Horst Sievert, Sameer Gafoor, Stefan Bertog, Predrag Matić, Ilona Hofmann, Laura Vaskelyte, Markus Reinartz CardioVascular Center Frankfurt - CVC, Frankfurt, Germany Blood Pressure-lowering Interventions Beside Renal Denervation What is on the Horizon? LINC 2015 Leipzig, Germany, Jan 27-30, 2015
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Horst Sievert, Sameer Gafoor,
Stefan Bertog, Predrag Matić,
Ilona Hofmann, Laura Vaskelyte, Markus Reinartz
CardioVascular Center Frankfurt - CVC,
Frankfurt, Germany
Blood Pressure-lowering Interventions Beside Renal Denervation What is on the Horizon?
LINC 2015 Leipzig, Germany, Jan 27-30, 2015
.
7 min
CardioVascular Center Frankfurt CVC
Blood Pressure-lowering Interventions
Beside Renal Denervation
• Deep brain stimulation
• Carotid sinus stimulation - electrical
- mechanical
• Carotid body ablation
• Bladder trigone stimulation
• Vagal nerve stimulation
• Central arteriovenous fistula
CardioVascular Center Frankfurt CVC
Deep brain stimulation
• Minimal invasive neurosurgical intervention
• Used since 50 years, nowadays well
established in the treatment of Parkinson
disease and other neurological disorders
• Also used for treatment of refractory pain
syndromes since 20 years
• Known to decrease BP
• Potentially a very selective stimulation could
have a selective effect on BP
CardioVascular Center Frankfurt CVC
Periaqueductal gray stimulation
Ventral PAG 30Hz 2v
Dorsal PAG
Jonathan Hyam, TRENDS 2013
CardioVascular Center Frankfurt CVC
Blood Pressure-lowering Interventions
Beside Renal Denervation
• Deep brain stimulation
• Carotid sinus stimulation - electrical
- mechanical
• Carotid body ablation
• Bladder trigone stimulation
• Vagal nerve stimulation
• Central arteriovenous fistula
Baroreflex Activation Therapy (BAT) The CVRx Implantable Cariotid Sinus Modulation System
Kidneys
↓ HR ↑ Vasodilation
↓ Stiffness
↑ Natriuresis
↓ Renin
secretion
Carotid Baroreceptor Stimulation
Heart Vessels
Brain
Autonomic Nervous System Inhibited Sympathetic Activity
Enhanced Parasympathetic Activity
Electrode, implanted at the carotid bulb
First Generation Lead (Bilateral)
New Generation Lead
(Unilateral)
Rheos neo
Baroreflex Activation Therapy (BAT) The CVRx Implantable Cariotid Sinus Modulation System
BP and Acute Muscle Sympathetic Nerve Activity
After 3 Months of Therapy
Time [mins]
0
50
100
150
200
250
0
50
100
150
0 9 18 27 36 45
AB
P [
mm
Hg
]M
SN
A [
%]
ONOFF ONOFF OFF
Heusser et al., J Hypertens 2009;27(suppl):S288
Barostim has entered the ESH/ESC guidelines
as an option to treat resistant hypertension
CardioVascular Center Frankfurt CVC
Blood Pressure-lowering Interventions
Beside Renal Denervation
• Deep brain stimulation
• Carotid sinus stimulation - electrical
- mechanical
• Carotid body ablation
• Bladder trigone stimulation
• Vagal nerve stimulation
• Central arteriovenous fistula
The MobiusHD™ Concept
Jan van der Heyden, MD, PhD
TRENDS 2014, Frankfurt
Baroreflex Activation Therapy (BAT) The CVRx Implantable Cariotid Sinus Modulation System
Kidneys
↓ HR ↑ Vasodilation
↓ Stiffness
↑ Natriuresis
↓ Renin
secretion
Carotid Baroreceptor Stimulation
Heart Vessels
Brain
Autonomic Nervous System Inhibited Sympathetic Activity
Enhanced Parasympathetic Activity
CardioVascular Center Frankfurt CVC
MobiusHD concept
• Implant placed in the
carotid sinus
• It passively amplifies
the signal generated
by the baroreceptors
surrounding the carotid
sinus - thereby signaling the
Central Nervous
System to lower blood
pressure.
10mm
Baroreceptors cover 50-80% of the diameter in this region
Vascular Dynamics, Inc.
CardioVascular Center Frankfurt CVC
14
Mechanism of Action
• MoebiusHD reshapes the
artery to a non-circular
cross section
• This increases the rate of change and amplitude of the vessel movement
• This leads to higher and more frequent afferent signaling to the central nervous system
Vessel Wall
- Fadali 1969
- Bagshaw 1987
- McKevitt 2003
CardioVascular Center Frankfurt CVC
• Female 53 years
• L 168 cm W 84 kg BMI 29.7
• CRF: AHT, nicotine
• Blood pressure range (official office cuff readings):