CardioVascular Center Frankfurt, Frankfurt, Germany; Minneapolis Veterans Affairs Medical Center, Minneapolis, USA.
Minneapolis Veterans Affairs Medical Center, Minneapolis, USA.
Cardiovasc Revasc Med. 2021 Mar;24:77-86. doi: 10.1016/j.carrev.2020.09.003. Epub 2020 Sep 7.
Renal sympathetic denervation using conventional non-irrigated radiofrequency catheters has potential technical shortcomings, including limited penetration depth and incomplete circumferential nerve damage, potentially impacting therapeutic efficacy. Against this background, second generation multi-electrode, radiofrequency and ultrasound renal denervation systems have been developed to provide more consistent circumferential nerve ablation. Irrigated catheters may allow deeper penetration while minimizing arterial injury. In this context, catheter-based chemical denervation, with selective infusion of alcohol, a potent neurolytic agent, into the perivascular space, may minimize endothelial, intimal and medial injury while providing circumferential neurolysis. Animal studies demonstrate pronounced renal norepinephrine level reductions and consistent renal nerve injury after perivascular alcohol infusion using the Peregrine Catheter. Early clinical studies demonstrated significant blood pressure reductions and a reasonable safety profile. Randomized sham-controlled trials (NCT03503773, NCT02910414) are underway to examine whether the aforementioned theoretical advantages of alcohol-medicated denervation with the Peregrine System™ Kit translate into clinical benefits.
使用传统非灌流射频导管进行肾脏去交感神经支配存在潜在的技术缺陷，包括有限的穿透深度和不完全的环形神经损伤，这可能会影响治疗效果。在此背景下，第二代多电极、射频和超声肾脏去交感神经支配系统已被开发出来，以提供更一致的环形神经消融。灌流导管可以允许更深的穿透，同时最大限度地减少动脉损伤。在这种情况下，基于导管的化学去神经支配，通过将强效神经溶解剂酒精选择性注入血管周围空间，可以在提供环形神经溶解的同时最小化内皮、内膜和中膜损伤。动物研究表明，使用 Peregrine 导管进行血管周围酒精输注后，肾去甲肾上腺素水平显著降低，肾神经损伤一致。早期的临床研究表明，血压显著降低，且安全性良好。正在进行随机假对照试验（NCT03503773、NCT02910414），以检验 Peregrine 系统™套件中酒精介导去神经支配的上述理论优势是否转化为临床益处。
