Skip to main content
Erschienen in: The International Journal of Cardiovascular Imaging 3/2018

27.09.2017 | Original Paper

Magnetic resonance guided renal denervation using active tracking: first in vivo experience in Swine

verfasst von: F. Bönner, S. Haberkorn, P. Behm, B. Schnackenburg, S. Krüger, S. Weiss, C. Meyer, M. Kelm, M. Neizel-Wittke

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 3/2018

Einloggen, um Zugang zu erhalten

Abstract

Interventional cardiovascular magnetic resonance (iCMR) might evolve as a technique to improve procedural success rates in cardiovascular interventions by combining intraprocedural guidance and simultaneous lesion imaging. The objective of the present study was to prove feasibility and estimate safety of renal sympathetic denervation guided by real-time iCMR using active tracking. Six pigs were examined in a 1.5 T MRI-System (Achieva, Philips Healthcare, Best, Netherlands) equipped with non-invasive hemodynamic control and in-room monitors displaying an interventional software platform [Interventional MRI Suite (iSuite), Philips Research, Hamburg, Germany]. MR-guided renal denervation was performed using a MR conditional non-irrigated ablation catheter with active tracking (Imricor, Burnsville, MN, USA). Real-time imaging for device guidance was performed with a TFE sequence, vessel patency was assessed with a 3D non-contrast angiography and velocity encoded imaging. Oedema of the renal artery was visualized by a high-resolution T2 SPIR sequence. Renal sympathetic denervation was feasible in all cases with survival of all animals. Non-contrast angiography displayed renal artery patency accompanied by equal flow conditions before and after the ablation in all cases as measured by velocity encoded imaging. Oedema imaging displayed a significant increase in relative signal intensity at renal artery ablations sites pre and post intervention (p < 0.05). The histologic examination revealed no signs of perforation or bleeding, while sufficient ablation lesions could be depicted. MR-guided renal sympathetic denervation using active tracking is feasible and the initial data suggest safety of this procedure. MR-guided renal sympathetic denervation offers the inherent strength of high soft tissue contrast thereby providing target information without the use of iodinated contrast agents or radiation.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Sarafidis PA, Georgianos P, Bakris GL (2013) Resistant hypertension—its identification and epidemiology. Nat Rev Nephrol 9(1):51–58CrossRefPubMed Sarafidis PA, Georgianos P, Bakris GL (2013) Resistant hypertension—its identification and epidemiology. Nat Rev Nephrol 9(1):51–58CrossRefPubMed
2.
Zurück zum Zitat Kearney PM, Whelton M, Reynolds K, Whelton PK, He J (2004) Worldwide prevalence of hypertension: a systematic review. J Hypertens 22(1):11–19CrossRefPubMed Kearney PM, Whelton M, Reynolds K, Whelton PK, He J (2004) Worldwide prevalence of hypertension: a systematic review. J Hypertens 22(1):11–19CrossRefPubMed
3.
Zurück zum Zitat Kumbhani DJ, Steg PG, Cannon CP, Eagle KA, Smith SC Jr, Crowley K, Goto S, Ohman EM, Bakris GL, Perlstein TS, Kinlay S, Bhatt DL (2013) Resistant hypertension: a frequent and ominous finding among hypertensive patients with atherothrombosis. Eur Heart J 34(16):1204–1214CrossRefPubMed Kumbhani DJ, Steg PG, Cannon CP, Eagle KA, Smith SC Jr, Crowley K, Goto S, Ohman EM, Bakris GL, Perlstein TS, Kinlay S, Bhatt DL (2013) Resistant hypertension: a frequent and ominous finding among hypertensive patients with atherothrombosis. Eur Heart J 34(16):1204–1214CrossRefPubMed
4.
Zurück zum Zitat Kumbhani DJ, Steg PG, Cannon CP, Eagle KA, Smith SC Jr, Hoffman E, Goto S, Ohman EM, Bhatt DL (2013) Adherence to secondary prevention medications and four-year outcomes in outpatients with atherosclerosis. Am J Med 126(8):693–700CrossRefPubMed Kumbhani DJ, Steg PG, Cannon CP, Eagle KA, Smith SC Jr, Hoffman E, Goto S, Ohman EM, Bhatt DL (2013) Adherence to secondary prevention medications and four-year outcomes in outpatients with atherosclerosis. Am J Med 126(8):693–700CrossRefPubMed
5.
Zurück zum Zitat Hoobler SW, Manning JT, Paine WG, McClellan SG, Helcher PO, Renfert H, Peet MM, Kahn EA (1951) The effects of splanchnicectomy on the blood pressure in hypertension: a controlled study. Circulation 4(2):173–183CrossRefPubMed Hoobler SW, Manning JT, Paine WG, McClellan SG, Helcher PO, Renfert H, Peet MM, Kahn EA (1951) The effects of splanchnicectomy on the blood pressure in hypertension: a controlled study. Circulation 4(2):173–183CrossRefPubMed
6.
Zurück zum Zitat Smithwick RH, Thompson JE (1953) Splanchnicectomy for essential hypertension; results in 1266 cases. J Am Med Assoc 152(16):1501–1504CrossRefPubMed Smithwick RH, Thompson JE (1953) Splanchnicectomy for essential hypertension; results in 1266 cases. J Am Med Assoc 152(16):1501–1504CrossRefPubMed
7.
Zurück zum Zitat Esler M (2000) The sympathetic system and hypertension. Am J Hypertens 13(6 Pt 2):99S–105S Esler M (2000) The sympathetic system and hypertension. Am J Hypertens 13(6 Pt 2):99S–105S
8.
Zurück zum Zitat Fischell TA, Vega F, Raju N, Johnson ET, Kent DJ, Ragland RR, Fischell DR, Almany SL, Ghazarossian VE (2013) Ethanol-mediated perivascular renal sympathetic denervation: preclinical validation of safety and efficacy in a porcine model. EuroIntervention 9(1):140–147CrossRefPubMed Fischell TA, Vega F, Raju N, Johnson ET, Kent DJ, Ragland RR, Fischell DR, Almany SL, Ghazarossian VE (2013) Ethanol-mediated perivascular renal sympathetic denervation: preclinical validation of safety and efficacy in a porcine model. EuroIntervention 9(1):140–147CrossRefPubMed
9.
Zurück zum Zitat Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K, Kapelak B, Walton A, Sievert H, Thambar S, Abraham WT, Esler M (2009) Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 373(9671):1275–1281CrossRefPubMed Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K, Kapelak B, Walton A, Sievert H, Thambar S, Abraham WT, Esler M (2009) Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 373(9671):1275–1281CrossRefPubMed
10.
Zurück zum Zitat Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Bohm M (2010) Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 376(9756):1903–1909CrossRefPubMed Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Bohm M (2010) Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 376(9756):1903–1909CrossRefPubMed
11.
Zurück zum Zitat Kandzari DE, Bhatt DL, Sobotka PA, O’Neill WW, Esler M, Flack JM, Katzen BT, Leon MB, Massaro JM, Negoita M, Oparil S, Rocha-Singh K, Straley C, Townsend RR, Bakris G (2012) Catheter-based renal denervation for resistant hypertension: rationale and design of the SYMPLICITY HTN-3 Trial. Clin Cardiol 35(9):528–535CrossRefPubMed Kandzari DE, Bhatt DL, Sobotka PA, O’Neill WW, Esler M, Flack JM, Katzen BT, Leon MB, Massaro JM, Negoita M, Oparil S, Rocha-Singh K, Straley C, Townsend RR, Bakris G (2012) Catheter-based renal denervation for resistant hypertension: rationale and design of the SYMPLICITY HTN-3 Trial. Clin Cardiol 35(9):528–535CrossRefPubMed
12.
Zurück zum Zitat Bhatt DL, Kandzari DE, O’Neill WW, D’Agostino R, Flack JM, Katzen BT, Leon MB, Liu M, Mauri L, Negoita M, Cohen SA, Oparil S, Rocha-Singh K, Townsend RR, Bakris GL (2014) A controlled trial of renal denervation for resistant hypertension. N Engl J Med 370(15):1393–1401CrossRefPubMed Bhatt DL, Kandzari DE, O’Neill WW, D’Agostino R, Flack JM, Katzen BT, Leon MB, Liu M, Mauri L, Negoita M, Cohen SA, Oparil S, Rocha-Singh K, Townsend RR, Bakris GL (2014) A controlled trial of renal denervation for resistant hypertension. N Engl J Med 370(15):1393–1401CrossRefPubMed
13.
Zurück zum Zitat Kandzari DE, Bhatt DL, Brar S, Devireddy CM, Esler M, Fahy M, Flack JM, Katzen BT, Lea J, Lee DP, Leon MB, Ma A, Massaro J, Mauri L, Oparil S, O’Neill WW, Patel MR, Rocha-Singh K, Sobotka PA, Svetkey L, Townsend RR, Bakris GL (2015) Predictors of blood pressure response in the SYMPLICITY HTN-3 trial. Eur Heart J 36(4):219–227CrossRefPubMed Kandzari DE, Bhatt DL, Brar S, Devireddy CM, Esler M, Fahy M, Flack JM, Katzen BT, Lea J, Lee DP, Leon MB, Ma A, Massaro J, Mauri L, Oparil S, O’Neill WW, Patel MR, Rocha-Singh K, Sobotka PA, Svetkey L, Townsend RR, Bakris GL (2015) Predictors of blood pressure response in the SYMPLICITY HTN-3 trial. Eur Heart J 36(4):219–227CrossRefPubMed
14.
Zurück zum Zitat Steigerwald K, Titova A, Malle C, Kennerknecht E, Jilek C, Hausleiter J, Nahrig JM, Laugwitz KL, Joner M (2012) Morphological assessment of renal arteries after radiofrequency catheter-based sympathetic denervation in a porcine model. J Hypertens 30(11):2230–2239CrossRefPubMed Steigerwald K, Titova A, Malle C, Kennerknecht E, Jilek C, Hausleiter J, Nahrig JM, Laugwitz KL, Joner M (2012) Morphological assessment of renal arteries after radiofrequency catheter-based sympathetic denervation in a porcine model. J Hypertens 30(11):2230–2239CrossRefPubMed
15.
Zurück zum Zitat Sakakura K, Ladich E, Cheng Q, Otsuka F, Yahagi K, Fowler DR, Kolodgie FD, Virmani R, Joner M (2014) Anatomic assessment of sympathetic peri-arterial renal nerves in man. J Am Coll Cardiol 64(7):635–643CrossRefPubMed Sakakura K, Ladich E, Cheng Q, Otsuka F, Yahagi K, Fowler DR, Kolodgie FD, Virmani R, Joner M (2014) Anatomic assessment of sympathetic peri-arterial renal nerves in man. J Am Coll Cardiol 64(7):635–643CrossRefPubMed
16.
Zurück zum Zitat Freyhardt P, Heckmann L, Beck A, Stolzenburg N, Schnorr J, Kamp J, Rinnenthal JL, Hamm B, Gunther RW, Streitparth F (2014) MR-guided high-focused ultrasound for renal sympathetic denervation-a feasibility study in pigs. J Ther Ultrasound 2:12CrossRefPubMedPubMedCentral Freyhardt P, Heckmann L, Beck A, Stolzenburg N, Schnorr J, Kamp J, Rinnenthal JL, Hamm B, Gunther RW, Streitparth F (2014) MR-guided high-focused ultrasound for renal sympathetic denervation-a feasibility study in pigs. J Ther Ultrasound 2:12CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Bonner F, Janzarik N, Jacoby C, Spieker M, Schnackenburg B, Range F, Butzbach B, Haberkorn S, Westenfeld R, Neizel-Wittke M, Flogel U, Kelm M (2015) Myocardial T2 mapping reveals age- and sex-related differences in volunteers. J Cardiovasc Magn Reson 17(1):9CrossRefPubMedPubMedCentral Bonner F, Janzarik N, Jacoby C, Spieker M, Schnackenburg B, Range F, Butzbach B, Haberkorn S, Westenfeld R, Neizel-Wittke M, Flogel U, Kelm M (2015) Myocardial T2 mapping reveals age- and sex-related differences in volunteers. J Cardiovasc Magn Reson 17(1):9CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Sakakura K, Ladich E, Fuimaono K, Grunewald D, O’Fallon P, Spognardi AM, Markham P, Otsuka F, Yahagi K, Shen K, Kolodgie FD, Joner M, Virmani R (2015) Comparison of renal artery, soft tissue, and nerve damage after irrigated versus nonirrigated radiofrequency ablation. Circ Cardiovasc Interv 8(1):e001720CrossRefPubMed Sakakura K, Ladich E, Fuimaono K, Grunewald D, O’Fallon P, Spognardi AM, Markham P, Otsuka F, Yahagi K, Shen K, Kolodgie FD, Joner M, Virmani R (2015) Comparison of renal artery, soft tissue, and nerve damage after irrigated versus nonirrigated radiofrequency ablation. Circ Cardiovasc Interv 8(1):e001720CrossRefPubMed
19.
Zurück zum Zitat Karampinos DC, Melkus G, Shepherd TM, Banerjee S, Saritas EU, Shankaranarayanan A, Hess CP, Link TM, Dillon WP, Majumdar S (2013) Diffusion tensor imaging and T2 relaxometry of bilateral lumbar nerve roots: feasibility of in-plane imaging. NMR Biomed 26(6):630–637PubMed Karampinos DC, Melkus G, Shepherd TM, Banerjee S, Saritas EU, Shankaranarayanan A, Hess CP, Link TM, Dillon WP, Majumdar S (2013) Diffusion tensor imaging and T2 relaxometry of bilateral lumbar nerve roots: feasibility of in-plane imaging. NMR Biomed 26(6):630–637PubMed
20.
Zurück zum Zitat Grothoff M, Gutberlet M, Hindricks G, Fleiter C, Schnackenburg B, Weiss S, Krueger S, Piorkowski C, Gaspar T, Wedan S, Lloyd T, Sommer P, Hilbert S (2017) Magnetic resonance imaging guided transatrial electrophysiological studies in swine using active catheter tracking - experience with 14 cases. Eur Radiol 27(5):1954–1962CrossRefPubMed Grothoff M, Gutberlet M, Hindricks G, Fleiter C, Schnackenburg B, Weiss S, Krueger S, Piorkowski C, Gaspar T, Wedan S, Lloyd T, Sommer P, Hilbert S (2017) Magnetic resonance imaging guided transatrial electrophysiological studies in swine using active catheter tracking - experience with 14 cases. Eur Radiol 27(5):1954–1962CrossRefPubMed
21.
Zurück zum Zitat Hilbert S, Sommer P, Gutberlet M, Gaspar T, Foldyna B, Piorkowski C, Weiss S, Lloyd T, Schnackenburg B, Krueger S, Fleiter C, Paetsch I, Jahnke C, Hindricks G, Grothoff M (2016) Real-time magnetic resonance-guided ablation of typical right atrial flutter using a combination of active catheter tracking and passive catheter visualization in man: initial results from a consecutive patient series. Europace 18(4):572–577CrossRefPubMed Hilbert S, Sommer P, Gutberlet M, Gaspar T, Foldyna B, Piorkowski C, Weiss S, Lloyd T, Schnackenburg B, Krueger S, Fleiter C, Paetsch I, Jahnke C, Hindricks G, Grothoff M (2016) Real-time magnetic resonance-guided ablation of typical right atrial flutter using a combination of active catheter tracking and passive catheter visualization in man: initial results from a consecutive patient series. Europace 18(4):572–577CrossRefPubMed
Metadaten
Titel
Magnetic resonance guided renal denervation using active tracking: first in vivo experience in Swine
verfasst von
F. Bönner
S. Haberkorn
P. Behm
B. Schnackenburg
S. Krüger
S. Weiss
C. Meyer
M. Kelm
M. Neizel-Wittke
Publikationsdatum
27.09.2017
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 3/2018
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-017-1244-6

Weitere Artikel der Ausgabe 3/2018

The International Journal of Cardiovascular Imaging 3/2018 Zur Ausgabe

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

26.04.2024 Mammografie Nachrichten

Routinemäßige Mammografien helfen, Brustkrebs frühzeitig zu erkennen. Anhand der Röntgenuntersuchung lassen sich aber auch kardiovaskuläre Risikopatientinnen identifizieren. Als zuverlässiger Anhaltspunkt gilt die Verkalkung der Brustarterien.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Adipositas-Medikament auch gegen Schlafapnoe wirksam

24.04.2024 Adipositas Nachrichten

Der als Antidiabetikum sowie zum Gewichtsmanagement zugelassene Wirkstoff Tirzepatid hat in Studien bei adipösen Patienten auch schlafbezogene Atmungsstörungen deutlich reduziert, informiert der Hersteller in einer Vorab-Meldung zum Studienausgang.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.