Balaji Poornima, Liu Xingzhou, Tran Vu Toan, Barry Michael A, Vien Albert, Yang Edward, Nguyen Duc Minh, Patel Urja, Lu Juntang, Alvarez Shirley, Bandodkar Sushil, Varikatt Winny, McEwan Alistair, Thomas Stuart P, Qian Pierre C
Cardiology Department (P.B., X.L., V.T.T., M.A.B., A.V., E.Y., D.M.N., U.P., J.L., S.P.T., P.C.Q.), Westmead Hospital, Sydney, Australia.
Westmead Applied Research Centre (P.B., X.L., A.V., S.P.T., P.C.Q.), University of Sydney, Australia.
Hypertension. 2025 Apr;82(4):680-689. doi: 10.1161/HYPERTENSIONAHA.124.24250. Epub 2025 Jan 30.
Transcatheter renal denervation (RDN) remains inconsistent despite developments in ablation technologies, due to the lack of an intraprocedural physiological end point. The aim of this study was to identify if aorticorenal ganglion (ARG) guided RDN using microwave (MW) catheter leads to more consistent denervation outcomes compared with empirical MW ablation.
Pigs underwent sham procedure (n=8) or bilateral RDN using an in-house built open-irrigated MW catheter. Before denervation, ipsilateral ARG pacing was performed leading to renal artery vasoconstriction. MW ablation group (MW-group; n=7) received 1 ablation (100-120 W for 360 seconds) in the mid-main renal artery based on artery caliber. ARG-guided-MW ablation group (ARG-MW-group; n=7) was permitted an additional ablation more distally or at higher power until a vasoconstrictive response was abolished. Animals were euthanized at 4 to 5 weeks post-procedure.
ARG pacing caused an ipsilateral reduction in renal artery caliber from 4.67 to 4 mm; =0.0006 in MW-group and 4.8 to 3.9 mm; =0.001 in ARG-MW-group. Repeat ARG pacing at euthanasia led to a reduction in renal artery caliber in MW-group from 5.1 to 4.8 mm; =0.006, but not in ARG-MW-group from 4.88 to 4.55 mm; =0.08. There were no differences in ablation injury volumes between the groups. Compared with undenervated sham controls, ARG-MW-RDN versus MW-RDN caused median reductions in viable nerve area (antityrosine hydroxylase staining) at 4 to 5 weeks by 92.6% (interquartile range, 0.94-19.59%; <0.0001) versus 55.02% (interquartile range, 15.87-75.11%; =0.006) and median renal cortical norepinephrine content by 68.06% (interquartile range, 27.16-38.39%; <0.0001) versus 25.25% (interquartile range, 56.97-157.7%; =NS).
ARG pacing serves as a physiological procedural end point to guide MW denervation to improve denervation outcomes.
尽管消融技术有所发展，但由于缺乏术中生理终点，经导管肾去神经支配术（RDN）的效果仍不一致。本研究的目的是确定与经验性微波（MW）消融相比，使用微波导管在主动脉肾神经节（ARG）引导下进行RDN是否能带来更一致的去神经支配效果。
猪接受假手术（n = 8）或使用自制的开放式灌注MW导管进行双侧RDN。在去神经支配之前，进行同侧ARG起搏，导致肾动脉血管收缩。MW消融组（MW组；n = 7）根据动脉管径在肾动脉主干中部接受1次消融（100 - 120瓦，持续360秒）。ARG引导MW消融组（ARG - MW组；n = 7）可在更远处或更高功率下进行额外消融，直至血管收缩反应消失。术后4至5周对动物实施安乐死。
ARG起搏使同侧肾动脉管径从4.67毫米降至4毫米；MW组P = 0.0006，ARG - MW组从4.8毫米降至3.9毫米；P = 0.001。安乐死时重复ARG起搏使MW组肾动脉管径从5.1毫米降至4.8毫米；P = 0.006，但ARG - MW组未出现此情况，肾动脉管径从4.88毫米降至4.55毫米；P = 0.08。两组间消融损伤体积无差异。与未去神经支配的假手术对照组相比，ARG - MW - RDN与MW - RDN在4至5周时导致存活神经面积（抗酪氨酸羟化酶染色）的中位数减少分别为92.6%（四分位间距，0.94 - 19.59%；P < 0.0001）和55.02%（四分位间距，15.87 - 75.11%；P = 0.006），肾皮质去甲肾上腺素含量的中位数减少分别为68.06%（四分位间距，27.16 - 38.39%；P < 0.0001）和25.25%（四分位间距，56.97 - 157.7%；P =无显著性差异）。
ARG起搏可作为生理手术终点，指导MW去神经支配以改善去神经支配效果。
