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Bertog S, Sharma A, Mahfoud F, Pathak A, Schmieder RE, Sievert K, Papademetriou V, Weber MA, Haratani N, Lobo MD, Saxena M, Kandzari DE, Fischell TA, Sievert H. Alcohol-Mediated Renal Sympathetic Neurolysis for the Treatment of Hypertension: The Peregrine™ Infusion Catheter. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 24:77-86. [PMID: 32958438 DOI: 10.1016/j.carrev.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/15/2020] [Accepted: 09/01/2020] [Indexed: 01/12/2023]
Abstract
Renal sympathetic denervation using conventional non-irrigated radiofrequency catheters has potential technical shortcomings, including limited penetration depth and incomplete circumferential nerve damage, potentially impacting therapeutic efficacy. Against this background, second generation multi-electrode, radiofrequency and ultrasound renal denervation systems have been developed to provide more consistent circumferential nerve ablation. Irrigated catheters may allow deeper penetration while minimizing arterial injury. In this context, catheter-based chemical denervation, with selective infusion of alcohol, a potent neurolytic agent, into the perivascular space, may minimize endothelial, intimal and medial injury while providing circumferential neurolysis. Animal studies demonstrate pronounced renal norepinephrine level reductions and consistent renal nerve injury after perivascular alcohol infusion using the Peregrine Catheter. Early clinical studies demonstrated significant blood pressure reductions and a reasonable safety profile. Randomized sham-controlled trials (NCT03503773, NCT02910414) are underway to examine whether the aforementioned theoretical advantages of alcohol-medicated denervation with the Peregrine System™ Kit translate into clinical benefits.
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Affiliation(s)
- Stefan Bertog
- CardioVascular Center Frankfurt, Frankfurt, Germany; Minneapolis Veterans Affairs Medical Center, Minneapolis, USA
| | - Alok Sharma
- Minneapolis Veterans Affairs Medical Center, Minneapolis, USA
| | - Felix Mahfoud
- Saarland University Hospital, Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Homburg/Saar, Germany; Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco
| | - Roland E Schmieder
- University Hospital of the Friedrich Alexander University Erlangen-Nürnberg, Germany
| | - Kolja Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany; Johannes Gutenberg Universität, Mainz, Germany
| | | | | | | | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London, UK
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London, UK
| | | | | | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, UK.
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Renal Artery Denervation in Resistant Hypertension: The Good, The Bad and The Future. Heart Lung Circ 2020; 29:94-101. [DOI: 10.1016/j.hlc.2019.06.723] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/04/2019] [Accepted: 06/24/2019] [Indexed: 02/05/2023]
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Renal Artery Denervation for Hypertension. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:7. [PMID: 30762119 DOI: 10.1007/s11936-019-0715-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW Hypertension (HTN) has a growing impact, already affecting over 1 billion people. An estimated 2-16% of those with HTN have resistant HTN. The sympathetic nervous system (SNS) is a recognized contributor to the pathophysiology of resistant HTN. Current hypertensive pharmacotherapy has not fully targeted the SNS; therefore, the SNS has become a prominent research therapeutic target. This review summarizes the evidence and rationale behind renal denervation (RDN) therapy and the technology available. RECENT FINDINGS Prior to the SYMPLICITY HTN-3 clinical trial, trials found RDN to be an effective procedure to control resistant hypertension. The failure of SYMPLICITY HTN-3 to meet its primary efficacy endpoint sparked further studies to address potential shortcomings. The subsequent SPYRAL program trials demonstrated efficacy of RDN therapy in a controlled manner; however, they were not adequately powered. Ongoing research is examining new, innovative RDN technology as well as defining appropriate patients to target for treatment. The data currently available for RDN in HTN and other states of SNS activation suffer from potential biases and limitations, highlighting the need for continued exploration. Contemporary studies are more promising and hypothesis-generating. Future trials and continued device innovation will be crucial for understanding the clinical applications of RDN therapy.
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Toutouzas K, Synetos A, Pietri P, Stefanadis C. Chemical renal denervation: an effective method to treat resistant hypertension? EUROINTERVENTION 2017; 13:e1129-e1130. [PMID: 29033389 DOI: 10.4244/eij-d-16-01000l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Freyhardt P, Donners R, Riemert A, Schnorr J, Stolzenburg N, Rinnenthal JL, Bernhardt U, Hamm B, Günther RW, Streitparth F. Renal denervation by CT-guided periarterial injection of hyperosmolar saline, vincristine, paclitaxel and guanethidine in a pig model. EUROINTERVENTION 2017; 12:e2262-e2270. [PMID: 27890860 DOI: 10.4244/eij-d-15-00354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the study was to evaluate the feasibility, safety and efficacy of renal sympathetic denervation with CT-guided periarterial injection of potentially neurolytic agents in pigs. METHODS AND RESULTS Unilateral injection of formulations containing either 5M hyperosmolar saline, vincristine, paclitaxel or guanethidine around the renal artery was performed in 24 normotensive pigs with six animals per group. Needle placement and injections were performed under CT fluoroscopy guidance. Blood pressure measurements and CT scans were performed immediately before and after the intervention and four weeks after treatment. After euthanasia, norepinephrine (NE) concentrations of both kidneys were determined. The renal arteries and surrounding tissue were examined histologically to evaluate nerve fibre degeneration. Procedures were technically successful with good periarterial distribution of the injectant in all but one pig in the guanethidine group. No major adverse events or post-interventional complications occurred. In the vincristine group, NE concentrations of the renal parenchyma were lower on the treated side in all pigs with a mean decrease of 53% (38%-62%, p<0.01) compared to the contralateral control. Correspondingly, histological examination revealed neural degeneration in all animals treated with vincristine. In the other groups, no significant drop of NE values, or histological signs of nerve fibre degeneration were found. CONCLUSIONS CT-guided periarterial injection of the different substances was feasible and safe. Renal sympathetic denervation was achieved with vincristine. In contrast, hyperosmolar saline, paclitaxel and guanethidine do not seem to be appropriate for renal denervation in a pig model at the dosage used.
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Affiliation(s)
- Patrick Freyhardt
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Karanasos A, Van Mieghem N, Bergmann MW, Hartman E, Ligthart J, van der Heide E, Heeger CH, Ouhlous M, Zijlstra F, Regar E, Daemen J. Multimodality Intra-Arterial Imaging Assessment of the Vascular Trauma Induced by Balloon-Based and Nonballoon-Based Renal Denervation Systems. Circ Cardiovasc Interv 2016; 8:e002474. [PMID: 26156150 DOI: 10.1161/circinterventions.115.002474] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Renal denervation is a new treatment considered for several possible indications. As new systems are introduced, the incidence of acute renal artery wall injury with relation to the denervation method is unknown. We investigated the acute repercussion of renal denervation on the renal arteries of patients treated with balloon-based and nonballoon-based denervation systems by quantitative angiography, intravascular ultrasound, and optical coherence tomography (OCT). METHODS AND RESULTS Twenty-five patients (50 renal arteries) underwent bilateral renal denervation with 5 different systems, 3 of which balloon-based (Paradise [n=5], Oneshot [n=6], and Vessix V2 [n=5)]) and 2 nonballoon-based (Symplicity [n=6] and EnligHTN [n=3]). Analysis included quantitative angiography and morphometric intravascular ultrasound measurements pre and post procedure and assessment of vascular trauma (dissection, edema, or thrombus) by OCT after denervation. A significant reduction in lumen size by quantitative angiography and intravascular ultrasound was observed in nonballoon denervation but not in balloon denervation. By postdenervation OCT, dissection was seen in 14 arteries (32.6%). The percentage of frames with dissection was higher in balloon-based denervation catheters. Thrombus and edema were detected in 35 (81.4%) and 32 (74.4%) arteries, respectively. In arteries treated with balloon-based denervation that had dissection by OCT, the balloon/artery ratio was higher (1.24 [1.17-1.32] versus 1.10 [1.04-1.18]; P<0.01). CONCLUSIONS A varying extent of vascular injury was observed after renal denervation in all systems; however, different patterns were identified in balloon-based and in nonballoon-based denervation systems. In balloon denervation, the presence of dissections by OCT was associated with a higher balloon/artery ratio.
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Affiliation(s)
- Antonios Karanasos
- From the Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center (A.K., N.V.M., E.H., J.L., E.v.d.H., F.Z., E.R., J.D.), Department of Radiology (M.O.), Rotterdam, The Netherlands; and Department of Interventional Cardiology, St. Georg Asklepios Klinik, Hamburg, Germany (M.W.B., C.-H.H.)
| | - Nicolas Van Mieghem
- From the Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center (A.K., N.V.M., E.H., J.L., E.v.d.H., F.Z., E.R., J.D.), Department of Radiology (M.O.), Rotterdam, The Netherlands; and Department of Interventional Cardiology, St. Georg Asklepios Klinik, Hamburg, Germany (M.W.B., C.-H.H.)
| | - Martin W Bergmann
- From the Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center (A.K., N.V.M., E.H., J.L., E.v.d.H., F.Z., E.R., J.D.), Department of Radiology (M.O.), Rotterdam, The Netherlands; and Department of Interventional Cardiology, St. Georg Asklepios Klinik, Hamburg, Germany (M.W.B., C.-H.H.)
| | - Eline Hartman
- From the Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center (A.K., N.V.M., E.H., J.L., E.v.d.H., F.Z., E.R., J.D.), Department of Radiology (M.O.), Rotterdam, The Netherlands; and Department of Interventional Cardiology, St. Georg Asklepios Klinik, Hamburg, Germany (M.W.B., C.-H.H.)
| | - Jurgen Ligthart
- From the Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center (A.K., N.V.M., E.H., J.L., E.v.d.H., F.Z., E.R., J.D.), Department of Radiology (M.O.), Rotterdam, The Netherlands; and Department of Interventional Cardiology, St. Georg Asklepios Klinik, Hamburg, Germany (M.W.B., C.-H.H.)
| | - Elco van der Heide
- From the Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center (A.K., N.V.M., E.H., J.L., E.v.d.H., F.Z., E.R., J.D.), Department of Radiology (M.O.), Rotterdam, The Netherlands; and Department of Interventional Cardiology, St. Georg Asklepios Klinik, Hamburg, Germany (M.W.B., C.-H.H.)
| | - Christian-H Heeger
- From the Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center (A.K., N.V.M., E.H., J.L., E.v.d.H., F.Z., E.R., J.D.), Department of Radiology (M.O.), Rotterdam, The Netherlands; and Department of Interventional Cardiology, St. Georg Asklepios Klinik, Hamburg, Germany (M.W.B., C.-H.H.)
| | - Mohamed Ouhlous
- From the Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center (A.K., N.V.M., E.H., J.L., E.v.d.H., F.Z., E.R., J.D.), Department of Radiology (M.O.), Rotterdam, The Netherlands; and Department of Interventional Cardiology, St. Georg Asklepios Klinik, Hamburg, Germany (M.W.B., C.-H.H.)
| | - Felix Zijlstra
- From the Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center (A.K., N.V.M., E.H., J.L., E.v.d.H., F.Z., E.R., J.D.), Department of Radiology (M.O.), Rotterdam, The Netherlands; and Department of Interventional Cardiology, St. Georg Asklepios Klinik, Hamburg, Germany (M.W.B., C.-H.H.)
| | - Evelyn Regar
- From the Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center (A.K., N.V.M., E.H., J.L., E.v.d.H., F.Z., E.R., J.D.), Department of Radiology (M.O.), Rotterdam, The Netherlands; and Department of Interventional Cardiology, St. Georg Asklepios Klinik, Hamburg, Germany (M.W.B., C.-H.H.)
| | - Joost Daemen
- From the Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center (A.K., N.V.M., E.H., J.L., E.v.d.H., F.Z., E.R., J.D.), Department of Radiology (M.O.), Rotterdam, The Netherlands; and Department of Interventional Cardiology, St. Georg Asklepios Klinik, Hamburg, Germany (M.W.B., C.-H.H.).
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Catheter based inhibition of arterial calcification by bisphosphonates in an experimental atherosclerotic rabbit animal model. Int J Cardiol 2014; 176:177-81. [DOI: 10.1016/j.ijcard.2014.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/13/2014] [Accepted: 07/05/2014] [Indexed: 11/24/2022]
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Stefanadis C, Synetos A, Tsioufis C, Drakopoulou M, Tsiamis E, Tousoulis D, Agrogiannis G, Patsouris E, Toutouzas K. Chemical renal denervation by vincristine: the role of the flow rate of delivery. Cardiovasc Intervent Radiol 2014; 37:1336-42. [PMID: 25112883 DOI: 10.1007/s00270-014-0958-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/19/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Vincristine has been proven promising regarding its safety and efficacy for the renal artery denervation both in experimental models and in humans. The aim of the study was to compare in an experimental model the efficacy of constant versus random flow rate delivery of vincristine on renal sympathetic denervation. METHODS We used 10 juvenile Landrace swine. After the introduction of a 7F sheath into the femoral artery, a guide wire was advanced into the distal part of the renal artery. Then the first delivery balloon catheter, which delivers vincristine in random flow rate, was advanced at the proximal part of the artery, and the balloon was inflated in order to locally deliver vincristine to the media of the renal artery. The process was repeated in the contralateral renal artery, with the use of the double balloon catheter that delivers vincristine with a constant flow rate. Euthanasia of the animals was performed at 28 days. All sections were processed for histological and immunohistochemical analysis. RESULTS The delivery of vincristine with both catheters was successful and uncomplicated. Immunohistochemistry showed that the mean number of intact nerves in all sections was significantly lower in the group of vincristine delivered with constant flow catheter compared to the group that the delivery was performed in a random fashion. (1.48 ± 0.37 vs. 1.70 ± 0.41, p = 0.04). CONCLUSION Chemical renal denervation with vincristine by a constant flow rate catheter is more effective compared to the denervation performed by a catheter that delivers vincristine in a random fashion.
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Affiliation(s)
- Christodoulos Stefanadis
- First Department of Cardiology, Athens Medical School, Hippokration Hospital, 9 Tepeleniou str., Paleo Psychico, 15452, Athens, Greece,
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Kapil V, Jain AK, Lobo MD. Renal Sympathetic Denervation - A Review of Applications in Current Practice. Interv Cardiol 2014; 9:54-61. [PMID: 29588780 PMCID: PMC5808654 DOI: 10.15420/icr.2011.9.1.54] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/18/2014] [Indexed: 02/07/2023] Open
Abstract
Resistant hypertension is associated with high morbidity and mortality despite numerous pharmacological strategies. A wealth of preclinical and clinical data have demonstrated that resistant hypertension is associated with elevated renal and central sympathetic tone. The development of interventional therapies to modulate the sympathetic nervous system potentially represents a paradigm shift in the strategy for blood pressure control in this subset of patients. Initial first-in-man and pivotal, randomised controlled trials of endovascular, radio-frequency renal sympathetic denervation have spawned numerous iterations of similar technology, as well as many novel concepts for achieving effective renal sympatholysis. This review details the current knowledge of these devices and the evidence base behind each technology.
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Affiliation(s)
- Vikas Kapil
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts Hypertension Clinic, Department of Clinical Pharmacology, Barts Health NHS Trust, London, UK
| | - Ajay K Jain
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - Melvin D Lobo
- William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts Hypertension Clinic, Department of Clinical Pharmacology, Barts Health NHS Trust, London, UK
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Percutaneous Computer Tomography-Guided Ethanol Sympathicolysis for the Treatment of Resistant Arterial Hypertension. Cardiovasc Intervent Radiol 2014; 37:513-8. [DOI: 10.1007/s00270-014-0850-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/22/2013] [Indexed: 10/25/2022]
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Hoye NA, Baldi JC, Putt TL, Schollum JB, Wilkins GT, Walker RJ. Endovascular renal denervation: a novel sympatholytic with relevance to chronic kidney disease. Clin Kidney J 2014; 7:3-10. [PMID: 25859344 PMCID: PMC4389153 DOI: 10.1093/ckj/sft130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/01/2013] [Indexed: 01/20/2023] Open
Abstract
Endovascular renal denervation (sympathectomy) is a novel procedure developed for the treatment of resistant hypertension. Evidence suggests that it reduces both afferent and efferent sympathetic nerve activity, which may offer clinical benefit over and above any blood pressure-lowering effect. Studies have shown objective improvements in left ventricular mass, ventricular function, central arterial stiffness, central haemodynamics, baroreflex sensitivity and arrhythmia frequency. Benefits have also been seen in insulin resistance, microalbuminuria and glomerular filtration rate. In chronic kidney disease, elevated sympathetic activity has been causally linked to disease progression and cardiovascular sequelae. Effecting a marked reduction in sympathetic hyperactivity may herald a significant step in the management of this and other conditions. In this in-depth review, the pathophysiology and clinical significance of the sympatholytic effects of endovascular renal denervation are discussed.
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Affiliation(s)
- Neil A Hoye
- Department of Medicine , Dunedin School of Medicine , Dunedin , New Zealand
| | - James C Baldi
- Department of Medicine , Dunedin School of Medicine , Dunedin , New Zealand
| | - Tracey L Putt
- Department of Medicine , Dunedin School of Medicine , Dunedin , New Zealand
| | - John B Schollum
- Department of Medicine , Dunedin School of Medicine , Dunedin , New Zealand
| | - Gerard T Wilkins
- Department of Medicine , Dunedin School of Medicine , Dunedin , New Zealand
| | - Robert J Walker
- Department of Medicine , Dunedin School of Medicine , Dunedin , New Zealand
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Chandra AP, Marron CD, Puckridge P, Spark JI. Severe bilateral renal artery stenosis after transluminal radiofrequency ablation of renal sympathetic nerve plexus. J Vasc Surg 2014; 62:222-5. [PMID: 24468285 DOI: 10.1016/j.jvs.2013.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/05/2013] [Accepted: 11/05/2013] [Indexed: 12/27/2022]
Abstract
Percutaneous renal sympathetic denervation is an evolving therapy for resistant hypertension. Evidence to date demonstrates a reduction of blood pressure in the short term to medium term. Reported complications relate to problems with vascular access vessels and dissection of the renal artery. Renal artery stenosis has not been described in the literature. We present a patient with hypertensive crisis, flash pulmonary edema, and deterioration of renal function, secondary to bilateral renal artery stenosis, 9 months after renal sympathetic radiofrequency ablation denervation.
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Affiliation(s)
- Abhilash P Chandra
- Department of Vascular Surgery, Flinders Medical Center and Flinders University, Bedford Park, South Australia, Australia
| | - Conor D Marron
- Department of Vascular Surgery, Flinders Medical Center and Flinders University, Bedford Park, South Australia, Australia
| | - Phillip Puckridge
- Department of Vascular Surgery, Flinders Medical Center and Flinders University, Bedford Park, South Australia, Australia
| | - James I Spark
- Department of Vascular Surgery, Flinders Medical Center and Flinders University, Bedford Park, South Australia, Australia.
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Tsioufis C, Mahfoud F, Mancia G, Redon J, Damascelli B, Zeller T, Schmieder RE. What the interventionalist should know about renal denervation in hypertensive patients: a position paper by the ESH WG on the interventional treatment of hypertension. EUROINTERVENTION 2014; 9:1027-35. [DOI: 10.4244/eijv9i9a175] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Renal artery nerve distribution and density in the porcine model: biologic implications for the development of radiofrequency ablation therapies. Transl Res 2013; 162:381-9. [PMID: 23911638 DOI: 10.1016/j.trsl.2013.07.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 07/02/2013] [Accepted: 07/07/2013] [Indexed: 11/24/2022]
Abstract
Catheter-based renal artery denervation has demonstrated to be effective in decreasing blood pressure among patients with refractory hypertension. The anatomic distribution of renal artery nerves may influence the safety and efficacy profile of this procedure. We aimed to describe the anatomic distribution and density of periarterial renal nerves in the porcine model. Thirty arterial renal sections were included in the analysis by harvesting a tissue block containing the renal arteries and perirenal tissue from each animal. Each artery was divided into 3 segments (proximal, mid, and distal) and assessed for total number, size, and depth of the nerves according to the location. Nerve counts were greatest proximally (45.62% of the total nerves) and decreased gradually distally (mid, 24.58%; distal, 29.79%). The distribution in nerve size was similar across all 3 sections (∼40% of the nerves, 50-100 μm; ∼30%, 0-50 μm; ∼20%, 100-200 μm; and ∼10%, 200-500 μm). In the arterial segments ∼45% of the nerves were located within 2 mm from the arterial wall whereas ∼52% of all nerves were located within 2.5 mm from the arterial wall. Sympathetic efferent fibers outnumbered sensory afferent fibers overwhelmingly, intermixed within the nerve bundle. In the porcine model, renal artery nerves are seen more frequently in the proximal segment of the artery. Nerve size distribution appears to be homogeneous throughout the artery length. Nerve bundles progress closer to the arterial wall in the distal segments of the artery. This anatomic distribution may have implications for the future development of renal denervation therapies.
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Renal denervation for treating resistant hypertension: current evidence and future insights from a global perspective. Int J Hypertens 2013; 2013:513214. [PMID: 24369496 PMCID: PMC3863475 DOI: 10.1155/2013/513214] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/14/2013] [Accepted: 10/18/2013] [Indexed: 12/13/2022] Open
Abstract
Adequate blood pressure control represents an important goal for all physicians due to the complications of hypertension which reduce patients' quality of life. A new interventional strategy to reduce blood pressure has been developed for patients with resistant hypertension. Catheter-based renal denervation has demonstrated excellent results in recent investigations associated with few side effects. With the growing diffusion of this technique worldwide, some medical societies have published consensus statements to guide physicians how to best apply this procedure. Questions remain to be answered such as the long-term durability of renal denervation, the efficacy in patients with other sympathetically mediated diseases, and whether renal denervation would benefit patients with stage 1 hypertension.
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Stefanadis C, Synetos A, Toutouzas K, Tsioufis C, Drakopoulou M, Tsiamis E, Agrogiannis G, Patsouris E, Tousoulis D. Barodenervation of the sympathetic nervous system of the renal artery. A new concept. Int J Cardiol 2013; 168:4443-4. [DOI: 10.1016/j.ijcard.2013.06.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/30/2013] [Indexed: 11/25/2022]
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Stefanadis C, Synetos A, Toutouzas K, Tsioufis C, Drakopoulou M, Tsiamis E, Agrogiannis G, Patsouris E, Tousoulis D. New double balloon delivery catheter for chemical denervation of the renal artery with vincristine. Int J Cardiol 2013; 168:4346-8. [PMID: 23735339 DOI: 10.1016/j.ijcard.2013.05.075] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 05/04/2013] [Indexed: 11/17/2022]
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Weber T, Zweiker R, Watschinger B, Grüner P, Koppelstätter C, Brandt MC, Horina J, Brussee H, Hohenstein K, Lambert T, Auer J, Hoppe UC. Clinical application of interventional renal sympathetic denervation: recommendations of the Austrian Society of Hypertension 2012. Wien Klin Wochenschr 2012. [DOI: 10.1007/s00508-012-0257-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Huan Y, Cohen DL. Renal denervation: a potential new treatment for severe hypertension. Clin Cardiol 2012; 36:10-4. [PMID: 23124953 DOI: 10.1002/clc.22071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 09/20/2012] [Indexed: 12/12/2022] Open
Abstract
Hypertension is a leading cause of cardiovascular morbidity and mortality. Drug-resistant hypertension remains common despite the availability of several classes of effective antihypertensive agents. Sympathetic hyperactivity has long been recognized as a major contributor to resistant hypertension, but radical sympathectomy was abandoned several decades ago due to its significant side effects. The newly developed, minimally invasive, catheter-based renal sympathetic denervation procedure has been shown in recent trials to produce impressive blood pressure reductions and a favorable safety profile in drug-resistant hypertension. Although the long-term efficacy and safety of renal denervation remains to be determined, emerging data suggest that the benefits of renal denervation may extend beyond blood pressure control.
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Affiliation(s)
- Yonghong Huan
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Granada JF, Buszman PP. Renal denervation therapies for refractory hypertension. Curr Cardiol Rep 2012; 14:619-25. [PMID: 22886514 DOI: 10.1007/s11886-012-0303-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The treatment of severe hypertension by the surgical obliteration of the renal sympathetic nerves was proposed almost 80 years ago. This approach, although highly effective in reducing blood pressure was associated with a significant amount of side effects and it was rapidly replaced by better tolerated medical therapy. The rapid progress in catheter based technologies occurring within the last 20 years facilitated the development of the first radio frequency renal artery denervation catheter. At the present time, several small trials have demonstrated the safety and efficacy of this approach among patients with refractory hypertension. Besides its effect on reducing blood pressure, other pleiotropic effects (ie, improving glycemia in diabetic patients) have been proposed. In this review, we discuss the anatomical and physiological rationale for this therapy, provide an update on the latest clinical data available and describe additional emerging technologies in this field.
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Affiliation(s)
- Juan F Granada
- Skirball Center for Cardiovascular Research for Cardiovascular Research Foundation, 8 Corporate Drive, Orangeburg, NY, USA.
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Tousoulis D, Androulakis E, Papageorgiou N, Stefanadis C. Novel therapeutic strategies in the management of arterial hypertension. Pharmacol Ther 2012; 135:168-75. [DOI: 10.1016/j.pharmthera.2012.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 04/26/2012] [Indexed: 02/05/2023]
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