Transcatheter adrenal artery ablation: A preclinical safety assessment in a porcine model

Transcatheter adrenal artery embolization (TAAE) has emerged as a minimally invasive technique for selective adrenal ablation, offering potential therapeutic applications for various adrenal disorders. However, its safety profile remains insufficiently characterized. This preclinical study aimed to evaluate the physiological, biochemical, and histological effects of ethanol-based TAAE in a large-animal model.

Twelve Bama miniature pigs were randomized into embolization (n = 6) and sham (n = 6) groups. The embolization group underwent selective unilateral adrenal artery embolization with absolute ethanol, while the sham group received catheterization without ethanol injection. Hemodynamic parameters, plasma adrenal hormones, renal function, and cardiac function were assessed preoperatively, intraoperatively, and at 4 weeks post-procedure. Histological analysis of adrenal tissues was performed to evaluate ablation effects.

TAAE induced a transient but significant rise in systolic blood pressure (from 128 ± 11 to 219 ± 13 mmHg, P < 0.01) and plasma norepinephrine levels (from 7.4 ± 0.8 to 1199 ± 247 nmol/dL, P < 0.01) during ethanol injection, which normalized by 4 weeks. No significant differences were observed in body weight, renal function, serum electrolytes, adrenal hormone levels, or echocardiographic parameters at follow-up. Histological analysis revealed localized adrenal cortical necrosis, architectural disruption, and increased interstitial fibrosis in the embolization group (P < 0.01), without evidence of systemic toxicity or off-target embolization.

TAAE is a feasible and well-tolerated method for targeted adrenal ablation in a porcine model. This study provides foundational preclinical evidence supporting further investigation of TAAE as a minimally invasive, organ-sparing approach for the treatment of diverse adrenal pathologies.