Shockwave lithotripsy with renoprotective pause is associated with renovascular vasoconstriction in humans

Michael Bailey, Franklin Lee, Ryan Hsi, Marla Paun, Barbrina Dunmire, Ziyue Liu, Mathew Sorensen, Jonathan Harper

Research output: Chapter in Book/Report/Conference proceedingConference contribution

3 Scopus citations

Abstract

Animal studies have shown that shock wave lithotripsy (SWL) delivered with an initial course of low-energy shocks followed by a pause reduces renal injury. The pause correlates with increased arterial resistive index (RI) during SWL as measured by ultrasound. This suggests that renal vasoconstriction is associated with protecting the kidney from injury. This study explored whether a similar increase in RI is observed in humans. Patients were prospectively recruited from two hospitals. All received an initial dose of 250 lowest energy shocks followed by a two-minute pause. Shock power was then ramped up at the discretion of the physician; shock rate was maintained at 1 Hz. Spectral Doppler velocity measurements were taken from an interlobar artery at baseline after induction, during the pause at 250 shocks, after 750 shocks, after 1500 shocks, and at the end of the procedure. RI was calculated from the peak systolic and end diastolic velocities and a linear mixed-effects model was used to compare RIs. The statistical model accounted for age, gender, laterality, and body mass index (BMI). Measurements were taken from 15 patients. Average RI ± standard deviation pretreatment, after 250 shocks, after 750 shocks, after 1500 shocks, and post treatment was 0.68 ± 0.06, 0.71 ± 0.07, 0.73 ± 0.06, 0.75 ± 0.07 and 0.75 ± 0.06, respectively. RI was found to be significantly higher after 250 shocks compared to pretreatment (p = 0.04). RI did not correlate with age, gender, BMI, or treatment side. This is suggestive that allowing a pause for renal vascular vasoconstriction to develop may be beneficial, and can be monitored for during SWL, providing real-time feedback as to when the kidney is protected.

Original languageEnglish (US)
Title of host publicationIEEE International Ultrasonics Symposium, IUS
PublisherIEEE Computer Society
Pages1013-1016
Number of pages4
ISBN (Electronic)9781479970490
DOIs
StatePublished - Oct 20 2014
Event2014 IEEE International Ultrasonics Symposium, IUS 2014 - Chicago, United States
Duration: Sep 3 2014Sep 6 2014

Publication series

NameIEEE International Ultrasonics Symposium, IUS
ISSN (Print)1948-5719
ISSN (Electronic)1948-5727

Other

Other2014 IEEE International Ultrasonics Symposium, IUS 2014
CountryUnited States
CityChicago
Period9/3/149/6/14

Keywords

  • resistive index
  • shock wave lithotripsy
  • ultrasound
  • vasoconstriction

ASJC Scopus subject areas

  • Acoustics and Ultrasonics

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