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Dai S, Zhao L, Wang G, Chen C, Li C, Xiao B, Miao Y. Celiac ganglia neurolysis suppresses high blood pressure in rats. Hypertens Res 2023; 46:1771-1781. [PMID: 37173429 DOI: 10.1038/s41440-023-01305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
The efficacy of renal denervation in the treatment of resistant hypertension has been controversial, and new strategies for its therapy are urgently needed. We performed the celiac ganglia neurolysis (CGN) or sham surgery on both spontaneously hypertensive rat (SHR) and Dahl salt-sensitive rat models of hypertension. Following CGN surgery in both strains, systolic blood pressure, diastolic blood pressure and mean arterial pressure were all lower than the levels in the respective sham surgery rats, which were maintained until the end of the study, 18 weeks postoperatively in SHRs and 12 weeks postoperatively in Dahl rats. CGN therapy destroyed ganglion cell structure and significantly inhibited celiac ganglia nerve viability. Four and twelve weeks after CGN, the plasma renin, angiotensin II and aldosterone levels were markedly attenuated, and the nitric oxide content was significantly increased in the CGN group compared with the respective sham surgery rats. However, CGN did not result in statistical difference in malondialdehyde levels compared with sham surgery in both strains. The CGN has efficacy in reducing high blood pressure and may be an alternative for resistant hypertension. Minimally invasive endoscopic ultrasound-guided celiac ganglia neurolysis (EUS-CGN) and percutaneous CGN are safe and convenient treatment approaches. Moreover, for hypertensive patients who need surgery due to abdominal disease or pain relief from pancreatic cancer, intraoperative CGN or EUS-CGN will be a good choice for hypertension therapy. The graphical abstract of antihypertensive effect of CGN.
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Affiliation(s)
- Shangnan Dai
- Pancreas Center, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Li Zhao
- Pancreas Center, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Guangfu Wang
- Pancreas Center, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Chongfa Chen
- Pancreas Center, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Chenchen Li
- Pancreas Center, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Pancreas Institute, Nanjing Medical University, Nanjing, China
| | - Bin Xiao
- Pancreas Center, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
- Pancreas Institute, Nanjing Medical University, Nanjing, China.
| | - Yi Miao
- Pancreas Center, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
- Pancreas Institute, Nanjing Medical University, Nanjing, China.
- Pancreas Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China.
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Solbu MD, Miroslawska A, Norvik JV, Eriksen BO, Steigen TK. Kidney function and markers of renal damage after renal denervation. Does method of measurement matter? The Reshape CV-Risk Study. J Clin Hypertens (Greenwich) 2021; 23:954-962. [PMID: 33592134 PMCID: PMC8678667 DOI: 10.1111/jch.14214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/16/2021] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
Data suggest that renal denervation (RDN) in treatment‐resistant hypertension (TRHT) is safe in terms of renal function. However, most studies report kidney function as creatinine‐based estimated glomerular filtration rate (eGFR), which may be biased by non‐renal factors. Damage markers other than albuminuria have never been evaluated after RDN. In this non‐randomized RDN trial, we studied changes in kidney function, assessed as measured GFR (mGFR) and various GFR estimates, six months and two years after RDN. We also examined changes in albuminuria and a biomarker of tubular dysfunction. Adult non‐diabetic patients with TRHT and eGFR ≥45 ml/min/1.73 m2 were recruited from hypertension clinics. Before bilateral RDN, mGFR was measured by iohexol clearance. We estimated eGFR from serum creatinine and cystatin C (eGFRcrea, eGFRcys, and eGFRcreacys), and albumin‐creatinine ratio (ACR) and N‐acetyl‐β‐D‐glucosaminidase (NAG)‐creatinine ratio (NAG‐CR) were measured in spot urines. All measurements were repeated after six and twenty‐four months. Twenty patients, mean age 54 (±9) years and baseline mGFR 83 (±20) ml/min/1.73 m2 underwent RDN. After six months, mGFR fell, eGFRcrea remained unchanged, whereas eGFRcys and eGFRcreacys increased. At 2 years’ follow‐up, eGFRcreacys was significantly lower than at baseline. mGFR was 78 (±28) ml/min/1.73 m2. Change in ambulatory systolic BP predicted change in eGFRcrea. Urinary NAG‐CR, but not ACR, increased during follow‐up. Different GFR assessments gave diverging results after RDN. Therefore, care should be taken to method when evaluating kidney function after RDN. Increases in a tubular dysfunction biomarker suggest that kidney damage may occur. Long‐term renal follow‐up is needed after RDN.
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Affiliation(s)
- Marit D Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Atena Miroslawska
- Clinical Cardiovascular Research Group, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Jon V Norvik
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjørn O Eriksen
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Terje K Steigen
- Clinical Cardiovascular Research Group, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
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Liu Y, Zhu B, Zhu L, Zhao L, Ding D, Liu Z, Fan Z, Zhao Q, Zhang Y, Wang J, Gao C. Clinical outcomes of laparoscopic‐based renal denervation plus adrenalectomy vs adrenalectomy alone for treating resistant hypertension caused by unilateral aldosterone‐producing adenoma. J Clin Hypertens (Greenwich) 2020; 22:1606-1615. [PMID: 32812324 DOI: 10.1111/jch.13963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Yahui Liu
- Department of Cardiology Henan University People's Hospital Henan Provincial People's Hospital Zhengzhou China
- Henan Provincial Key Lab for Control of Coronary Heart Disease Central China Fuwai Hospital Zhengzhou China
| | - Binbin Zhu
- Henan Provincial Key Lab for Control of Coronary Heart Disease Central China Fuwai Hospital Zhengzhou China
- Department of Cardiology Zhengzhou University People's Hospital Henan Provincial People's Hospital Zhengzhou China
| | - Lijie Zhu
- Henan Provincial Key Lab for Control of Coronary Heart Disease Central China Fuwai Hospital Zhengzhou China
- Department of Cardiology Zhengzhou University People's Hospital Henan Provincial People's Hospital Zhengzhou China
| | - Linwei Zhao
- Henan Provincial Key Lab for Control of Coronary Heart Disease Central China Fuwai Hospital Zhengzhou China
- Department of Cardiology Zhengzhou University People's Hospital Henan Provincial People's Hospital Zhengzhou China
| | - Degang Ding
- Department of Urinary Surgery Zhengzhou University People's Hospital Henan Provincial People's Hospital Zhengzhou China
| | - Zhonghua Liu
- Department of Urinary Surgery Zhengzhou University People's Hospital Henan Provincial People's Hospital Zhengzhou China
| | - Zhiqiang Fan
- Department of Urinary Surgery Zhengzhou University People's Hospital Henan Provincial People's Hospital Zhengzhou China
| | - Qiuping Zhao
- Henan Provincial Key Lab for Control of Coronary Heart Disease Central China Fuwai Hospital Zhengzhou China
- Department of Cardiology Zhengzhou University People's Hospital Henan Provincial People's Hospital Zhengzhou China
| | - You Zhang
- Henan Provincial Key Lab for Control of Coronary Heart Disease Central China Fuwai Hospital Zhengzhou China
- Department of Cardiology Zhengzhou University People's Hospital Henan Provincial People's Hospital Zhengzhou China
- Henan Institute of Cardiovascular Epidemiology Zhengzhou University People's Hospital Henan Provincial People's Hospital Zhengzhou China
| | - Jiguang Wang
- Department of Hypertension Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital The Shanghai Institute of Hypertension Shanghai China
| | - Chuanyu Gao
- Department of Cardiology Henan University People's Hospital Henan Provincial People's Hospital Zhengzhou China
- Henan Provincial Key Lab for Control of Coronary Heart Disease Central China Fuwai Hospital Zhengzhou China
- Department of Cardiology Zhengzhou University People's Hospital Henan Provincial People's Hospital Zhengzhou China
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Laparoscopic-based perivascular renal sympathetic nerve denervation: a feasibility study in a porcine model. Eur J Med Res 2020; 25:22. [PMID: 32552871 PMCID: PMC7301974 DOI: 10.1186/s40001-020-00422-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study aims to evaluate the effects and safety of laparoscopic-based perivascular renal sympathetic nerve denervation (RDN) in a porcine model fed a high-fat diet. Method Thirty-six high-fat diet-fed Bama minipigs were randomly divided into an RDN group (n = 18), in which minipigs received laparoscopic-based perivascular RDN, and a sham group (n = 18). All pigs were fed the high-fat diet after the operation to establish a model of obesity-induced hypertension. Bama pigs in the RDN and sham groups were killed at 3 time points [2 days after RDN (n = 6), day 90 (n = 6) and day 180 (n = 6)]. Result The systolic blood pressure (SBP) and noradrenaline (NE) concentration in the kidney tissue were significantly lower in the RDN group than in the sham group at 2 days (113.83 ± 3.26 mmHg vs 129.67 ± 3.32 mmHg, P = 0.011, and 112.02 ± 17.34 ng/g vs 268.48 ± 20.61 ng/g, P < 0.001, respectively), 90 days (116.83 ± 3.88 mmHg vs 145.00 ± 4.22 mmHg, P = 0.001, respectively) and 180 days (129.33 ± 2.87 mmHg vs 168.57 ± 2.86 mmHg, P < 0.001, and 152.15 ± 16.61 ng/g vs 318.97 ± 24.84 ng/g, P < 0.001, respectively) after the operation. The diastolic blood pressure (DBP) was significantly lower in the RDN group than in sham group at 90 and 180 days after the operation (72.17 ± 2.7 mmHg vs 81.50 ± 2.22 mmHg, P = 0.037, and 76.83 ± 2.75 mmHg vs 86.33 ± 2.22 mmHg P = 0.021, respectively). Based on the pathological evaluation, the renal sympathetic nerve fascicles were successfully disrupted by radiofrequency energy after laparoscopic-based perivascular RDN, but the intima was intact. Tyrosine hydroxylase (TH) expression was decreased, while the expression of the S100 protein was increased in treated renal arteries after RDN. Conclusions Laparoscopic-based perivascular RDN prevented the occurrence and development of hypertension, and thus it may be an efficient and safe method for controlling blood pressure in an experimental model.
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Renal denervation vascular effects: An “insider's” view. Hellenic J Cardiol 2020; 61:197-198. [DOI: 10.1016/j.hjc.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/03/2020] [Indexed: 12/26/2022] Open
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Gao C, Zhao L, Zhu L, Li M, Ding D, Liu Z, Fan Z, Zhang Y, Zhao W, Wang J. Laparoscopic-based perivascular unilateral renal sympathetic nerve denervation for treating resistant hypertension: a case report. Hypertens Res 2019; 42:1162-1165. [PMID: 30814662 PMCID: PMC8075987 DOI: 10.1038/s41440-019-0237-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/10/2019] [Accepted: 02/10/2019] [Indexed: 11/27/2022]
Abstract
A 38-year-old man with a history of resistant hypertension for more than 10 years underwent laparoscopic-based perivascular unilateral renal sympathetic nerve denervation in 2012. After the operation, the patient’s blood pressure has been controllable while the antihypertensive drug intake has decreased over 6 years. Laparoscopic-based perivascular unilateral renal sympathetic nerve denervation may be a potentially feasible and effective option in treating patients with resistant hypertension.
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Affiliation(s)
- Chuanyu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, 450000, P.R. China. .,Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, 450000, P.R. China. .,Henan Institute of Cardiovascular Epidemiology, Zhengzhou, 450000, P.R. China.
| | - Linwei Zhao
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, 450000, P.R. China.,Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, 450000, P.R. China
| | - Lijie Zhu
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, 450000, P.R. China.,Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, 450000, P.R. China
| | - Muwei Li
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, 450000, P.R. China.,Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, 450000, P.R. China
| | - Degang Ding
- Department of Urinary Surgery, Zhengzhou University People's Hospital, Zhengzhou, 450000, P.R. China
| | - Zhonghua Liu
- Department of Urinary Surgery, Zhengzhou University People's Hospital, Zhengzhou, 450000, P.R. China
| | - Zhiqiang Fan
- Department of Urinary Surgery, Zhengzhou University People's Hospital, Zhengzhou, 450000, P.R. China
| | - You Zhang
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, 450000, P.R. China.,Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, 450000, P.R. China.,Henan Institute of Cardiovascular Epidemiology, Zhengzhou, 450000, P.R. China
| | - Wenli Zhao
- Cardiac Catheterization Room, Zhengzhou University People's Hospital, Zhengzhou, 450000, P.R. China
| | - Jiguang Wang
- Department of hypertension, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, 200000, P.R. China. .,The Shanghai Institute of Hypertension, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, 200000, P.R. China.
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Han W, Guan S, Gan Q, Zhai X, Wang M, Qu X. The safety of renal denervation as assessed by optical coherence tomography: pre- and post-procedure comparison with multi-electrode ablation catheter in animal experiment. Hellenic J Cardiol 2019; 61:190-196. [PMID: 30684647 DOI: 10.1016/j.hjc.2019.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/03/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To prove the effectiveness and safety of multi-electrode ablation catheter in renal denervation (RDN) by optical coherence tomography (OCT). METHODS Sixteen renal arteries were enrolled from 8 pigs. Angiography and OCT were performed to analyze the morphological changes before RDN and at 1-month follow-up. Blood pressure and creatinine were measured to prove the effectiveness and safety of the catheter. RESULTS One renal artery was excluded because of the small diameter. Fifteen renal arteries successfully underwent renal denervation and OCT. Mean blood pressure was significantly reduced at 1 month after RDN (122.40 ± 3.54 mmHg vs. 106.50 ± 2.06 mmHg, n = 8, P < .001). Creatinine follow-up after 1 month showed no significant change (45.37 ± 7.44 vs. 65.87 ± 49.20 μmol/L, n = 8, P = 0.275). The minimal lumen diameter showed that the renal artery immediately narrowed after the procedure (7.17 ± 0.60 mm vs. 5.93 ± 0.97 mm, n = 15, P < .001). Vasospasm, vascular wall edemas, and thrombus formations all showed significant changes after the procedure except renal artery dissection (0% vs. 21.4%, P = 0.067) under the OCT. Adverse event as renal artery occluded showed no significant difference (0% vs. 6.7%, P > .05). OCT results showed no significant difference in vasospasm, dissections, wall edemas, and thrombus formations (P > .05) at 1 month after the procedure. CONCLUSION This multi-electrode ablation catheter could cause minor injury to renal artery instantly after RDN, but it is found to be safe in the animal model at 1-month follow-up.
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Affiliation(s)
- Wenzheng Han
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Shaofeng Guan
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Qian Gan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xinrong Zhai
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Ming Wang
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Xinkai Qu
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
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