New procedure at Erie hospital offers hope for those with stubbornly high blood pressure

Five different medications couldn't control Steven Davis' high blood pressure.

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

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

Determined to lower his blood pressure and reduce his risk for 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 it done, other than those involved in clinical trials.

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

"In these cases, the nerves sense the blood pressure is less than what the kidneys want it to be," said Dr. Matthew "Casey" Becker, the LECOM Health cardiologist who performs the renal denervation. "It tells the kidney to secrete chemicals and hormones that raise the blood pressure, even if it is already high."

Ten years of studies have shown that destroying these nerves do not cause health issues, Becker said. The U.S. Food & Drug Administration approved the procedure in November.

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

"I helped build those lights," Davis said.

Patient remains awake throughout the procedure

Davis remained sedated but awake throughout the procedure, which took 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, which in this case is a thin tube with four attached electrodes, was then threaded through the incision and into Davis' right femoral artery. Becker guided the catheter into Davis' renal artery through the patient's abdominal aorta.

"Because this device is spiral, you can position it inside the artery in such a way 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 for reference, Becker guided the electrodes into the proper position. He then told the team to "light them up."

Device automatically adjusts the power during nerve ablation

Kelsey Huddleson, a LECOM Health radiation technician, pushed a button on the remote connected to a small generator that controls the radiofrequency energy delivered through the electrodes.

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

"Sometimes it will determine that only two, or three of the electrodes are in a proper position, and it will only deliver energy through those ones," Becker said.

The energy was delivered for one minute, then 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.

Once Becker was finished, the dozen nurses, technicians and Medtronic representatives who worked on the procedure broke into applause.

"I would clap, but my arms are restrained," said Davis, whose arms were lightly tied to the operating room table so he wouldn't accidentally contaminate his incision.

Might take weeks or months to reach new, lower BP level

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

"What we see on average is that patients who get this therapy take two to three fewer blood pressure medications than they did, and a 20 millimeter decrease in their blood pressure," said Becker, meaning that someone with blood pressure of 160/90 would see it decline to 140/70. "Compare that to what is considered a breakthrough blood pressure medicine, which usually shows a three to four millimeter decrease in blood pressure."

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

Though Davis' procedure was performed in an operating room, renal denervations will be done in Millcreek Community's new heart catheterization labs when they are completed later this spring.

"This is an option for almost anyone who is having trouble controlling their blood pressure through medications," Becker said.

Contact David Bruce at dbruce@timesnews.com. Follow him on X @ETNBruce.

This article originally appeared on Erie Times-News: LECOM Health unveils new procedure for high blood pressure