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Extent of vascular injury varies after renal denervation
Results of a new study suggest that balloon- and nonballoon-based renal denervation systems produce a varying extent of vascular injury.
“In patients undergoing renal denervation using five different devices, OCT revealed that a varying extent of vascular injury characterized by dissection, thrombus or edema was observed after renal denervation with all systems,” Antonios Karanasos, MD, PhD, of Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues wrote in Circulation: Cardiovascular Interventions.
In all, 25 patients (mean age, 63.4 ± 10.1 years) who underwent bilateral renal denervation to a total of 50 renal arteries were enrolled. Karanasos and colleagues tested five different renal denervation systems: three balloon-based systems — Paradise (ReCor Medical), OneShot (Covidien) and Vessix V2 (Boston Scientific) — and two nonballoon-based systems — Symplicity (Medtronic) and EnligHTN (St. Jude Medical).
The researchers performed quantitative angiography and morphometric IVUS measurements before and after denervation and used OCT to determine vascular trauma, including dissection, edema or thrombus, after the procedure.
Data from quantitative angiography and IVUS demonstrated a significant reduction in lumen size after nonballoon denervation, but not balloon denervation. OCT analysis revealed dissection in 32.6% of arteries, with the rate of frames with dissection higher in balloon-based catheters.
Furthermore, thrombus occurred in 81.4% of arteries and edema in 74.4% of arteries. In arteries treated with balloon-based denervation that had dissection, the balloon-to-artery ratio was higher (1.24 vs. 1.1; P < .01).
“Our findings suggest that in these devices, postprocedural angiographic abnormalities should not be disregarded and raise suspicion of vascular injury, while a conservative approach on balloon selection could be considered,” Karanasos and colleagues concluded. – by Brian Ellis
Disclosure: Karanasos reports receiving financial support for OCT-related research from St. Jude Medical. The other researchers report no relevant financial disclosures.