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Beta radiation for renal nerve denervation: initial feasibility and safety.

MedStar author(s):

Citation: Eurointervention. 9(6):738-44, 2013 Oct.PMID: 24169134Institution: MedStar Washington Hospital CenterDepartment: MedStar Heart InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Beta Particles | *Sympathectomy | Animals | Blood Pressure/de [Drug Effects] | Brachytherapy | Humans | Renal Artery/ir [Innervation] | Splanchnic NervesYear: 2013 ISSN:

1774-024X

Name of journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of CardiologyAbstract: AIMS: In small clinical trials, sympathetic renal denervation using radiofrequency (RF) energy shows promise in treating resistant hypertension. However, the RF procedure is lengthy and is associated with pain during ablation. Vascular brachytherapy, a proven treatment for in-stent restenosis, has the potential to cause nerve fibrosis. The purpose of the present study was to assess the safety and feasibility of renal artery brachytherapy for sympathetic renal denervation.CONCLUSIONS: This initial feasibility and safety study of renal nerve denervation, mediated by low and intermediate beta-radiation dosages, indicates that this approach can cause nerve fibrosis while avoiding significant damage to the renal artery.METHODS AND RESULTS: A total of 10 normotensive domestic swine underwent vascular brachytherapy to left and right renal arteries using the Beta-Cath 3.5 Fr delivery system at doses of 25 Gy (n=8) and 50 Gy (n=8) at 2 mm from the source centre. These groups were compared to untreated arteries that served as control (n=4). Follow-up obtained at one or two months included angiogram, intravascular ultrasound, and histopathology analysis. The vascular brachytherapy procedure was safe and no apparent angiographic or ultrasound injuries to the vessel were seen. Histology showed a varying degree of thermal injury more pronounced in the 50 Gy group. The majority of examined nerves showed some degree of injury; there was a dose-related effect on nerve injury severity. There were varying degrees of arteriolar changes in the examined sections, with most showing a 2-20% degree of endothelial cell loss.All authors: Barbash IM, Chan R, Makuria AT, Randolph P, Virmani R, Waksman RFiscal year: FY2014Digital Object Identifier:

http://dx.doi.org/10.4244/EIJV9I6A118

Date added to catalog: 2016-05-24

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	24169134	Available		24169134

AIMS: In small clinical trials, sympathetic renal denervation using radiofrequency (RF) energy shows promise in treating resistant hypertension. However, the RF procedure is lengthy and is associated with pain during ablation. Vascular brachytherapy, a proven treatment for in-stent restenosis, has the potential to cause nerve fibrosis. The purpose of the present study was to assess the safety and feasibility of renal artery brachytherapy for sympathetic renal denervation.

CONCLUSIONS: This initial feasibility and safety study of renal nerve denervation, mediated by low and intermediate beta-radiation dosages, indicates that this approach can cause nerve fibrosis while avoiding significant damage to the renal artery.

METHODS AND RESULTS: A total of 10 normotensive domestic swine underwent vascular brachytherapy to left and right renal arteries using the Beta-Cath 3.5 Fr delivery system at doses of 25 Gy (n=8) and 50 Gy (n=8) at 2 mm from the source centre. These groups were compared to untreated arteries that served as control (n=4). Follow-up obtained at one or two months included angiogram, intravascular ultrasound, and histopathology analysis. The vascular brachytherapy procedure was safe and no apparent angiographic or ultrasound injuries to the vessel were seen. Histology showed a varying degree of thermal injury more pronounced in the 50 Gy group. The majority of examined nerves showed some degree of injury; there was a dose-related effect on nerve injury severity. There were varying degrees of arteriolar changes in the examined sections, with most showing a 2-20% degree of endothelial cell loss.

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