title: Vascular lesions induced by renal nerve ablation as assessed by optical coherence tomography: pre- and post-procedural comparison with the Simplicity catheter system and the EnligHTN multi-electrode renal denervation catheter.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Raemistrasse 100, Zurich CH-8091, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Templin
authors.forename: Milosz
authors.initials: M
authors.lastname: Jaguszewski
authors.forename: Jelena R
authors.initials: JR
authors.lastname: Ghadri
authors.forename: Isabella
authors.initials: I
authors.lastname: Sudano
authors.forename: Roman
authors.initials: R
authors.lastname: Gaehwiler
authors.forename: Jens P
authors.initials: JP
authors.lastname: Hellermann
authors.forename: Renate
authors.initials: R
authors.lastname: Schoenenberger-Berzins
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
authors.forename: Georg
authors.initials: G
authors.lastname: Noll
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation; D004351:Drug Resistance; D004487:Edema / Q000209:etiology; D004566:Electrodes / Q000009:adverse effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012077:Renal Artery / Q000293:injuries*; D013035:Spasm / Q000209:etiology; D013562:Sympathectomy / Q000009:adverse effects* / Q000295:instrumentation; D013927:Thrombosis / Q000209:etiology; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology
chemical_list: D000959:Antihypertensive Agents
keywords: Catheter-based renal nerve ablation; EnligHTN multi-electrode renal denervation catheter; Optical coherence tomography; Simplicity catheter system; Vascular lesions