Procedural and Anatomical Determinants of Multielectrode Renal Denervation Efficacy: Insights From Preclinical Models
Radiofrequency renal denervation is under investigation for treatment of hypertension with variable success. We developed preclinical models to examine the dependence of ablation biomarkers on renal denervation treatment parameters and anatomic variables. One hundred twenty-nine porcine renal arteri...
| Main Authors: | , , , , , , , , , |
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| Other Authors: | |
| Format: | Article |
| Language: | English |
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Ovid Technologies (Wolters Kluwer Health)
2020
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| Online Access: | https://hdl.handle.net/1721.1/128764 |
| _version_ | 1826195202160721920 |
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| author | Tzafriri, Abraham R. Mahfoud, Felix Keating, John H. Spognardi, Anna-Maria Markham, Peter M. Wong, Gee Highsmith, Debby O’Fallon, Patrick Fuimaono, Kristine 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. Mahfoud, Felix Keating, John H. Spognardi, Anna-Maria Markham, Peter M. Wong, Gee Highsmith, Debby O’Fallon, Patrick Fuimaono, Kristine Edelman, Elazer R |
| author_sort | Tzafriri, Abraham R. |
| collection | MIT |
| description | Radiofrequency renal denervation is under investigation for treatment of hypertension with variable success. We developed preclinical models to examine the dependence of ablation biomarkers on renal denervation treatment parameters and anatomic variables. One hundred twenty-nine porcine renal arteries were denervated with an irrigated radiofrequency catheter with multiple helically arrayed electrodes. Nerve effects and ablation geometries at 7 days were characterized histomorphometrically and correlated with associated renal norepinephrine levels. Norepinephrine exhibited a threshold dependence on the percentage of affected nerves across the range of treatment durations (30-60 s) and power set points (6-20 W). For 15 W/30 s treatments, norepinephrine reduction and percentage of affected nerves tracked with number of electrode treatments, confirming additive effects of helically staggered ablations. Threshold effects were only attained when ≥4 electrodes were powered. Histomorphometry and computational modeling both illustrated that radiofrequency treatments directed at large neighboring veins resulted in subaverage ablation areas and, therefore, contributed suboptimally to efficacy. Account for measured nerve distribution patterns and the annular geometry of the artery revealed that, regardless of treatment variables, total ablation area and circumferential coverage were the prime determinants of renal denervation efficacy, with increased efficacy at smaller diameters. |
| first_indexed | 2024-09-23T10:09:01Z |
| format | Article |
| id | mit-1721.1/128764 |
| institution | Massachusetts Institute of Technology |
| language | English |
| last_indexed | 2024-09-23T10:09:01Z |
| publishDate | 2020 |
| publisher | Ovid Technologies (Wolters Kluwer Health) |
| record_format | dspace |
| spelling | mit-1721.1/1287642022-09-30T19:13:07Z Procedural and Anatomical Determinants of Multielectrode Renal Denervation Efficacy: Insights From Preclinical Models Tzafriri, Abraham R. Mahfoud, Felix Keating, John H. Spognardi, Anna-Maria Markham, Peter M. Wong, Gee Highsmith, Debby O’Fallon, Patrick Fuimaono, Kristine Edelman, Elazer R Massachusetts Institute of Technology. Institute for Medical Engineering & Science Radiofrequency renal denervation is under investigation for treatment of hypertension with variable success. We developed preclinical models to examine the dependence of ablation biomarkers on renal denervation treatment parameters and anatomic variables. One hundred twenty-nine porcine renal arteries were denervated with an irrigated radiofrequency catheter with multiple helically arrayed electrodes. Nerve effects and ablation geometries at 7 days were characterized histomorphometrically and correlated with associated renal norepinephrine levels. Norepinephrine exhibited a threshold dependence on the percentage of affected nerves across the range of treatment durations (30-60 s) and power set points (6-20 W). For 15 W/30 s treatments, norepinephrine reduction and percentage of affected nerves tracked with number of electrode treatments, confirming additive effects of helically staggered ablations. Threshold effects were only attained when ≥4 electrodes were powered. Histomorphometry and computational modeling both illustrated that radiofrequency treatments directed at large neighboring veins resulted in subaverage ablation areas and, therefore, contributed suboptimally to efficacy. Account for measured nerve distribution patterns and the annular geometry of the artery revealed that, regardless of treatment variables, total ablation area and circumferential coverage were the prime determinants of renal denervation efficacy, with increased efficacy at smaller diameters. National Institutes of Health (Grant R01-GM-49039) 2020-12-09T21:37:09Z 2020-12-09T21:37:09Z 2019-09 2019-02 2020-09-18T18:24:02Z Article http://purl.org/eprint/type/JournalArticle 0194-911X 1524-4563 https://hdl.handle.net/1721.1/128764 Tzafriri, Abraham R. et al. "Procedural and Anatomical Determinants of Multielectrode Renal Denervation Efficacy: Insights From Preclinical Models." Hypertension 74, 3 (September 2019): 546–554 © 2019 Lippincott Williams and Wilkins en http://dx.doi.org/10.1161/hypertensionaha.119.12918 Hypertension Creative Commons Attribution-Noncommercial-Share Alike http://creativecommons.org/licenses/by-nc-sa/4.0/ application/pdf Ovid Technologies (Wolters Kluwer Health) PMC |
| spellingShingle | Tzafriri, Abraham R. Mahfoud, Felix Keating, John H. Spognardi, Anna-Maria Markham, Peter M. Wong, Gee Highsmith, Debby O’Fallon, Patrick Fuimaono, Kristine Edelman, Elazer R Procedural and Anatomical Determinants of Multielectrode Renal Denervation Efficacy: Insights From Preclinical Models |
| title | Procedural and Anatomical Determinants of Multielectrode Renal Denervation Efficacy: Insights From Preclinical Models |
| title_full | Procedural and Anatomical Determinants of Multielectrode Renal Denervation Efficacy: Insights From Preclinical Models |
| title_fullStr | Procedural and Anatomical Determinants of Multielectrode Renal Denervation Efficacy: Insights From Preclinical Models |
| title_full_unstemmed | Procedural and Anatomical Determinants of Multielectrode Renal Denervation Efficacy: Insights From Preclinical Models |
| title_short | Procedural and Anatomical Determinants of Multielectrode Renal Denervation Efficacy: Insights From Preclinical Models |
| title_sort | procedural and anatomical determinants of multielectrode renal denervation efficacy insights from preclinical models |
| url | https://hdl.handle.net/1721.1/128764 |
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