Renal Sympathetic Denervation – A Review of Applications in Current Practice

Kapil, Vikas; Jain, Ajay; Lobo, Melvin D.

doi:10.15420/icr.2011.9.1.54

Cited by 8 publications

(9 citation statements)

References 92 publications

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“…26–29 A separate class of catheters makes us of microinjection of neurotoxin (e.g. alcohol) to chemically ablate renal nerves and has the potential advantage of facilitating deeper nerve injury whilst avoiding endothelial damage.…”

Section: Renal Sympathetic Denervationmentioning

confidence: 99%

Interventional procedures and future drug therapy for hypertension

2016

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Hypertension management poses a major challenge to clinicians globally once non-drug (lifestyle) measures have failed to control blood pressure (BP). Although drug treatment strategies to lower BP are well described, poor control rates of hypertension, even in the first world, suggest that more needs to be done to surmount the problem. A major issue is non-adherence to antihypertensive drugs, which is caused in part by drug intolerance due to side effects. More effective antihypertensive drugs are therefore required which have excellent tolerability and safety profiles in addition to being efficacious. For those patients who either do not tolerate or wish to take medication for hypertension or in whom BP control is not attained despite multiple antihypertensives, a novel class of interventional procedures to manage hypertension has emerged. While most of these target various aspects of the sympathetic nervous system regulation of BP, an additional procedure is now available, which addresses mechanical aspects of the circulation. Most of these new devices are supported by early and encouraging evidence for both safety and efficacy, although it is clear that more rigorous randomized controlled trial data will be essential before any of the technologies can be adopted as a standard of care.

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Section: Renal Sympathetic Denervationmentioning

confidence: 99%

Interventional procedures and future drug therapy for hypertension

2016

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“…Current endovascular catheter systems typically access the renal arteries via the femoral artery and deliver radiofrequency (RF) or ultrasound (US) energy resulting in focal frictional heating of the arterial wall [ 7 ]. Other devices use neurotoxic agents such as alcohol or guanethedine [ 8 ]. This causes the destruction of the peri-arterial adventitial afferent and efferent renal nerves.…”

Section: Renal Denervationmentioning

confidence: 99%

“…It is likely that different iterations of the technology will be associated with different technical success and complication rates. There is an increasing utilisation of multi-electrode catheters for RF ablation and irrigated balloon catheters for US ablation [ 8 ]. Alternatively, catheters are being developed to introduce microinjection of neurotoxin (e.g.…”

Section: Renal Denervationmentioning

confidence: 99%

Device-based Therapy for Hypertension

Saxena

Mahfoud

et al. 2016

Curr Hypertens Rep

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Hypertension continues to be a major contributor to global morbidity and mortality, fuelled by an abundance of patients with uncontrolled blood pressure despite the multitude of pharmacological options available. This may occur as a consequence of true resistant hypertension, through an inability to tolerate current pharmacological therapies, or non-adherence to antihypertensive medication. In recent years, there has been a rapid expansion of device-based therapies proposed as novel non-pharmacological approaches to treating resistant hypertension. In this review, we discuss seven novel devices—renal nerve denervation, baroreflex activation therapy, carotid body ablation, central iliac arteriovenous anastomosis, deep brain stimulation, median nerve stimulation, and vagal nerve stimulation. We highlight how the devices differ, the varying degrees of evidence available to date and upcoming trials. This review also considers the possible factors that may enable appropriate device selection for different hypertension phenotypes.

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“…At one point in 2013 there were more than 60 companies with technologies in development for RDN including first and second generation RF ablation catheters, ultrasound catheters, radiotherapy catheters, cryotherapy and chemical ablation technologies. 18 Following the Symplicity HTN-3 announcement a number of companies have announced their withdrawal from the field of device therapy for hypertension including such large entities as Covidien. However, several of the major devices manufactures including Boston Scientific, Medtronic and St Jude Medical, having suspended clinical trial activity within pre-existing programmes, have announced their intention to commit to the field of renal sympathectomy.…”

Section: Current State Of Rdn Therapy In the Ukmentioning

confidence: 99%

“…Chemical ablation techniques with alcohol or guanethidine also offer potential advantage in obviating endothelial damage although it remains unclear whether or not dissemination of neurotoxin beyond the periadventitial layer could be an undesired effect of such therapy. 18 Determining which energy modality and ablation therapy is best to achieve near complete renal nerve ablation in the absence of damage to the renal artery lumen (and off-target effects) remains a priority.…”

Section: Critical Areas To Address To Determine the Role Of Rdn As A mentioning

confidence: 99%

Joint UK societies’ 2014 consensus statement on renal denervation for resistant hypertension

Lobo

Belder

Cleveland

et al. 2014

Heart

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Resistant hypertension continues to pose a major challenge to clinicians worldwide and has serious implications for patients who are at increased risk of cardiovascular morbidity and mortality with this diagnosis. Pharmacological therapy for resistant hypertension follows guidelines-based regimens although there is surprisingly scant evidence for beneficial outcomes using additional drug treatment after three antihypertensives have failed to achieve target blood pressure. Recently there has been considerable interest in the use of endoluminal renal denervation as an interventional technique to achieve renal nerve ablation and lower blood pressure. Although initial clinical trials of renal denervation in patients with resistant hypertension demonstrated encouraging office blood pressure reduction, a large randomised control trial (Symplicity HTN-3) with a sham-control limb, failed to meet its primary efficacy end point. The trial however was subject to a number of flaws which must be taken into consideration in interpreting the final results. Moreover a substantial body of evidence from non-randomised smaller trials does suggest that renal denervation may have an important role in the management of hypertension and other disease states characterised by overactivation of the sympathetic nervous system. The Joint UK Societies does not recommend the use of renal denervation for treatment of resistant hypertension in routine clinical practice but remains committed to supporting research activity in this field. A number of research strategies are identified and much that can be improved upon to ensure better design and conduct of future randomised studies.

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Renal Sympathetic Denervation – A Review of Applications in Current Practice

Cited by 8 publications

References 92 publications

Interventional procedures and future drug therapy for hypertension

Interventional procedures and future drug therapy for hypertension

Device-based Therapy for Hypertension

Joint UK societies’ 2014 consensus statement on renal denervation for resistant hypertension

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