Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Raemistrasse 100, Zurich CH-8091, Switzerland.
Eur Heart J. 2013 Jul;34(28):2141-8, 2148b. doi: 10.1093/eurheartj/eht141. Epub 2013 Apr 25.
Catheter-based renal nerve ablation (RNA) using radiofrequency energy is a novel treatment for drug-resistant essential hypertension. However, the local endothelial and vascular injury induced by RNA has not been characterized, although this importantly determines the long-term safety of the procedure. Optical coherence tomography (OCT) enables in vivo visualization of morphologic features with a high resolution of 10-15 µm. The objective of this study was to assess the morphological features of the endothelial and vascular injury induced by RNA using OCT.
In a prospective observational study, 32 renal arteries of patients with treatment-resistant hypertension underwent OCT before and after RNA. All pre- and post-procedural OCT pullbacks were evaluated regarding vascular changes such as vasospasm, oedema (notches), dissection, and thrombus formation. Thirty-two renal arteries were evaluated, in which automatic pullbacks were obtained before and after RNA. Vasospasm was observed more often after RNA then before the procedure (0 vs. 42%, P < 0.001). A significant decrease in mean renal artery diameter after RNA was documented both with the EnligHTN (4.69 ± 0.73 vs. 4.21 ± 0.87 mm; P < 0.001) and with the Simplicity catheter (5.04 ± 0.66 vs. 4.57 ± 0.88 mm; P < 0.001). Endothelial-intimal oedema was noted in 96% of cases after RNA. The presence of thrombus formations was significantly higher after the RNA then before ablation (67 vs. 18%, P < 0.001). There was one evidence of arterial dissection after RNA with the Simplicity catheter, while endothelial and intimal disruptions were noted in two patients with the EnligHTN catheter.
Here we show that diffuse renal artery constriction and local tissue damage at the ablation site with oedema and thrombus formation occur after RNA and that OCT visualizes vascular lesions not apparent on angiography. This suggests that dual antiplatelet therapy may be required during RNA.
基于导管的肾脏神经消融（RNA）使用射频能量是治疗耐药性原发性高血压的一种新方法。然而，RNA 引起的局部内皮和血管损伤尚未得到描述，尽管这对该手术的长期安全性非常重要。光学相干断层扫描（OCT）能够以 10-15μm 的高分辨率对形态特征进行体内可视化。本研究的目的是使用 OCT 评估 RNA 引起的内皮和血管损伤的形态特征。
在一项前瞻性观察研究中，32 例患有难治性高血压的患者的 32 条肾动脉在 RNA 治疗前后进行了 OCT 检查。所有术前和术后的 OCT 回拉均评估了血管变化，如血管痉挛、水肿（切迹）、夹层和血栓形成。对 32 条肾动脉进行了评估，其中在 RNA 治疗前后自动进行了 OCT 回拉。RNA 治疗后血管痉挛的发生率高于治疗前（0 比 42%，P < 0.001）。RNA 治疗后平均肾动脉直径显著减小，使用 EnligHTN（4.69 ± 0.73 比 4.21 ± 0.87mm；P < 0.001）和 Simplicity 导管（5.04 ± 0.66 比 4.57 ± 0.88mm；P < 0.001）。RNA 治疗后，96%的病例存在内皮-内膜水肿。RNA 治疗后血栓形成的发生率明显高于治疗前（67 比 18%，P < 0.001）。使用 Simplicity 导管有一例动脉夹层的证据，而使用 EnligHTN 导管有两例患者存在内皮和内膜破裂。
在这里，我们显示弥漫性肾动脉收缩和局部消融部位的组织损伤，伴有水肿和血栓形成，发生在 RNA 治疗后，OCT 可显示血管造影上不明显的血管病变。这表明在 RNA 治疗期间可能需要双联抗血小板治疗。
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