Predictors for success in renal denervation–a single centre retrospective analysis

Reshetnik, Alexander; Gohlisch, Christopher; Scheurig-Muenkler, Christian; Bucourt, Maximilian de; Zidek, Walter; Tölle, Markus; Giet, Markus van der

doi:10.1038/s41598-018-33783-3

Cited by 13 publications

(13 citation statements)

References 26 publications

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“…The study did not involve blind randomization for the use of a particular type of catheter; patients were included in the groups as the catheters were modifi ed. In this study by analogy with previously published studies (13) the patients in whom BP reduction of 10 mmHg or more was achieved were considered as responders.…”

Section: Methodsmentioning

confidence: 99%

Renal denervation in resistant hypertension treatment

OREKHOV¹,

SABITOV²,

KARAZHANOVA³

2022

BLL

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BACKGROUND AND OBJECTIVES: Purpose of the study is the assessment of the effectiveness of renal denervation with different types of catheters, as well as its long-term effects, in the patients with resistant hypertension. MATERIALS AND METHODS: This single-center prospective study included 81 patients who underwent a renal denervation procedure using 2 types of catheters: monopolar and helical (Medtronic Inc., Minneapolis, Minnesota, the USA) between 2015 and 2018. Baseline demographics, clinical, functional and laboratory characteristics of the patients were assessed. A comparative analysis of the dynamics of offi ce systolic and diastolic blood pressure during 5 years of follow-up was carried out. The Kaplan-Meier method was used to study the survival of the patients with resistant hypertension after renal denervation. RESULTS: A total of 81 patients with a mean age of 57.79 ± 9.87 years, of whom 37.04 % were men, were included in the 2-stage study (fi rst stage using monopolar catheters and second stage using spiral catheters). At the time of inclusion, study participants were receiving an average of 4.5 ± 1.4 antihypertensive medications. In 36 (or 44.4 %), the procedure was performed using a monopolar catheter; in 45 (or 55.6 %), a spiral catheter was used. There were no statistically signifi cant differences between the two groups of the patients. The analysis established statistically signifi cant changes in the dynamics of offi ce SBP and DBP (p < 0.001) assessed 1, 2, 3, 4, and 5 years after the renal denervation procedure. The analysis demonstrated a stability in the reduction of offi ce SBP and DBP during the 5-year follow-up. The results of the study showed that the median survival time was 1061 days from the beginning of follow-up (95% CI: 728.03 to 1 393.97 days); the median survival time in the monopolar catheter group was 777 days (95% CI: 692.314 to 861.686) and in the spiral catheter group 1 294 days (95% CI: 713.079 to 1 874.921). FINDINGS: Our results demonstrated the effi ciency and safety of renal denervation in both short-term and long-term follow-up using monopolar and spiral catheters in the treatment of uncontrolled hypertension with combined antihypertensive therapy. The most signifi cant is the demonstrated stability of the effect after the procedure. In addition, the survival rate of the patients with resistant hypertension after the intervention has been carried out (Tab. 2, Fig. 3, Ref. 22).

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Section: Methodsmentioning

confidence: 99%

Renal denervation in resistant hypertension treatment

OREKHOV¹,

SABITOV²,

KARAZHANOVA³

2022

BLL

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“…Response to RDN was defined as a ≥10 mm Hg reduction in office systolic BP or ≥5 mm Hg reduction in 24‐hours ambulatory systolic BP, as used in previous studies 9,23‐25 . Major adverse events were defined as safety endpoints, and it was reported whether they were related to study intervention.…”

Section: Methodsmentioning

confidence: 99%

“…For a post hoc sample size evaluation, a clinically relevant difference of ≥10 mm Hg in office systolic BP was assumed 9,23‐26 . For the power analysis, we used a simulation‐based approach with 1000 simulations on the mixed model with dependent variable office systolic BP over time and independent variables time‐point (1, 6, 12, 24, and 36 months), including random patient intercepts.…”

Section: Methodsmentioning

confidence: 99%

Clinical benefits and safety of renal denervation in severe arterial hypertension: A long‐term follow‐up study

Naduvathumuriyil

Held

Steigmiller

et al. 2020

J of Clinical Hypertension

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Funding information TFL has received research grants from Boston Scientific and St. Jude Medical and consulting honoraria from Medtronic and St. Jude Medical. IS and AJF received lecture honoraria from Medtronic. FR reports grant support for the ESC-HFA Postgraduate Course in Heart Failure from Novartis, Servier, Bayer, Abbott and Astra Zeneca and the VASCEND trial from Novartis (all payments directly to the University of Zurich). FR has been paid for the time spent as a committee member for clinical trials, advisory boards, other forms of consulting and lectures or presentations. These payments were made directly to the University of Zurich and no personal payments were received in relation to these trials or other activities since January 2018.

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“…3 The significant reduction in BP may be related with the placebo effect or with the increased baseline BP prior to procedure. 26 The changes in patient seletion and technique, and the results of recent randomized trials bring new perspectives into the treatment of RH, whose pressure control is inadequate, despite all the available drug armamentarium. The most robust randomized trials have already shown the biological validity and clinical utility of RSD.…”

Section: Post Symplicity Htn-3 Studiesmentioning

confidence: 99%

Renal Sympathetic Denervation Using a Novel Device: A Clinical Case Discussion and Literature Update

Ferreira¹,

Fuks²,

Staico³

et al. 2021

International Journal of Cardiovascular Sciences

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Resistant hypertension (RH) is directly related to increased mortality, severe renal changes, and cardiac and cerebrovascular diseases, due to lack of adequate drug treatment. 1 Cardiovascular disease mortality increases progressively and linearly as BP increases, whereas BP lowering is associated with significantly reduced risks. [2][3][4][5] Increased sympathetic tone in renal arteries is one of the major components of RH, and catheters have been developed using several technologies which allow for radiofrequency ablation (RA) and blood pressure (BP) reduction. The discussions and controversies about the effectiveness of this treatment are quite broad, especially when associated with the use of new devices. In this clinical case study, with an 18-month follow-up, we describe the development of knowledge regarding this technique and its evidence basis. Clinical CaseMale patient, 48 years old, with uncontrolled RH, under treatment with seven antihypertensive drugs at maximum tolerated daily doses (Atenolol 100 mg, Furosemide 80 mg, Hydrochlorothiazide 25 mg, Spironolactone 25 mg, Hydralazine Hydrochloride 200 mg, Methyldopa 1000 mg and Telmisartan 160 mg). Office blood pressure remained above 185/105 mmHg and mean arterial pressures measured by Ambulatory Blood Pressure Monitoring (ABPM) were 186/120 mmHg over the total period, 193/127 mmHg while awake, and 174/107 mmHg during sleep. All major causes of secondary hypertension (primary hyperaldosteronism, pheochromocytoma, aortic coarctation, Cushing syndrome, hyperthyroidism, renal parenchymal disease, renal artery stenosis, obstructive sleep apnea syndrome) were excluded by biochemical, graphic and imaging exams. In late November 2017, the patient was admitted due to failure to obtain adequate BP control. In that occasion, complementary exams, such as electrocardiogram, echocardiogram and renal function, did not reveal abnormal findings.Renal Sympathetic Denervation (RSD) was indicated due to the ineffectiveness of medical treatment and the change of habits to which he was submitted. The procedure was performed on November 17, 2018.The Symplicity Spyral catheter (Medtronic, Galway, Ireland) (Figure 1) was used, which allows for multiple simultaneous radiofrequency (RF) ablations in the renal artery.We opted for conscious sedation with benzodiazepine and venous opioid, to avoid intense visceral pain, caused by RF ablation, and possible patient mobilization. The angiographic image showed anatomy favorable for RSD, with adequate-caliber major arteries and bilateral branches, and absence of accessory branches (Figure 2). Access to the renal arteries was facilitated by an angioplasty guidewire, which allowed for the placement of the Symplicity Spyral catheter, whose helical pattern conforms to the lumen, taking the shape of these branches, and delivering RF energy simultaneously to

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Predictors for success in renal denervation–a single centre retrospective analysis

Cited by 13 publications

References 26 publications

Renal denervation in resistant hypertension treatment

Renal denervation in resistant hypertension treatment

Clinical benefits and safety of renal denervation in severe arterial hypertension: A long‐term follow‐up study

Renal Sympathetic Denervation Using a Novel Device: A Clinical Case Discussion and Literature Update

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