Anatomical and procedural determinants of ambulatory blood pressure lowering following catheter-based renal denervation using radiofrequency
Name
nihms-1030562.pdf
Description
Accepted version
Size
1.42 MB
Format
Adobe PDF
Checksum (MD5)
2079d93f93ab2b5e9dc10c89a4f7fe07
Author(s)
Lauder, Lucas
Ewen, Sebastian
Tzafriri, A Rami
Edelman, Elazer R
Cremers, Bodo
Kulenthiran, Saarraaken
Ukena, Christian
Linz, Dominik
Kindermann, Ingrid
Tsioufis, Costas
Date Issued
October 2018
Journal
Cardiovascular Revascularization Medicine
Publisher
Elsevier BV
Citation
Lauder, Lucas et al. "Anatomical and procedural determinants of ambulatory blood pressure lowering following catheter-based renal denervation using radiofrequency." Cardiovascular Revascularization Medicine 19, 7, Part B (October 2018): 845-851 © 2018 Elsevier
Version
Author's final manuscript
Abstract
Background/purpose: Catheter-based renal sympathetic denervation (RDN) has been introduced to lower blood pressure (BP) and sympathetic activity in patients with uncontrolled hypertension with at best equivocal results. It has been postulated that anatomic and procedural elements introduce unaccounted variability and yet little is known of the impact of renal anatomy and procedural parameters on BP response to RDN. Methods/materials: Anatomical parameters such as length and diameter were analyzed by quantitative vascular analysis and the prevalence of accessory renal arteries and renal artery disease were documented in 150 patients with resistant hypertension undergoing bilateral RDN using a mono-electrode radiofrequency catheter (Symplicity Flex, Medtronic). Results: Accessory renal arteries and renal artery disease were present in 56 (37%) and 14 patients (9%), respectively. At 6-months, 24 h-ambulatory BP was reduced by 11/6 mm Hg (p < 0.001 for both). Change of systolic blood pressure (SBP) was not related to the presence of accessory renal arteries (p = 0.543) or renal artery disease (p = 0.598). Patients with at least one main renal artery diameter ≤ 4 mm had a more pronounced reduction of 24 h-ambulatory SBP compared to patients where both arteries were >4 mm (−19 vs. −10 mmHg; p = 0.038). Neither the length of the renal artery nor the number of RF ablations influenced 24 h-ambulatory BP reduction at 6 months. Conclusions: 24 h-ambulatory BP lowering was most pronounced in patients with smaller renal artery diameter but not related to renal artery length, accessory arteries or renal artery disease. Further, there was no dose-response relationship observed with increasing number of ablations. Condensed abstract: Because little is known of the impact of renal anatomy and procedural parameters on blood pressure (BP) response to renal denervation (RDN), anatomical and procedural data were analyzed in 150 patients undergoing bilateral RDN. BP lowering was most pronounced in patients with smaller renal artery diameter but not related to renal artery length, the presence of renal artery disease or accessory renal arteries. Further, there was no dose-response relationship observed with increasing number of ablations.
MIT Department
Massachusetts Institute of Technology. Institute for Medical Engineering & Science
Harvard University--MIT Division of Health Sciences and Technology
Terms of Use
Creative Commons Attribution-NonCommercial-NoDerivs License
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DOI of Published Version
https://doi.org/10.1016/j.carrev.2018.02.016
