Long-term follow-up of renal arteries after radio-frequency catheter-based denervation using optical coherence tomography and angiography

Abstract

Optical coherence tomography (OCT) imaging at the time of renal denervation (RDN) showed that procedure might cause spasm, intimal injury or thrombus formation. In the present study, we assessed the healing of renal arteries after RDN using OCT and renal angiography in long-term follow-up. OCT and renal angiography were performed in 12 patients (22 arteries) 18.41 ± 5.83 months after RNS. There were no adverse events or complications during the long-term follow-up. In ten patients (83 %), significant reductions of blood pressure was achieved without a change of the antihypertensive medications. We demonstrated the presence of 26 areas of focal intimal thickening identified by OCT in 10 (83 %) patients and in 14 (63 %) arteries. The mean area of focal intimal thickening was 0.054 ± 0.033 mm(2). No vessel dissection, thrombus, intimal tear or acute vasospasm were observed during the OCT analysis. Also, the quantitative angiography analysis revealed a significant reduction of the minimal and proximal lumen diameters at follow-up as compared to measurements obtained before RDN. Renal arteries have a favorable "long-term" vessel healing response after RDN. Focal intimal thickening and a modest reduction of the minimal lumen diameter may be observed after RF denervation. Further studies are needed to determine whether intravascular imaging may be helpful in evaluating the vessel healing of RF RDN.

Laparoscopic-based perivascular unilateral renal sympathetic nerve denervation for treating resistant hypertension: a case report

“…This has been confirmed in a study conducted on beagles [8,9]. Moreover, direct stimulation using RF energy as well as the use of catheter and wire on the arterial intima may cause intimal injury and/or thrombosis [10,11], which may trigger the progression of atherosclerosis. To minimize these side effects, we found that laparoscopicbased perivascular RDN was effective in controlling the BP and allowed for a decrease in the amount of antihypertensive drugs.…”

Clinical outcomes of laparoscopic‐based renal denervation plus adrenalectomy vs adrenalectomy alone for treating resistant hypertension caused by unilateral aldosterone‐producing adenoma

“…Despite the failure of the SYMPLICITY HTN‐3 trial to meet its primary efficacy end point, recent positive results from the SPYRAL HTN‐ON MED 22 and RADIANCE‐HTN SOLO 23 trials sparked our interest in studying the denervation methods. However, we believed that direct stimulation using RF energy and the use of catheter and wire on the arterial intima could result in intimal injury and/or thrombosis, 13,24 which may trigger the progression of atherosclerosis. Moreover, an inappropriate ablation device may lead to inadequate ablation, which in turn results in uncertainty in the effects of RDN 14 …”

Laparoscopic-based perivascular renal sympathetic nerve denervation: a feasibility study in a porcine model

“…Nevertheless, the problems associated with this procedure should not be ignored. Currently, although the number of patients who undergo percutaneous endovascular RDN is limited and the follow-up period is short, some side effects have been reported [15], i.e., lumen stenosis, atrial wall hematoma, intimal tears, intraluminal thrombosis, intima-media thickening [16][17][18][19], etc. Most of these factors may be caused by the direct delivery of RF energy or stimulation of the endothelium by the wire and catheter.…”