Sebastian Ewen1, Christian Ukena2, Thomas Felix Lüscher3, Martin Bergmann4, Peter J Blankestijn5, Erwin Blessing6, Bodo Cremers2, Oliver Dörr7, Dagmara Hering8, Lukas Kaiser4, Holger Nef7, Elias Noory9, Markus Schlaich8, Faisal Sharif10, Isabella Sudano3, Britta Vogel6, Michiel Voskuil11, Thomas Zeller9, Abraham R Tzafriri12, Elazer R Edelman12, Lucas Lauder2, Bruno Scheller2, Michael Böhm2, Felix Mahfoud2. 1. Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. Electronic address: Sebastian.Ewen@uks.eu. 2. Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. 3. Kardiologie, Universitäres Herzzentrum, Universitätsspital, Zürich, Switzerland. 4. Kardiologie, Asklepios Klinik St. Georg, Hamburg, Germany. 5. Department of Nephrology, University Medical Center, Utrecht, the Netherlands. 6. Medizinische Klinik III, Universitätsklinikum Heidelberg, Germany. 7. Medizinische Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinikum, Gießen, Germany. 8. Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia. 9. Angiologie, Universitätsherzzentrum, Bad Krozingen, Germany. 10. Galway University Hospitals, Ireland. 11. Department of Cardiology, University Medical Center, Utrecht, the Netherlands. 12. Institute for Medical Engineering and Science, MIT, Cambridge MA and Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Abstract
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.
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.
Authors: Abraham R Tzafriri; Felix Mahfoud; John H Keating; Anna-Maria Spognardi; Peter M Markham; Gee Wong; Debby Highsmith; Patrick O'Fallon; Kristine Fuimaono; Elazer R Edelman Journal: Hypertension Date: 2019-07-15 Impact factor: 10.190
Authors: Lucas Lauder; Sebastian Ewen; Abraham Rami Tzafriri; Elazer Reuven Edelman; Thomas Felix Lüscher; Peter J Blankenstijn; Oliver Dörr; Markus Schlaich; Faisal Sharif; Michiel Voskuil; Thomas Zeller; Christian Ukena; Bruno Scheller; Michael Böhm; Felix Mahfoud Journal: EuroIntervention Date: 2018-05-20 Impact factor: 6.534