Transcatheter non-contact microwave ablation may enable circumferential renal artery denervation while sparing the vessel intima and media

Qian, Pierre; Barry, Michael A.; Al-Raisi, Sara; Kovoor, Pramesh; Pouliopoulos, Jim; Nalliah, C.; Bhaskaran, Abhishek; Chik, W.; Kurup, Rahul; James, Virginia; Varikatt, Winny; McEwan, Alistair; Thiagalingam, Aravinda; Thomas, Stuart P.

doi:10.4244/eij-d-16-00509

Cited by 10 publications

(6 citation statements)

References 19 publications

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“…While the focus now has been directed towards more distal denervation (distal segment and distal to the bifurcation), improving ablation systems to reach deeper targets may also be beneficial, if this could be attained safely. Initial experimental studies using alternative energy modalities, including microwave ablation and chemical denervation, reported on lesion depth of 5-8 mm 21,25 . However, until additional research is conducted to evaluate the efficacy and safety of such modalities further, their use remains experimental.…”

Section: Discussionmentioning

confidence: 99%

Comparison of new-generation renal artery denervation systems: assessing lesion size and thermodynamics using a thermochromic liquid crystal phantom model

Raisi

Barry²,

Qian³

et al. 2017

EuroIntervention

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Section: Discussionmentioning

confidence: 99%

Comparison of new-generation renal artery denervation systems: assessing lesion size and thermodynamics using a thermochromic liquid crystal phantom model

Raisi

Barry²,

Qian³

et al. 2017

EuroIntervention

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“…An open‐irrigated 7F microwave RDN catheter was designed and fabricated in‐house as described previously. 5 , 6 The microwave catheter was delivered over a 0.014‐inch wire to the distal main artery and centered using its expandable splines aided by orthogonal angiographic views. After an initial treatment in the distal main renal artery, the splines were collapsed and the catheter withdrawn ≈25 mm, the splines re‐expanded, and another ablation at the midportion of the main renal artery was performed.…”

Section: Methodsmentioning

confidence: 99%

Long‐Term Safety and Efficacy of Transcatheter Microwave and Radiofrequency Denervation in a Chronic Ovine Model

Balaji,

Barry,

Tran

et al. 2024

JAHA

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Background Transcatheter renal denervation (RDN) has had inconsistent efficacy and concerns for durability of denervation. We aimed to investigate long‐term safety and efficacy of transcatheter microwave RDN in vivo in normotensive sheep in comparison to conventional radiofrequency ablation. Methods and Results Sheep underwent bilateral RDN, receiving 1 to 2 microwave ablations (maximum power of 80–120 W for 240 s–480 s) and 12 to 16 radiofrequency ablations (180 s–240 s) in the main renal artery in a paired fashion, alternating the side of treatment, euthanized at 2 weeks (acute N=15) or 5.5 months (chronic N=15), and compared with undenervated controls (N=4). Microwave RDN produced substantial circumferential perivascular injury compared with radiofrequency at both 2 weeks [area 239.8 (interquartile range [IQR] 152.0–343.4) mm 2 versus 50.1 (IQR, 32.0–74.6) mm 2 , P <0.001; depth 16.4 (IQR, 13.9–18.9) mm versus 7.5 (IQR, 6.0–8.9) mm P <0.001] and 5.5 months [area 20.0 (IQR, 3.4–31.8) mm 2 versus 5.0 (IQR, 1.4–7.3) mm 2 , P =0.025; depth 5.9 (IQR, 1.9–8.8) mm versus 3.1 (IQR, 1.2–4.1) mm, P =0.005] using mixed models. Renal denervation resulted in significant long‐term reductions in viability of renal sympathetic nerves [58.9% reduction with microwave ( P =0.01) and 45% reduction with radiofrequency ( P =0.017)] and median cortical norepinephrine levels [71% reduction with microwave ( P <0.001) and 72.9% reduction with radiofrequency ( P <0.001)] at 5.5 months compared with undenervated controls. Conclusions Transcatheter microwave RDN produces deep circumferential perivascular ablations without significant arterial injury to provide effective and durable RDN at 5.5 months compared with radiofrequency RDN.

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“…Additional technologies that were tested for application in RAD include cryoablation with cryocatheter Freezor Xtra (Cryocath: Medtronic Inc., Minneapolis, MN, USA), and microwave energy using an in-house built irrigated catheter [59,60]. Although alternative modalities may have benefits over RF including larger depth, vascular endothelium sparing, and the ability to negotiate challenging anatomy; comprehensive evaluation of their safety and efficacy is warranted prior to wide scale clinical utility.…”

Section: Chemical Denervationmentioning

confidence: 99%

Renal Artery Denervation in Resistant Hypertension: The Good, The Bad and The Future

Raisi

Pouliopoulos

Swinnen

et al. 2020

Heart, Lung and Circulation

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Transcatheter non-contact microwave ablation may enable circumferential renal artery denervation while sparing the vessel intima and media

Abstract: Transcatheter microwave ablation for RDN appears feasible and provides a heating pattern that may enable more complete denervation while sparing the renal arterial intima and media.

Cited by 10 publications

References 19 publications

Comparison of new-generation renal artery denervation systems: assessing lesion size and thermodynamics using a thermochromic liquid crystal phantom model

Comparison of new-generation renal artery denervation systems: assessing lesion size and thermodynamics using a thermochromic liquid crystal phantom model

Long‐Term Safety and Efficacy of Transcatheter Microwave and Radiofrequency Denervation in a Chronic Ovine Model

Renal Artery Denervation in Resistant Hypertension: The Good, The Bad and The Future

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