Abstract
The catheter-based renal denervation (RDN) showed promising results for patients in lowering BP, but there were also many non-responders. One of the possible reasons was the incomplete neural ablation due to the ablation of renal nerves at random sites resulting in asymmetric innervation patterns along the renal artery. We developed a laparoscopic ablation system that is optimized for complete RDN regardless of renal arterial innervation and size. To demonstrate its effectiveness, we evaluated the system using computational simulation and 28-day survival model using pigs. The ablations were focused around the tunica externa, and the ablation patterns could be predicted numerically during RDN treatment. In the animal study, the mean reduction of systolic BP and diastolic BP in the bilateral main renal arteries was 22.8 mmHg and 14.4 mmHg (P<0.001), respectively. The respond to immunostaining targeting tyrosine hydroxylase was significantly reduced at treatment site (108.2 ± 7.5 (control) vs. 63.4 ± 8.7 (treatment), P<0.001), and an increased degree of sympathetic signals interruption to kidneys was associated with the efficacy of RDN. The laparoscopic ablation system achieved complete circumferential RDN at the treatment site and could numerically predict the ablation patterns. These findings clearly suggest that the proposed system can significantly improve the RDN effectiveness by reducing the variation to the percentage of injured nerves and open up a new opportunity to treat uncontrolled hypertension.
Highlights
The sympathetic nervous system controls blood pressure (BP) by modulating water intake and peripheral arterial vasoconstriction
The catheter-based renal denervation (RDN) approach has been introduced as an improved strategy over sympathectomy, which significantly reduces invasiveness and selectively disrupts the renal sympathetic nerves compared to sympathectomy
The current study shows that the laparoscopic ablation system proposed here is optimized for complete RDN regardless of renal arterial innervation and size
Summary
The sympathetic nervous system controls blood pressure (BP) by modulating water intake and peripheral arterial vasoconstriction. Experience with surgical sympathectomy, which completely divides the thoracic and lumbar sympathetic ganglia, showed that interrupting sympathetic nerves could lead to the postoperative reductions in BP [2] These methods were abandoned from the practice due to perioperative morbidity and complications arising from the procedure [3]. Elevating the ablation energy to increase lesion depth would predispose the irreversible injury to intima, such as atherosclerosis, thrombosis, or stenosis [17,18,19]. These fundamental limitations identified from the clinical study warranted the need for a further optimized RDN system
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