Investigations of Laser-Assisted Renal Denervation for Treatment of Resistant Hypertension

IF 2.2 3区医学 Q2 DERMATOLOGY Lasers in Surgery and Medicine Pub Date : 2024-07-04 DOI:10.1002/lsm.23823

Junghyun Hwang, Hwarang Shin, Minwoo Jung, Hyun Wook Kang

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Abstract

Background and Objectives

Renal denervation (RDN) is an emerging surgical treatment for resistant hypertension. However, the current RDN using radiofrequency can cause undesirable thermal damage to the medial and luminal layers due to direct contact between the arterial lumen and energy source. The aim of this study is to evaluate the feasibility of the new laser-assisted RDN by exploring the potential treatment conditions.

Methods

For ex vivo testing, six different treatment conditions (10 and 20 W applied for delivery of 300, 450, and 600 J) were tested on the porcine liver and renal artery (RA) by using a continuous wave 1064 nm laser wavelength. The ablated area in the liver tissue was measured to estimate the extent of the coagulated area. Histological evaluation was performed on the treated RA tissues to confirm the extent of thermal nerve damage.

Results

The ablated depth, length, and area in the liver tissue increased with laser power and total energy. According to the histological results, 20 W groups yielded more significant damage to the RA nerves than 10 W groups at the total energy of 300 J (0.0 ± 0.0 mm for 10 W vs. 2.9 ± 1.0 mm for 20 W), 450 J (1.9 ± 0.6 mm for 10 W vs. 6.8 ± 1.5 mm for 20 W), and 600 J (2.9 ± 0.4 mm for 10 W vs. 7.3 ± 0.8 mm for 20 W). The treated RA exhibited insignificant medial injury in depth (medial thinning ≤ 25%), and no difference in the medial thinning was found among the six groups (p = 0.4).

Conclusion

The current study demonstrated that the 1064 nm laser at 20 W with delivery of 450 J could effectively damage the RA nerves with no or minimal injury to the surrounding tissue. The proposed laser-assisted RDN may enhance physiological effects with insignificant complications in in vivo situations. Further in vivo studies will be conducted to validate the current findings by evaluating the extent of blood pressure reduction and norepinephrine changes after the laser-assisted RDN on a large animal model.

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激光辅助肾脏去神经化治疗顽固性高血压的研究。

背景和目的：肾脏去神经支配（RDN）是治疗抵抗性高血压的一种新兴手术疗法。然而，由于动脉管腔与能量源直接接触，目前使用射频的 RDN 会对内侧和管腔层造成不良的热损伤。本研究旨在通过探索潜在的治疗条件，评估新型激光辅助 RDN 的可行性：在体外测试中，使用波长为 1064 nm 的连续波激光，在猪肝和肾动脉（RA）上测试了六种不同的治疗条件（10 W 和 20 W，输出功率分别为 300、450 和 600 J）。测量肝脏组织的消融面积，以估计凝固区域的范围。对处理过的 RA 组织进行组织学评估，以确认热神经损伤的程度：结果：肝组织中的烧蚀深度、长度和面积随着激光功率和总能量的增加而增加。组织学结果显示，在总能量为 300 J（10 W 为 0.0 ± 0.0 mm，20 W 为 2.9 ± 1.0 mm）、450 J（10 W 为 1.9 ± 0.6 mm，20 W 为 6.8 ± 1.5 mm）和 600 J（10 W 为 2.9 ± 0.4 mm，20 W 为 7.3 ± 0.8 mm）时，20 W 组比 10 W 组对 RA 神经的损伤更明显。治疗后的 RA 在深度上表现出不明显的内侧损伤（内侧变薄≤25%），六组之间的内侧变薄没有差异（P = 0.4）：目前的研究表明，功率为20 W、输出功率为450 J的1064 nm激光可有效损伤RA神经，而对周围组织无损伤或损伤极小。拟议中的激光辅助 RDN 可增强生理效应，且并发症不明显。我们还将进行进一步的体内研究，通过在大型动物模型上评估激光辅助 RDN 后血压降低的程度和去甲肾上腺素的变化来验证目前的研究结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lasers in Surgery and Medicine 医学-外科

CiteScore

5.40

自引率

12.50%

发文量

119

审稿时长

1 months

期刊介绍： Lasers in Surgery and Medicine publishes the highest quality research and clinical manuscripts in areas relating to the use of lasers in medicine and biology. The journal publishes basic and clinical studies on the therapeutic and diagnostic use of lasers in all the surgical and medical specialties. Contributions regarding clinical trials, new therapeutic techniques or instrumentation, laser biophysics and bioengineering, photobiology and photochemistry, outcomes research, cost-effectiveness, and other aspects of biomedicine are welcome. Using a process of rigorous yet rapid review of submitted manuscripts, findings of high scientific and medical interest are published with a minimum delay.