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LECOM Health unveils new procedure for high blood pressure

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Dr. Matthew “Casey” Becker of LECOM Health uses radio waves to heat and destroy nerves in the arteries near the kidneys.

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Five different medications failed to control Steven Davis’ high blood pressure.

Despite taking the pills every day, the 73-year-old Millcreek Township man’s blood pressure often stayed between 160/90 and 180/100. It was high enough to put him at increased risk of stroke and heart attack.

“I already had triple-bypass heart surgery about two years ago,” said Davis, who works part-time as a driver for LECOM Health. “One day my blood pressure would be great and the next day it would be sky high.”

Determined to lower his blood pressure and reduce his risk of a life-threatening illness, Davis agreed to undergo a new procedure called renal denervation at Millcreek Community Hospital. He was the first patient in the region to have this done, apart from those involved in clinical trials.

Instead of using drugs to lower blood pressure, doctors use radiofrequency waves to heat and destroy the nerves in the arteries near the kidneys. In patients like Davis, these nerves become overactive and cause high blood pressure.

“In these cases, the nerves sense that blood pressure is lower than what the kidneys want,” says Dr. Matthew “Casey” Becker, the LECOM Health cardiologist who performs the kidney denervation. “It tells the kidney to secrete chemicals and hormones that increase blood pressure, even when it is already high.”

Ten years of research has shown that destroying these nerves does not cause any health problems, Becker said. The U.S. Food & Drug Administration approved the procedure in November.

Davis was wheeled into an operating room at Millcreek Community just before 10 a.m. Thursday. He was awake and alert enough to see that the lights above the operating table were made by Steris, his former employer.

“I helped build those lights,” Davis said.

The patient remains awake during the entire procedure

Davis remained sedated but awake during the procedure, which lasted about 45 minutes. Becker and his team of nurses and technicians made a small incision near Davis’ groin – the only incision they needed.

A catheter, in this case a thin tube with four electrodes attached, was then inserted through the incision into Davis’ right femoral artery. Becker guided the catheter through the patient’s abdominal aorta into Davis’ renal artery.

“Because this device is spiral-shaped, you can place it in the artery so that the four electrodes are all in areas where they can deliver energy to four different spots within a 20 millimeter area,” Becker said.

The energy pulses stop the excessive activity of the nerves without damaging other parts of the renal artery, Becker said.

Using a continuous X-ray image of the renal artery as a reference, Becker guided the electrodes to the correct position. He then told the team to “light them up.”

The device automatically adjusts power during nerve ablation

Kelsey Huddleson, a radiation technician from LECOM Health, pressed a button on the remote control connected to a small generator that controls the radio frequency energy delivered through the electrodes.

The device automatically adjusts power by continuously monitoring the temperature and resistance in the artery.

“Sometimes it will determine that only two or three of the electrodes are in the correct position, and it will deliver energy only through those electrodes,” Becker said.

The energy was delivered for one minute, after which Becker moved the electrodes and repeated the process. He treated five spots in the right renal artery and its main branches before moving to Davis’ left renal artery and treating three more.

When Becker finished, the dozens of nurses, technicians and Medtronic representatives who worked on the procedure burst into applause.

“I was going to clap, but my arms are restrained,” said Davis, whose arms were lightly strapped to the operating table so he wouldn’t accidentally contaminate his incision.

It may take weeks or months to reach a new, lower blood pressure level

Kidney denervation is not a quick fix, Backer said. It takes weeks, sometimes months, for the patient’s blood pressure to reach the new, lower level.

“What we see on average is that patients who receive this therapy take two to three fewer blood pressure medications than they did, and a drop of 20 millimeters in their blood pressure,” Becker said, meaning someone with a blood pressure of 160/90 would doing. see it drop to 140/70. “Compare that to what is considered a breakthrough blood pressure drug, which usually shows a drop in blood pressure of three to four millimeters.”

According to Medtronic, the procedure is well tolerated, with a high adverse rate of 0.4% during clinical trials. Davis was able to go home from the hospital the next day

Although Davis’ procedure was performed in an operating room, renal denervations will be performed in Millcreek Community’s new cardiac catheterization labs when completed later this spring.

“This is an option for almost anyone who has trouble controlling their blood pressure with medications,” Becker said.

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