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Clinical Trial
. 2018 Oct-Nov;19(7 Pt B):845-851.
doi: 10.1016/j.carrev.2018.02.016. Epub 2018 Mar 2.

Anatomical and procedural determinants of ambulatory blood pressure lowering following catheter-based renal denervation using radiofrequency

Lucas Lauder  1 , Sebastian Ewen  2 , Abraham R Tzafriri  3 , Elazer R Edelman  4 , Bodo Cremers  1 , Saarraaken Kulenthiran  1 , Christian Ukena  1 , Dominik Linz  1 , Ingrid Kindermann  1 , Costas Tsioufis  5 , Bruno Scheller  1 , Michael Böhm  1 , Felix Mahfoud  6
Affiliations
Clinical Trial

Anatomical and procedural determinants of ambulatory blood pressure lowering following catheter-based renal denervation using radiofrequency

Lucas Lauder et al. Cardiovasc Revasc Med. 2018 Oct-Nov.

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.

Keywords: Ambulatory blood pressure; Anatomical; Procedural determinants; Renal denervation.

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Figures

Figure 1:
Figure 1:
Nomenclature of the renal artery
Figure 2:
Figure 2:
Change of systolic office (A) and ambulatory blood pressure (B) at 6 months. BP: Blood pressure.
Figure 3:
Figure 3:
Change of systolic blood pressure at 6 months in the presence of small renal arteries (diameter unilaterally or bilaterally ≤4 mm). p-values are comparison between groups. BP: blood pressure.
Figure 4:
Figure 4:
Change of systolic blood pressure at 6 months according to number of ablations per diameter of the left (A) and right main renal artery (B). p-values are comparison between groups. BP: blood pressure.
See this image and copyright information in PMC

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References

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