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Impact of Lesion Placement on Renal Denervation
Study Questions:
What is the impact of lesion location and number on efficacy and safety of renal denervation?
Methods:
The authors studied the impact of different lesion placements on efficacy and safety of renal denervation in pigs. The right renal artery was treated in different fashions in sets of study animals, while the left renal artery was used as a control. The experiments assessed the impact of number of lesions and the location (main renal artery, renal artery branches, or both) on treatment efficacy as well as the durability of the response. Renal norepinephrine tissue content and renal axonal density were assessed as efficacy endpoints.
Results:
The number of lesions in the renal artery did not impact efficacy, but treating the distal segment of the renal artery or the branches was associated with enhanced procedural efficacy. Combination treatment of branches as well as the main artery was associated with the most reproducible response. The impact of the denervation was sustained for 28 days and there were no complications noted on follow-up angiography.
Conclusions:
The locus of ablation in the renal arterial bed is a key determinant of the efficacy of renal denervation.
Perspective:
Renal denervation was one of the most promising therapies of the past few years that did not live up to its expectations when tested in a rigorous sham-controlled study. One of the challenges with renal denervation is the lack of a method for assessing success of the procedure. Further, the optimal treatment protocol in humans has yet to be established, and this study suggests that there may be a role for treatment of both the main renal artery and the branch vessels (at least in pigs). It is likely that studies like this will serve as an impetus to refine the treatment protocol and develop a more effective treatment strategy for human renal denervation before the procedure is tested again in large randomized controlled trials.
Clinical Topics: Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Interventions and Imaging, Angiography, Nuclear Imaging
Keywords: Angiography, Catheter Ablation, Denervation, Norepinephrine, Renal Artery, Treatment Outcome
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