FOCUS ON SYMPATHETIC DENERVATION

Long-term stimulation of sympathetic activity has been linked to the pathophysiology of chronic diseases such as systemic hypertension, metabolic syndrome, sleep apnea, heart failure, liver cirrhosis and rheumatoid arthritis. Thus, reduction of sympathetic nerve activity via local nerve ablation has emerged as an attractive therapy for hypertension and other chronic diseases. As a result, the last decade has witnessed intense research into minimally invasive renal sympathetic denervation — from catheter-based drug delivery systems to sonic and RF ablation devices.

Since the inception of this novel technology, CBSET has led the way in developing animal models for assessing safety, as well as quantitative methods for assessing and understanding efficacy, including biomarker assays, histomorphometry, and even computational modeling. These have been presented in international conferences and published in peer-reviewed journals, cementing CBSET’s status as a key opinion leader in the evaluation of neuroablation technologies.


Renal Denervation
CBSET has developed specialized expertise in the development and application of minimally invasive device-based interventional therapies for renal denervation.
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Seminal CBSET-authored preclincal research papers related to sympathetic denervation:

546ga1Procedural and Anatomical Determinants of Multielectrode Renal Denervation Efficacy. Tzafriri AR, Mahfoud F, Keating JH, Spognardi AM, Markham PM, Wong G, Highsmith D, O’Fallon P, Fuimaono K, Edelman ER. Hypertension. 2019 Sep;74(3):546-554. doi: 10.1161/HYPERTENSIONAHA.119.12918.

Splenic artery denervation: target micro-anatomy, feasibility, and early preclinical experience. Mazen Albaghdadi, Fernando Garcia-Polite, Brett Zani, John Keating, Raffaele Melidone, Anna Spognardi, Peter Markham, Abraham Tzafriri. Translational Research. doi:10.1016/j.trsl.2019.07.012. 

Pulmonary Artery Denervation Using Catheter based Ultrasonic Energy. Rothman A, Jonas M, Castel D, Tzafriri AR, Traxler H, Shav D, Leon MB, Ben-Yehuda O, Rubin L. EuroIntervention. 2019 May 7. pii: EIJ-D-18-01082. doi: 10.4244/EIJ-D-18-01082. 

Renal sympathetic nerve denervation using intraluminal ultrasound within a cooling balloon preserves the arterial wall and reduces sympathetic nerve activity. Pathak A, Coleman L, Roth A, Stanley J, Bailey L, Markham P, Ewen S, Morel C, Despas F, Honton B, Senard JM, Fajadet J, Mahfoud F. EuroIntervention. 2015 Aug 22;11(4):477-84.

scitransmed-coverArterial microanatomy determines the success of energy-based renal denervation in controlling hypertension. Tzafriri AR, Keating JH, Markham PM, Spognardi AM, L Stanley JR, Wong G, Zani BG, Highsmith D, O’Fallon P, Fuimaono K, Mahfoud F, Edelman ER. Sci Transl Med. 2015 Apr 29;7(285):285ra65. doi: 10.1126/scitranslmed.aaa3236.

Comparison of renal artery, soft tissue, and nerve damage after irrigated versus nonirrigated radiofrequency ablation. Sakakura K, Ladich E, Fuimaono K, Grunewald D, O’Fallon P, Spognardi AM, Markham P, Otsuka F, Yahagi K, Shen K, Kolodgie FD, Joner M, Virmani R. Circ Cardiovasc Interv. 2014 Dec 31;8(1). pii: e001720. doi: 10.1161.

Innervation patterns may limit response to endovascular renal denervation. Tzafriri AR, Mahfoud F, Keating JH, Markham PM, Spognardi A, Wong G, Fuimaono K, Böhm M, Edelman ER. J Am Coll Cardiol. 2014 Sep 16;64(11):1079-87.

renaldenervationchartMethodological Standardization for the Pre-Clinical Evaluation of Renal Sympathetic Denervation. Sakakura K, Ladich E, Edelman ER, Markham P, Stanley JR, Keating J, Kolodgie FD, Virmani R, Joner M. JACC Cardiovasc Interv. 2014 Sep 9.

Evaluation of renal nerve morphological changes and norepinephrine levels following treatment with novel bipolar radiofrequency delivery systems in a porcine model. Cohen-Mazor M, Mathur P, Stanley JR, Mendelsohn FO, Lee H, Baird R, Zani BG, Markham PM, Rocha-Singh K. J Hypertens. 2014 May 28


CBSET-authored clinical papers related to sympathetic denervation:

Anatomical and procedural determinants of ambulatory blood pressure lowering following catheter-based renal denervation using radiofrequency. Lauder L, Ewen S, Tzafriri AR, Edelman ER, Cremers B, Kulenthiran S, Ukena C, Linz D, Kindermann I, Tsioufis C, Scheller B, Böhm M, Mahfoud F. Cardiovasc Revasc Med. 2018 Oct – Nov;19(7 Pt B):845-851. doi: 10.1016/j.carrev.2018.02.016. 

Renal artery anatomy assessed by quantitative analysis of selective renal artery in 1000 patients with hypertension. Lauder L, Ewen S, Tzafriri AR, Edelman ER, Lüscher TF, Blankenstijn PJ, Dörr O, Schlaich M, Sharif F, Voskuil M, Zeller T, Ukena C, Scheller B, Böhm M, Mahfoud F, EuroIntervention. 2018 May 20;14(1):121-128. doi: 10.4244/EIJ-D-18-00112. 

Anatomical and procedural determinants of catheter-based renal denervation. S Ewen; C Ukena; T Luscher; M Bergmann; P Blankestijn; B Cremers; E Blessing; O Doerr; H Nef; M Schlaich; F Sharif; MVoskuil; T Zeller; AR Tzafriri; E Edelman; M Boehm; F Mahfoud. Cardiovasc Revasc Med. 2016 Oct – Nov;17(7):474-479. doi: 10.1016/j.carrev.2016.08.004.