp histologicalevidencesupportingthedurabilityofsuccessfulradiofrequencyrenaldenervationinanormotensiveporcinemodel AT tunevstefan histologicalevidencesupportingthedurabilityofsuccessfulradiofrequencyrenaldenervationinanormotensiveporcinemodel AT schlaichmarkus histologicalevidencesupportingthedurabilityofsuccessfulradiofrequencyrenaldenervationinanormotensiveporcinemodel AT leedavidp histologicalevidencesupportingthedurabilityofsuccessfulradiofrequencyrenaldenervationinanormotensiveporcinemodel AT finnalokev histologicalevidencesupportingthedurabilityofsuccessfulradiofrequencyrenaldenervationinanormotensiveporcinemodel AT trudeljulie histologicalevidencesupportingthedurabilityofsuccessfulradiofrequencyrenaldenervationinanormotensiveporcinemodel AT hettrickdouglasa histologicalevidencesupportingthedurabilityofsuccessfulradiofrequencyrenaldenervationinanormotensiveporcinemodel AT mahfoudfelix histologicalevidencesupportingthedurabilityofsuccessfulradiofrequencyrenaldenervationinanormotensiveporcinemodel AT kandzaridavide histologicalevidencesupportingthedurabilityofsuccessfulradiofrequencyrenaldenervationinanormotensiveporcinemodel |