TY - JOUR
T1 - Anatomical and procedural determinants of catheter-based renal denervation
AU - Ewen, Sebastian
AU - Ukena, Christian
AU - Lüscher, Thomas Felix
AU - Bergmann, Martin
AU - Blankestijn, Peter J
AU - Blessing, Erwin
AU - Cremers, Bodo
AU - Dörr, Oliver
AU - Hering, Dagmara
AU - Kaiser, Lukas
AU - Nef, Holger
AU - Noory, Elias
AU - Schlaich, Markus
AU - Sharif, Faisal
AU - Sudano, Isabella
AU - Vogel, Britta
AU - Voskuil, Michiel
AU - Zeller, Thomas
AU - Tzafriri, Abraham R
AU - Edelman, Elazer R
AU - Lauder, Lucas
AU - Scheller, Bruno
AU - Böhm, Michael
AU - Mahfoud, Felix
N1 - Copyright © 2016 Elsevier Inc. All rights reserved.
PY - 2016/8/20
Y1 - 2016/8/20
N2 - BACKGROUND/PURPOSE: Catheter-based renal sympathetic denervation (RDN) can reduce blood pressure (BP) and sympathetic activity in certain patients with uncontrolled hypertension. Less is known about the impact of renal anatomy and procedural parameters on subsequent BP response.METHODS/MATERIALS: A total of 564 patients with resistant hypertension underwent bilateral RDN in 9 centers in Europe and Australia using a mono-electrode radiofrequency catheter (Symplicity Flex, Medtronic). Anatomical criteria such as prevalence of accessory renal arteries (ARA), presence of renal artery disease (RAD), length, and diameter were analyzed blinded to patient's characteristics.RESULTS: ARA was present in 171 patients (30%), and RAD was documented in 71 patients (13%). On average 11±2.7 complete 120-s ablations were performed, equally distributed on both sides. After 6months, BP was reduced by 19/8mmHg (p<0.001 for both). Change of systolic blood pressure (SBP) was not related to the presence of ARA (-18 vs. -20mmHg; p=NS) or RAD (-16 vs. -20mmHg; p=NS). Patients with a bilateral diameter≤4mm had a more pronounced reduction of SBP compared to patients with a unilateral diameter≤4mm or a bilateral diameter>4mm (-29 vs. -26 vs. -17mmHg; p<0.001). Neither the length of the renal artery nor the number of RF ablations influenced BP reduction after 6months.CONCLUSIONS: The diameter of renal arteries correlated with SBP change after RDN at 6-month follow-up. Change of SBP was not related to the lengths of the renal artery, presence of ARA, RAD, or the number of RF ablations delivered by a mono-electrode catheter.
AB - BACKGROUND/PURPOSE: Catheter-based renal sympathetic denervation (RDN) can reduce blood pressure (BP) and sympathetic activity in certain patients with uncontrolled hypertension. Less is known about the impact of renal anatomy and procedural parameters on subsequent BP response.METHODS/MATERIALS: A total of 564 patients with resistant hypertension underwent bilateral RDN in 9 centers in Europe and Australia using a mono-electrode radiofrequency catheter (Symplicity Flex, Medtronic). Anatomical criteria such as prevalence of accessory renal arteries (ARA), presence of renal artery disease (RAD), length, and diameter were analyzed blinded to patient's characteristics.RESULTS: ARA was present in 171 patients (30%), and RAD was documented in 71 patients (13%). On average 11±2.7 complete 120-s ablations were performed, equally distributed on both sides. After 6months, BP was reduced by 19/8mmHg (p<0.001 for both). Change of systolic blood pressure (SBP) was not related to the presence of ARA (-18 vs. -20mmHg; p=NS) or RAD (-16 vs. -20mmHg; p=NS). Patients with a bilateral diameter≤4mm had a more pronounced reduction of SBP compared to patients with a unilateral diameter≤4mm or a bilateral diameter>4mm (-29 vs. -26 vs. -17mmHg; p<0.001). Neither the length of the renal artery nor the number of RF ablations influenced BP reduction after 6months.CONCLUSIONS: The diameter of renal arteries correlated with SBP change after RDN at 6-month follow-up. Change of SBP was not related to the lengths of the renal artery, presence of ARA, RAD, or the number of RF ablations delivered by a mono-electrode catheter.
KW - Ablation
KW - Accessory renal artery
KW - Diameter
KW - Renal artery stenosis
U2 - 10.1016/j.carrev.2016.08.004
DO - 10.1016/j.carrev.2016.08.004
M3 - Article
C2 - 27617388
SN - 1878-0938
VL - 17
SP - 474
EP - 479
JO - Cardiovascular revascularization medicine : including molecular interventions
JF - Cardiovascular revascularization medicine : including molecular interventions
IS - 7
ER -