Stimulation Mapping of the Pulmonary Artery for Denervation Procedures: an Experimental Study

Leandro, Heber Ivan Condori; Вахрушев, А. Д.; Гончарова, Н. С.; Korobchenko, L; Koshevaya, E; Mitrofanova, Lubov; Andreeva, E. M.; Моисеева, О. М.; Lebedev, Dmitry; Mikhaylov, Evgeny N.

doi:10.1007/s12265-020-10079-4

Cited by 4 publications

(9 citation statements)

References 16 publications

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“…Acute PA lesions resulting from laser ablation are similar to the histological changes found after radiofrequency ablation, as described earlier by our group [8]. Nerve fiber expression varied from one sheep to another, regardless of whether it was detected in the adventitia and perivascular fat tissue or remained in the tunica media, a fact that could be assumed due to the amount of energy applied.…”

Section: Discussionsupporting

confidence: 82%

“…PA samples were obtained from 7 male Landrace pigs (mean weight 36.1 ± 2.3 kg) and 7 Katumsky sheep (mean weight 34.4 ± 2.8 kg; p > 0.05). Animals were euthanized under general anesthesia by a lethal bolus of potassium chloride as described elsewhere [8]. After sternum removal, gross PA samples were excised and included the following parts: the main PA trunk, PA bifurcation, left and right PAs with the surrounding perivascular tissue, until sub-segmentary branches.…”

Section: Ovine Porcine and Human Pulmonary Artery Nerve Distribution Evaluationmentioning

confidence: 99%

“…Recently, PA stimulation mapping delineating the phrenic and laryngeal recurrent nerves close to the PA has been demonstrated to be feasible during transcatheter PADN. Moreover, evoked reactions during high-frequency stimulation reveal specific autonomic responses in determined areas, which might be potential targets for PADN [8].…”

Section: Introductionmentioning

confidence: 99%

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An Ovine Model for Percutaneous Pulmonary Artery Laser Denervation: Perivascular Innervation and Ablation Lesion Characteristics

Leandro

Koshevaya

Mitrofanova

et al. 2021

IJMS

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Background: Pulmonary artery denervation (PADN) is an evolving interventional procedure capable to reduce pulmonary artery (PA) pressure. We aimed to compare PA nerve distribution in different specimens and assess the feasibility of an ovine model for a denervation procedure and evaluate the acute changes induced by laser energy. Methods: The experiment was divided into two phases: (1) the analysis of PA nerve distribution in sheep, pigs, and humans using histological and immunochemical methods; (2) fiberoptic PADN in sheep and postmortem laser lesion characteristics. Results: PA nerve density and distribution in sheep differ from humans, although pigs and sheep share similar characteristics, nerve fibers are observed in the media layer, adventitia, and perivascular tissue in sheep. Necrosis of the intima and focal hemorrhages within the media, adventitia, and perivascular adipose tissue were evidenced post laser PADN. Among the identified lesions, 40% reached adventitia and could be classified as effective for PADN. The use of 20 W ablation energy was safer and 30 W-ablation led to collateral organ damage. Conclusions: An ovine model is suitable for PADN procedures; however, nerve distribution in the PA bifurcation and main branches differ from human PA innervation. Laser ablation can be safely used for PADN procedures.

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Section: Discussionsupporting

confidence: 82%

Section: Ovine Porcine and Human Pulmonary Artery Nerve Distribution Evaluationmentioning

confidence: 99%

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An Ovine Model for Percutaneous Pulmonary Artery Laser Denervation: Perivascular Innervation and Ablation Lesion Characteristics

Leandro

Koshevaya

Mitrofanova

et al. 2021

IJMS

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“…Some authors have proposed to use mapping of the ANS using nuclear medicine techniques [ 96 ] to optimize PADN procedures and one case reported on the use of high-output burst electrical stimulation to map the ablation sites on computed tomography images [ 97 ]. Similarly, in a very recent experimental trial, ablation at certain PA sites with evoked heart rate responses, lead to disappearance of neural markers’ expression [ 98 ]. In the CTEPH randomized clinical trial, a three-dimensional electroanatomical mapping system was used with remote magnetic navigation for the PADN procedures for the first time [ 86 ].…”

Section: Invasive Strategies Targeting the Autonomic Nervous Systementioning

confidence: 99%

“…In any case, as long as the catheter applications are solely based on where sympathetic nerve fibers should lay (which is based, in turn, on anatomic descriptions from three to four cases [ 10 , 82 ]), it appears that the efficacy of the denervation procedures will largely depend on individual distribution and depth of the sympathetic/parasympathetic fibers and the size, thickness, and composition of the PA wall. This limitation may be overcome by the recently described PA mapping strategies [ 86 , 98 ].…”

Section: Invasive Strategies Targeting the Autonomic Nervous Systementioning

confidence: 99%

Neurohormonal Modulation as a Therapeutic Target in Pulmonary Hypertension

García‐Lunar

Pereda

Ibáñez

et al. 2020

Cells

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The autonomic nervous system (ANS) and renin-angiotensin-aldosterone system (RAAS) are involved in many cardiovascular disorders, including pulmonary hypertension (PH). The current review focuses on the role of the ANS and RAAS activation in PH and updated evidence of potential therapies targeting both systems in this condition, particularly in Groups 1 and 2. State of the art knowledge in preclinical and clinical use of pharmacologic drugs (beta-blockers, beta-three adrenoceptor agonists, or renin-angiotensin-aldosterone signaling drugs) and invasive procedures, such as pulmonary artery denervation, is provided.

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Transcatheter radiofrequency pulmonary artery denervation in swine: the evaluation of lesion degree, hemodynamics and pulmonary hypertension inducibility

et al. 2021

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Background Mechanisms of positive effects of pulmonary artery (PA) denervation (PADN) remain poorly understood. The study aimed to evaluate pulmonary hemodynamic changes after PADN and their association with the extent of PA wall damage in an acute thromboxane A2 (TXA2)-induced pulmonary hypertension (PH) model in swine. Methods In this experimental sham-controlled study, 17 normotensive male white Landrace pigs (the mean weight 36.2 ± 4.5 kg) were included and randomly assigned to group I (n = 9)—PH modeling before and after PADN, group II (n = 4)—PADN only, or group III (n = 4)—PH modeling before and after a sham procedure. Radiofrequency (RF) PADN was performed in the PA trunk and at the proximal parts of the right and left PAs. PA wall lesions were characterized at the autopsy study using histological and the immunohistochemical examination. Results In groups I and II, no statistically significant changes in the mean pulmonary arterial pressure nor systemic blood pressure were found after PADN (−0.8 ± 3.4 vs 4.3 ± 8.6 mmHg, P = 0.47; and 6.0 ± 15.9 vs -8.3 ± 7.5 mmHg, P = 0.1; correspondingly). There was a trend towards a lower diastolic pulmonary arterial pressure after PADN in group I when compared with group III during repeat PH induction (34.4 ± 2.9 vs 38.0 ± 0.8; P = 0.06). Despite the presence of severe PA wall damage at the RF application sites, S100 expression was preserved in the majority of PA specimens. The presence of high-grade PA lesions was associated with HR acceleration after PADN (ρ = 0.68, p = 0.03). No significant correlation was found between the grade of PA lesion severity and PA pressure after PADN with or without PH induction. Conclusions Extended PADN does not affect PH induction using TXA2. Significant PA adventitia damage is associated with HR acceleration after PADN. Possible delayed effects of PADN on perivascular nerves and pulmonary hemodynamics require further research in chronic experiments.

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Stimulation Mapping of the Pulmonary Artery for Denervation Procedures: an Experimental Study

Cited by 4 publications

References 16 publications

An Ovine Model for Percutaneous Pulmonary Artery Laser Denervation: Perivascular Innervation and Ablation Lesion Characteristics

An Ovine Model for Percutaneous Pulmonary Artery Laser Denervation: Perivascular Innervation and Ablation Lesion Characteristics

Neurohormonal Modulation as a Therapeutic Target in Pulmonary Hypertension

Transcatheter radiofrequency pulmonary artery denervation in swine: the evaluation of lesion degree, hemodynamics and pulmonary hypertension inducibility

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