Post-procedural optical coherence tomography imaging after renal denervation revealed small cavities and attached small thrombi at the sites of radiofrequency energy delivery.
Case Report (n=1)
No
What are the optical coherence tomography findings immediately following percutaneous catheter-based renal denervation?
Optical coherence tomography imaging immediately after renal denervation reveals small cavities and attached thrombi at radiofrequency ablation sites.
Percutaneous catheter-based renal denervation is an emerging technique to treat severe and ‘resistant’ arterial hypertension. We report the case of a 56-year-old woman who was considered as ‘resistant’ hypertensive despite being treated with four antihypertensive drugs (including one diuretic) and was referred for percutaneous catheter-based renal denervation to our institution. The procedure was performed in accordance with the manufacturer's protocol, under general anaesthesia and after having given the patient 500 mg of aspirin and 5000 IU of heparin. Briefly, six, 2-min low-power RF ablations were performed within the main stem of each renal artery with the first ablation spot being located distally and subsequent ablations performed by moving proximally in the vessel lumen. Renal angiograms and optical coherence tomography (OCT) imaging (DragonFly catheter, LightLab Imaging) were performed before (Panel A) and after (Panel B) the procedure. Pre-procedural renal angiogram and OCT findings were normal. Post-procedural renal angiograms demonstrated irregularities at spots where radiofrequency energy was delivered (C, cavity). Optical coherence tomography imaging confirmed the presence of small cavities (C) and revealed small thrombi (T) attached to these areas.
“Absolutely, the lesions are certainly more pronounced than I expected. Obviously, we now need to see 1) whether these lesions disappear, say at 1 month (studies we are currently planning), and 2) whether thrombus formation can be prevented with, say, ticagrelor. Indeed, embolization of such thrombi may impair renal function due to destruction of glomeruli.”
Cook et al. (Wed,) conducted a case report in Resistant arterial hypertension (n=1). Percutaneous catheter-based renal denervation was evaluated on Optical coherence tomography (OCT) and angiographic findings. Post-procedural optical coherence tomography imaging after renal denervation revealed small cavities and attached small thrombi at the sites of radiofrequency energy delivery.