Firouznia Kavous, Hosseininasab Sayed Jaber, Amanpour Saeid, Haj-Mirzaian Arya, Miri Roza, Muhammadnejad Ahad, Muhammadnejad Samad, Jalali Amir H, Ahmadi Farrokhlagha, Rokni-Yazdi Hadi
Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TMUS), Tehran, 1419733141, Iran,
Cardiovasc Intervent Radiol. 2015 Aug;38(4):977-84. doi: 10.1007/s00270-015-1109-0. Epub 2015 May 6.
Renal nerves are a recent target in the treatment of hypertension. Renal sympathetic denervation (RSD) is currently performed using catheter-based radiofrequency ablation (RFA) and because this method has limitations, percutaneous magnetic resonance (MR)-guided periarterial ethanol injection is a suggested alternative. However, few studies have been conducted on the effectiveness of percutaneous ethanol injection for RSD.
To evaluate the feasibility, efficacy, and complications of computed tomography (CT)-guided periarterial ethanol injection.
Ethanol (10 ml, 99.6%) was injected around the right renal artery in six sheep under CT guidance with the left kidney serving as a control. Before and after the intervention, the sheep underwent MR imaging studies and the serum creatinine level was measured. One month after the intervention, the sheep were euthanized and norepinephrine (NE) concentration in the renal parenchyma was measured to evaluate the efficacy of the procedure. The treated tissues were also examined histopathologically to evaluate vascular, parenchymal, and neural injury.
The right kidney parenchymal NE concentration decreased significantly compared with the left kidney after intervention (average reduction: 40%, P = 0.0016). Histologic examination revealed apparent denervation with no other vascular or parenchymal injuries observed in the histological and imaging studies.
Effective and feasible RSD was achieved using CT-guided periarterial ethanol injection. This technique may be a potential alternative to catheter-based RFA in the treatment of hypertension.
肾神经是近期高血压治疗的靶点。肾交感神经去神经支配术（RSD）目前通过基于导管的射频消融（RFA）来实施，由于这种方法存在局限性，经皮磁共振（MR）引导下肾动脉周围乙醇注射是一种建议的替代方法。然而，关于经皮乙醇注射用于RSD有效性的研究较少。
评估计算机断层扫描（CT）引导下肾动脉周围乙醇注射的可行性、有效性及并发症。
在CT引导下，对6只绵羊的右肾动脉周围注射10 ml 99.6%的乙醇，以左肾作为对照。干预前后，对绵羊进行磁共振成像研究并测量血清肌酐水平。干预1个月后，对绵羊实施安乐死并测量肾实质中去甲肾上腺素（NE）浓度，以评估该操作的有效性。对处理后的组织进行组织病理学检查，以评估血管、实质和神经损伤情况。
干预后，右肾实质NE浓度与左肾相比显著降低（平均降低：40%，P = 0.0016）。组织学检查显示明显的去神经支配，在组织学和影像学研究中未观察到其他血管或实质损伤。
CT引导下肾动脉周围乙醇注射可实现有效且可行的RSD。该技术可能是治疗高血压时基于导管的RFA的一种潜在替代方法。
