Laparoscopic-based perivascular unilateral renal sympathetic nerve denervation for treating resistant hypertension: a case report

Gao, Chuanyu; Zhao, Linwei; Zhu, Lihua; Li, Muwei; Ding, Degang; Z, Liu; Fan, Zhiqiang; Zhang, You; Zhao, Wenli; Wang, Ji‐Guang

doi:10.1038/s41440-019-0237-3

Cited by 8 publications

(6 citation statements)

References 12 publications

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“…One case showed that even unilateral RDN can be fully successful and decrease BP to a remarkable extent in a 12-month period [ 27 ]. Gao et al reported considerable BP decrease with laparoscopic-based perivascular unilateral RDN [ 28 ]. In an animal model, unilateral RDN improved mean arterial pressure and cardiac autonomic balance in congestive heart failure by reducing sympathetic tone [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of extensive artery isolation during robotic-assisted partial nephrectomy on blood pressure of patients with poorly controlled hypertension: a preliminary study

Wang

Zhao

et al. 2022

Int Urol Nephrol

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Purpose To investigate whether extensive renal artery isolation during robotic-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC) affects blood pressure (BP) of patients with poorly controlled hypertension. Methods We included 60 patients diagnosed with poorly controlled hypertension who underwent RAPN by an experienced surgeon. The renal artery of the treated kidney was sufficiently isolated. Systolic BP (SBP), diastolic BP (DBP) and antihypertensive medication information were obtained at baseline and 3- and 6-month follow-up after surgery. Primary endpoints were changes in BP, and medications. Predictors of SBP reduction at 3 months were assessed by multivariable logistic regression. Results All 60 RAPN procedures were successful, with no major intra- or postoperative complications. Mean SBP and DBP decreased significantly at 3 months after surgery (SBP, −7.8 ± 6.3 mmHg, P < 0.001; DBP, −4.2 ± 6.4 mmHg, P = 0.01). SBP and DBP did not differ between 3- and 6-month follow-up. The mean number of BP medications prescribed was lower at 3 months than baseline (1.7 ± 1.0 vs 2.1 ± 1.0, P = 0.016). The only significant predictor of SBP reduction at 3 months was baseline SBP. Conclusions Renal denervation with extensive renal artery isolation during RAPN may improve BP control among patients with poorly controlled hypertension in short term.

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Section: Discussionmentioning

confidence: 99%

Effect of extensive artery isolation during robotic-assisted partial nephrectomy on blood pressure of patients with poorly controlled hypertension: a preliminary study

Wang

Zhao

et al. 2022

Int Urol Nephrol

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“…However, we believed that direct stimulation using RF energy and the use of catheter and wire on the arterial intima could result in intimal injury and/or thrombosis, 13,24 which may trigger the progression of atherosclerosis. Moreover, an inappropriate ablation device may lead to inadequate ablation, which in turn results in uncertainty in the effects of RDN 14 …”

Section: Discussionmentioning

confidence: 99%

“…A case study reported by our team showed that laparoscopic‐based RDN from the adventitia of renal artery could effectively treat resistant hypertension 14 . In that report, our team for the first time used laparoscopic RDN from the adventitia of renal artery for resistant hypertension.…”

Section: Introductionmentioning

confidence: 91%

Clinical outcomes of laparoscopic‐based renal denervation plus adrenalectomy vs adrenalectomy alone for treating resistant hypertension caused by unilateral aldosterone‐producing adenoma

Liu

Zhu

et al. 2020

J of Clinical Hypertension

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Previous studies describing renal denervation (RDN) from the intima of the renal artery for the treatment of resistant hypertension have reported variable efficacies, and RDN triggers renal intimal injury and atherosclerosis. This study aimed to evaluate the efficacy and safety of RDN from the adventitia of renal artery plus unilateral laparoscopic adrenalectomy to treat patients with resistant hypertension caused by unilateral aldosterone-producing adenoma (APA). A total of 60 consecutive patients with resistant hypertension caused by unilateral APA were enrolled in this study. Patients were randomly assigned to undergo RDN from the adventitia of the renal artery plus adrenalectomy (RDN group, n = 30) or adrenalectomy alone (control group, n = 30) and were followed up for 12 months. The primary efficacy end point was the change in 24-hours mean ambulatory systolic blood pressure (SBP) from baseline to 12 months. At the 12-month follow-up, the mean reduction of 24-hours average SBP and office SBP in the RDN group was 20.7 ± 15.2 and 37.1 ± 26.0 mm Hg, respectively, which was significantly higher than the mean reduction of 24-hours average SBP (11.9 ± 11.1 mm Hg, P = .017) and the office SBP (25.9 ± 16.8 mm Hg, P = .035) in the control group. Serum potassium levels returned to normal 12 months post-procedure. Patients in the RDN group had higher proportion of cured clinical and biochemical outcomes than those in the control group (35.7% vs 17.9% in clinical outcome; 96.4% vs 89.3% in biochemical outcome, respectively). There were no procedural-, device-, or treatment-related safety events during the 12-month followup period between the groups. In conclusion, RDN from the adventitia of the renal artery plus unilateral laparoscopic adrenalectomy is more effective than adrenalectomy alone for treating resistant hypertension caused by unilateral APA.

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“…Thus, novel neuromodulation approaches targeting sympathetic nerve inhibition might be potential for the treatment of resistant hypertension. Tremendous evidences have proved that neuromodulation techniques such as functional electrical stimulation (FES) of the carotid baroreceptor (Scheffers et al, 2010;Bisognano et al, 2011;Lohmeier and Iliescu, 2011;Bakris et al, 2012;Hoppe et al, 2012)/vagus nerve (Plachta et al, 2014;Gierthmuehlen et al, 2016;Annoni et al, 2019) and renal sympathetic denervation (RSD) by different devices and techniques [including surgical sympathectomy (Smithwick, 1948), laparoscopic sympathectomy (Gao et al, 2019), catheterbased radiofrequency ablation (Krum et al, 2009), endovascular ultrasound (Fengler et al, 2019), injection of neurotoxic agents (Lohmeier and Hall, 2019), external stereotactic radiofrequency (Cai et al, 2019), external high-intensity focused ultrasound (Wang et al, 2013), etc.,] might reduce BP through sympathetic nerve activity inhibition. However, these procedures of current neuromodulation methods are either invasive or associated with complete nerve damage.…”

Section: Introductionmentioning

confidence: 99%

Blood Pressure Modulation With Low-Intensity Focused Ultrasound Stimulation to the Vagus Nerve: A Pilot Animal Study

Lin

Chen

et al. 2020

Front. Neurosci.

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Objective For hypertensive individuals, their blood pressure (BP) is often managed by taking medications. However, antihypertensive drugs might cause adverse effects such as congestive heart failure and are ineffective in significant numbers of the hypertensive population. As an alternative method for hypertension management, non-drug devices-based neuromodulation approaches such as functional electrical stimulation (FES) have been proposed. The FES approach requires the implantation of a stimulator into the body. One recently emerging technique, called low-intensity focused ultrasound stimulation (FUS), has been proposed to non-invasively modulate neural activities. In this pilot study, the feasibility of adopting low-intensity FUS neuromodulation for BP regulation was investigated using animal models. Methods A FUS system was developed for BP modulation in rabbits. For each rabbit, the low-intensity FUS with different acoustic intensities was used to stimulate its exposed left vagus nerve, and the BP waveform was synchronously recorded in its right common carotid artery. The effects of the different FUS intensities on systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MAP), and heart rate (HR) were extensively examined from the BP recordings. Results The results demonstrated that the proposed FUS method could successfully induce changes in SBP, DBP, MAP, and HR values. When increasing acoustic intensities, the values of SBP, DBP, and MAP would tend to decrease more substantially. Conclusion The findings of this study suggested that BP could be modulated through the FUS, which might provide a new way for non-invasive and non-drug management of hypertension.

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Laparoscopic-based perivascular unilateral renal sympathetic nerve denervation for treating resistant hypertension: a case report

Cited by 8 publications

References 12 publications

Effect of extensive artery isolation during robotic-assisted partial nephrectomy on blood pressure of patients with poorly controlled hypertension: a preliminary study

Effect of extensive artery isolation during robotic-assisted partial nephrectomy on blood pressure of patients with poorly controlled hypertension: a preliminary study

Clinical outcomes of laparoscopic‐based renal denervation plus adrenalectomy vs adrenalectomy alone for treating resistant hypertension caused by unilateral aldosterone‐producing adenoma

Blood Pressure Modulation With Low-Intensity Focused Ultrasound Stimulation to the Vagus Nerve: A Pilot Animal Study

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