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EuroIntervention. 2019 May 7. pii: EIJ-D-18-01082. doi: 10.4244/EIJ-D-18-01082. [Epub ahead of print]

Pulmonary Artery Denervation Using Catheter based Ultrasonic Energy.

Author information

1
Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.

Abstract

AIMS:

Pulmonary arterial hypertension is a devastating disease characterized by pulmonary vascular remodelling and right heart failure. Radio-frequency pulmonary artery denervation (PDN) improves pulmonary hemodynamics in pre-clinical and early clinical studies, however denervation depth is limited. High-frequency non-focused ultrasound can deliver energy to the vessel adventitia, sparing the intima and media. We therefore investigated the feasibility, safety and efficacy of ultrasound PDN.

METHODS AND RESULTS:

Histological examination demonstrated that innervation of human pulmonary arteries are predominantly sympathetic (71%), with >40% of nerves at a depth of >4mm. Finite element analysis of ultrasound energy distribution and ex-vivo studies demonstrated generation of temperatures >47ÂșC to a depth of 10mm. In domestic swine PDN reduced mean pulmonary artery pressure induced by thromboxane A2 in comparison to sham. No adverse events were observed to 95-days. Histological examination identified structural and immunohistological alterations of nerves in PDN treated animals, with sparing of the intima and media and reduced tyrosine hydroxylase staining 95-days post-procedure indicating persistent alteration of the structure of sympathetic nerves.

CONCLUSIONS:

Ultrasound PDN is safe and effective in the pre-clinical setting, with energy delivery to a depth that will permit targeting sympathetic nerves in humans.

PMID:
31062694
DOI:
10.4244/EIJ-D-18-01082
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