MR-guided high-focused ultrasound for renal sympathetic denervation—a feasibility study in pigs

Journal of Therapeutic Ultrasound

Florian Streitparth¹  Rolf W Günther¹  Bernd Hamm¹  Jan L Rinnenthal²  Julia Kamp¹  Jörg Schnorr¹  Nicola Stolzenburg¹  Alexander Beck¹  Lilian Heckmann¹  Patrick Freyhardt¹ 

[1] Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany;Department of Neuropathology, Charité - Universitätsmedizin Berlin, Berlin 13353, Germany

关键词: MRgHiFUS sympathicolysis;    Renal sympathetic denervation;    Hypertension;   

Others  :  1132959
DOI  :  10.1186/2050-5736-2-12

 received in 2014-03-24, accepted in 2014-06-09,  发布年份 2014

【 摘 要 】

Background

Renal sympathetic denervation has recently gained clinical relevance for the treatment of therapy-resistant hypertension. Denervation is currently mainly performed using catheter-based transarterial radiofrequency ablation of periarterial sympathetic nerve fibers. Since this approach has numerous limitations, we conducted a study to evaluate the feasibility, safety, and efficacy of magnetic resonance-guided high-focused ultrasound (MRgHiFUS) for renal sympathetic denervation in pigs as an alternative to catheter-based ablation.

Methods

Renal periarterial MRgHiFUS was performed under general anesthesia in ten pigs. Blood pressure measurements and magnetic resonance imaging (MRI) of the kidneys, renal arteries, and surrounding structures were obtained immediately before and after the interventions and after 4 weeks. Histological examinations of periarterial tissues and determination of renal norepinephrine (NE) concentration were performed to assess treatment efficacy.

Results and discussion

In each pig, 9.8 ± 2.6 sonications with a mean energy deposition of 2,670 ± 486 J were performed. The procedure was well tolerated by all pigs. No major complications occurred. MRgHiFUS induced periarterial edema in three pigs, but only one pig showed corresponding histological changes. The NE level of the treated kidney was lower in five pigs (-8% to -38%) compared to the untreated side. Overall, there was no significant difference between the NE values of both kidneys in any of the treated pigs. Postinterventional MRI indicated absorption of ultrasound energy at the transverse process and fascia.

Conclusion

MRgHiFUS had some thermal periarterial effects but failed to induce renal denervation. Insufficient energy deposition is most likely attributable to a small acoustic window with beam path impediment in the porcine model. Since HiFUS treatment in humans is expected to be easier to perform due to better access to renal sympathetic nerves, further studies of this method are desirable to investigate the potential of MRgHiFUS as an alternative for patients not suitable for catheter-based renal sympathicolysis.

【 授权许可】

   
2014 Freyhardt et al.; licensee BioMed Central Ltd.

【 图 表 】

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