Arterial microanatomy determines the success of energy-based renal denervation in controlling hypertension
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 intr...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | en_US |
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American Association for the Advancement of Science (AAAS)
2016
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| Online Access: | http://hdl.handle.net/1721.1/102941 https://orcid.org/0000-0002-7832-7156 |
| _version_ | 1826210673432985600 |
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| author | 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 Mahfoud, Felix Edelman, Elazer R |
| author2 | Massachusetts Institute of Technology. Institute for Medical Engineering & Science |
| author_facet | Massachusetts Institute of Technology. Institute for Medical Engineering & Science 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 Mahfoud, Felix Edelman, Elazer R |
| author_sort | Tzafriri, Abraham R. |
| collection | MIT |
| description | 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. |
| first_indexed | 2024-09-23T14:53:40Z |
| format | Article |
| id | mit-1721.1/102941 |
| institution | Massachusetts Institute of Technology |
| language | en_US |
| last_indexed | 2024-09-23T14:53:40Z |
| publishDate | 2016 |
| publisher | American Association for the Advancement of Science (AAAS) |
| record_format | dspace |
| spelling | mit-1721.1/1029412022-09-29T11:18:31Z Arterial microanatomy determines the success of energy-based renal denervation in controlling hypertension 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 Mahfoud, Felix Edelman, Elazer R Massachusetts Institute of Technology. Institute for Medical Engineering & Science Edelman, Elazer R. 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. National Institutes of Health (U.S.) (NIH grant R01 GM-49039) 2016-06-03T17:23:44Z 2016-06-03T17:23:44Z 2015-04 Article http://purl.org/eprint/type/JournalArticle 1946-6234 1946-6242 http://hdl.handle.net/1721.1/102941 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. https://orcid.org/0000-0002-7832-7156 en_US http://dx.doi.org/10.1126/scitranslmed.aaa3236 Science Translational Medicine 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. application/pdf American Association for the Advancement of Science (AAAS) PMC |
| spellingShingle | 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 Mahfoud, Felix Edelman, Elazer R Arterial microanatomy determines the success of energy-based renal denervation in controlling hypertension |
| title | Arterial microanatomy determines the success of energy-based renal denervation in controlling hypertension |
| title_full | Arterial microanatomy determines the success of energy-based renal denervation in controlling hypertension |
| title_fullStr | Arterial microanatomy determines the success of energy-based renal denervation in controlling hypertension |
| title_full_unstemmed | Arterial microanatomy determines the success of energy-based renal denervation in controlling hypertension |
| title_short | Arterial microanatomy determines the success of energy-based renal denervation in controlling hypertension |
| title_sort | arterial microanatomy determines the success of energy based renal denervation in controlling hypertension |
| url | http://hdl.handle.net/1721.1/102941 https://orcid.org/0000-0002-7832-7156 |
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