Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension

We are evaluating CT-guided ozone-mediated lumbar or renal denervation as a safe, effective modification of traditional neurolysis for treating patients with resistant hypertension. Currently, renal denervation methods are costly and they're not very easy to perform. We propose a less invasive CT-guided ozone-based technique targeting lumbar ganglia for treating resistant hypertension. Compared to catheter-based renal denervation, novel technique avoids renal artery access, contrast agents, and specialized catheters. It is simpler, low-cost, and it demonstrates a favorable safety profile.

[Narrator] To begin, help the patient into a prone position while ensuring comfort and stability. Place a metal wire along the midline of the torso, approximately at the T12 to L3 vertebral level. Use a CT scanner to obtain anteroposterior and lateral images of the lumbar spine. On the transverse images, identify the left renal artery origin level. Record the corresponding transverse plane position. On the selected transverse image, locate injection target point A at the anterolateral third of the vertebral side. Then draw a line from point A along the outer lateral border of the left psoas major to the body surface. Identify the intersection of this line with the body surface as the skin puncture point B. Correlate the metal wire on the body surface with point C. Measure the length from point A to point B as the needle insertion depth. Then measure the length of BC as the lateral deviation from the midline. Now adjust the patient bed to the recorded position from the transverse image. Activate the laser positioning line. Mark a line along the projection line A and another along the pre-placed metal midline, line B. Remove the metal wire from the patient's back. On line A, mark point B according to the length of the BC segment. Next, insert a 21-gauge needle with depth markers at point B, puncturing at the predefined angle and depth. Conduct CT with two-millimeter slice thickness, 0.4 to 0.8 centimeters around the puncture zone to confirm needle placement. Attach a 10-milliliter syringe to the needle. Aspirate to confirm there is no blood or gas. Inject 2.5 milliliters of 10% ropivacaine. Then use a 20-milliliter syringe to draw 10 milliliters of an oxygen-ozone gas mixture from a medical ozone generator. Inject it slowly through the needle. Perform a repeat CT scan to confirm ozone distribution. The control rate of home systolic blood pressure significantly improved from 60% at week four to 80% at weeks eight and 12. While the diastolic blood pressure control rate rose from 93.3% at week four to 100% at weeks eight and 12. Among patients with normal baseline renal function, only two failed to achieve systolic blood pressure below 140 millimeters of mercury at eight and 12 weeks, respectively. Morning systolic and diastolic blood pressures remained significantly higher than others during the 12th week post-procedure. For patients with normal baseline renal function, the control rates at the four time points were 55.6%, 90%, 77.8%, and 90%, respectively.