Renal Denervation by Transaortic Periarterial Ethanol Injection: An Experimental Study in Porcines

• Published in: Cardiovascular and interventional radiology 2018-12, Vol.41 (12), p.1943-1951
• Main Authors: Freyhardt, Patrick, Schütze, Josephine, Donners, Ricardo, Schnorr, Jörg, Stolzenburg, Nicola, Rinnenthal, Jan L., Penzkofer, Tobias, Hamm, Bernd, Günther, Rolf W., Streitparth, Florian
• Format: Article
• Language: English
• Subjects: Ablation; Animals; Arteries; Blood pressure; Cardiology; Catheters; Computed tomography; Degeneration; Denervation; Denervation - methods; Ethanol; Ethanol - administration & dosage; Euthanasia; Fatalities; Feasibility studies; Female; Fluoroscopy; Follow-Up Studies; Imaging; Infarction; Injection; Kidney - diagnostic imaging; Kidney - innervation; Kidneys; Laboratory Investigation; Medical instruments; Medicine; Medicine & Public Health; Models, Animal; Norepinephrine; Nuclear Medicine; Peripheral Nerves - diagnostic imaging; Peripheral Nerves - drug effects; Radiography, Interventional; Radiology; Renal artery; Sheaths; Solvents - administration & dosage; Swine; Tomography, X-Ray Computed - methods; Ultrasound; Veins & arteries
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-018-2045-6

Aims To evaluate the feasibility, safety and efficacy of renal sympathetic denervation via endoluminal transaortic periarterial ethanol injection. Methods and Results In 11 normotensive pigs transaortic puncture was performed with a 90-cm 21G needle with subsequent unilateral ethanol injection to the periarterial space. Needle placement was achieved using a 7F steerable sheath fluoroscopically positioned slightly above the renal artery origin. Blood pressure measurements and abdominal CT scans were performed immediately pre- and postintervention and 4 weeks later. After euthanasia norepinephrine concentration of both kidneys (RTNEC) was determined and renal arteries and surrounding tissues histologically examined to assess induced nerve fibre degeneration. Results All but one procedure were technically successful. One major complication with accidental ethanol injection into the renal artery and subsequent infarction occurred. One pig died from no intervention-related cardiac arrest. The 4-week follow-up was uneventful in the remaining 10 animals. RTNEC was significantly lower on the treated side in eight of ten pigs (mean decrease 36.6%) with correlating histopathological signs of nerve degeneration. Conclusions Renal sympathicolysis by transaortic periarterial ethanol injection was feasible and effective in a porcine model. This approach may be an alternative to catheter-based RFA or other methods of renal denervation.