The role of renal nerve stimulation in percutaneous renal denervation for hypertension: A mini‐review

Huang, Hui‐Chun; Cheng, Hao‐Min; Chia, Yook Chin; Li, Yan; Minh, Huynh Van; Siddique, Saulat; Sukonthasarn, Apichard; Tay, Jam Chin; Turana, Yuda; Verma, Narsingh; Kario, Kazuomi; Wang, Tzung‐Dau

doi:10.1111/jch.14554

Cited by 5 publications

(3 citation statements)

References 41 publications

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“…Renal denervation is used to lower the blood pressure of hypertensive patients via the inhibition of sympathetic activity [99][100][101]. It may have beneficial effects in other indications beyond hypertension, such as renal failure [102,103] and atrial fibrillation [104].…”

Section: Renal Denervation and Atherosclerosismentioning

confidence: 99%

Sympathetic Nervous System and Atherosclerosis

Wang,

Anesi,

Maier

et al. 2023

IJMS

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Atherosclerosis is characterized by the narrowing of the arterial lumen due to subendothelial lipid accumulation, with hypercholesterolemia being a major risk factor. Despite the recent advances in effective lipid-lowering therapies, atherosclerosis remains the leading cause of mortality globally, highlighting the need for additional therapeutic strategies. Accumulating evidence suggests that the sympathetic nervous system plays an important role in atherosclerosis. In this article, we reviewed the sympathetic innervation in the vasculature, norepinephrine synthesis and metabolism, sympathetic activity measurement, and common signaling pathways of sympathetic activation. The focus of this paper was to review the effectiveness of pharmacological antagonists or agonists of adrenoceptors (α1, α2, β1, β2, and β3) and renal denervation on atherosclerosis. All five types of adrenoceptors are present in arterial blood vessels. α1 blockers inhibit atherosclerosis but increase the risk of heart failure while α2 agonism may protect against atherosclerosis and newer generations of β blockers and β3 agonists are promising therapies against atherosclerosis; however, new randomized controlled trials are warranted to investigate the effectiveness of these therapies in atherosclerosis inhibition and cardiovascular risk reduction in the future. The role of renal denervation in atherosclerosis inhibition in humans is yet to be established.

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Section: Renal Denervation and Atherosclerosismentioning

confidence: 99%

Sympathetic Nervous System and Atherosclerosis

Wang,

Anesi,

Maier

et al. 2023

IJMS

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“…Published guidelines in 2023 [8] recommended the use of opioids and benzodiazepines for the monitored anesthesia care approach. And some studies [9] reported the use of propofol combined with remifentanil to provide sedation and analgesia during RDN. Nevertheless, inappropriate anesthetic regimen can lead to airway and hemodynamic instability and can interference treatment effect.…”

Section: Introductionmentioning

confidence: 99%

Anesthetic Management during Endovascular Ultrasound Renal Denervation for hypertensive patients with Obstructive Sleep Apnea: Two case reports.

Huang,

Zheng,

2023

Preprint

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Endovascular ultrasound renal denervation (u-RDN) is a new, effective and non-pharmacological therapy for hypertensive patients with obstructive sleep apnea (OSA), requiring analgesia and sedation due to pain and discomfort. However, most OSA patients have difficult airways, and the selection of sedative and analgesic drugs is limited during u-RDN because drugs affecting sympathetic nerve activity need to avoid as much as possible. Appropriate anesthesia method can provide adequate analgesia and maintain stability of respiration and circulation, which is also related to better u-RDN results. Therefore, the anesthetic management of hypertensive patients with OSA during u-RDN is challenging and it is clinically important to explore best perioperative anesthesia strategy in the management of u-RDN procedure in these patients. We describe two cases of anesthesia management for hypertensive patients with severe OSA during u-RDN, which demonstrate that conscious analgesia based on remifentanil infusion combined with intermittent fentanyl bolus to enhance analgesia may improve hemodynamic stability, reduce the risk of respiratory depression and the need for airway support in hypertensive patients with OSA during u-RDN.

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“…RNS was performed immediately before and after RDN in bilateral proximal (approximately the midpoint of the proximal half of main renal artery) and distal (≈ 1 cm proximal to the bifurcation of branch renal arteries) main renal arteries using the 4 Fr quadripolar catheter (Advanced St. Jude Fix 4 polar Supreme 4F JSN), with bipolar stimulation from poles 1 to 2 (Figure [A]), under general anesthesia by intravenous infusion of a therapeutic dose (0.5–0.7 ml/kg/h) of propofol. 2 The pacing frequency was set at 10 Hz and the pacing output at 20 mA, with a pulse duration of 10 ms. All patients underwent 24-hour ambulatory BP monitoring at baseline and 6 months after RDN. Antihypertensive medications as prescribed at baseline were required to be taken at least 24 hours before ambulatory BP monitoring performed 6 months after RDN to make the results comparable under the same medication burden.…”

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confidence: 99%