OBJECTIVE: Hypertension is the leading attributable cause of cardiovascular mortality worldwide. Patients with hypertension have multiple comorbidities including high rates of concomitant renal disease. Current pharmacological approaches are inadequate in the treatment of resistant hypertension. Renal sympathetic denervation (RDN) has been shown to effectively treat resistant hypertension. The traditional use of iodinated contrast in RDN is contraindicated in patients with significant renal insufficiency. In patients with renal impairment, carbon dioxide (CO2) can be used as an alternative contrast material for RDN. This article describes the technical aspects of RDN using CO2 angiography. METHODS: Our centre is experienced in the innovative RDN procedure using CO2 angiography. We describe the protocol for CO2 angiography for RDN using a home-made CO2 delivery system and the Symplicity™ (Minneapolis MN 55432 USA) catheter (Medtronic) device. RESULTS: CO2 angiography is an excellent alternative to iodinated contrast for RDN procedures. CONCLUSION: CO2 angiography for RDN is a safe and effective alternative to iodinated contrast. RDN using CO2 angiography is an easy and feasible procedure that can be used in patients with renal insufficiency or iodinated contrast allergies. Advances in knowledge: There is a paucity of descriptive reports for CO2 angiography for RDN and we provide details of the optimal protocol for the procedure. In particular, we describe the use of a Symplicity Spyral™ catheter (Medtronic), which has not been reported to date for use in this procedure.
OBJECTIVE:Hypertension is the leading attributable cause of cardiovascular mortality worldwide. Patients with hypertension have multiple comorbidities including high rates of concomitant renal disease. Current pharmacological approaches are inadequate in the treatment of resistant hypertension. Renal sympathetic denervation (RDN) has been shown to effectively treat resistant hypertension. The traditional use of iodinated contrast in RDN is contraindicated in patients with significant renal insufficiency. In patients with renal impairment, carbon dioxide (CO2) can be used as an alternative contrast material for RDN. This article describes the technical aspects of RDN using CO2 angiography. METHODS: Our centre is experienced in the innovative RDN procedure using CO2 angiography. We describe the protocol for CO2 angiography for RDN using a home-made CO2 delivery system and the Symplicity™ (Minneapolis MN 55432 USA) catheter (Medtronic) device. RESULTS:CO2 angiography is an excellent alternative to iodinated contrast for RDN procedures. CONCLUSION:CO2 angiography for RDN is a safe and effective alternative to iodinated contrast. RDN using CO2 angiography is an easy and feasible procedure that can be used in patients with renal insufficiency or iodinated contrast allergies. Advances in knowledge: There is a paucity of descriptive reports for CO2 angiography for RDN and we provide details of the optimal protocol for the procedure. In particular, we describe the use of a Symplicity Spyral™ catheter (Medtronic), which has not been reported to date for use in this procedure.
Authors: Murray D Esler; Henry Krum; Paul A Sobotka; Markus P Schlaich; Roland E Schmieder; Michael Böhm Journal: Lancet Date: 2010-11-17 Impact factor: 79.321
Authors: Donald Lloyd-Jones; Robert Adams; Mercedes Carnethon; Giovanni De Simone; T Bruce Ferguson; Katherine Flegal; Earl Ford; Karen Furie; Alan Go; Kurt Greenlund; Nancy Haase; Susan Hailpern; Michael Ho; Virginia Howard; Brett Kissela; Steven Kittner; Daniel Lackland; Lynda Lisabeth; Ariane Marelli; Mary McDermott; James Meigs; Dariush Mozaffarian; Graham Nichol; Christopher O'Donnell; Veronique Roger; Wayne Rosamond; Ralph Sacco; Paul Sorlie; Randall Stafford; Julia Steinberger; Thomas Thom; Sylvia Wasserthiel-Smoller; Nathan Wong; Judith Wylie-Rosett; Yuling Hong Journal: Circulation Date: 2008-12-15 Impact factor: 29.690
Authors: Henry Krum; Markus Schlaich; Rob Whitbourn; Paul A Sobotka; Jerzy Sadowski; Krzysztof Bartus; Boguslaw Kapelak; Anthony Walton; Horst Sievert; Suku Thambar; William T Abraham; Murray Esler Journal: Lancet Date: 2009-03-28 Impact factor: 79.321