Cor Vasa 2014, 56(3):e228-e234 | DOI: 10.1016/j.crvasa.2014.02.004

Technical and safety aspects of renal denervation

Karol Čurilaa,b,*, Ján Rosac,d, Petr Toušeka,b, Jiří Widimský jr.c,d, Petr Widimskýa,b
a III. interní-kardiologická klinika, Kardiocentrum 3. lékařské fakulty Univerzity Karlovy, Praha, Česká republika
b Fakultní nemocnice Královské Vinohrady, Praha, Česká republika
c Centrum pro hypertenzi, III. interní klinika, 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika
d Všeobecná fakultní nemocnice, Praha, Česká republika

Aims: Renal denervation is a novel method used to treat patients with resistant hypertension. Several studies showing the efficacy of this method in blood pressure reduction have been published. However, there is a lack of data that focused on the technical aspects of the procedure. The aim of this paper is to present and discuss the technical and safety issues of the procedure.

Methods and results: 37 patients underwent renal denervation using a Symplicity catheter between 10/2011 and 8/2013. Number of ablations, procedural time, consumption of contrast agent and complication rate during hospitalization were recorded. Bilateral denervation was performed on 35 patients; in 29 of the cases, at least 4 ablations in each renal artery were done. The average duration of procedure was 57 ± 10 min and the average amount of contrast agent used was 93 ± 29 ml. During the study, both values were trending downward as the numbers of procedures increased. We observed minor complications in 9 patients. None of them were serious and none resulted in patient disability.

Conclusion: Renal denervation is for skilled interventional cardiologist and it is an easy and safe method with a short learning curve. It may be accompanied by minor complications, not deteriorating patient health status.

Keywords: Complication; Renal denervation; Safety; Technical aspect

Received: December 31, 2013; Revised: February 8, 2014; Accepted: February 10, 2014; Published: June 1, 2014  Show citation

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Čurila K, Rosa J, Toušek P, Widimský J, Widimský P. Technical and safety aspects of renal denervation. Cor Vasa. 2014;56(3):e228-234. doi: 10.1016/j.crvasa.2014.02.004.
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    References

    1. P.M. Kearney, M. Whelton, K. Reynolds, et al., Global burden of hypertension: analyses of worldwide data, Lancet 365 (2005) 217-223. Go to original source...
    2. P. Widimsky, P. Osmancik, J. Widimsky jr., Renal denervation: the hope for patients with refractory hypertension?, Cor et Vasa 53 (2011) 517-521. Go to original source...
    3. D.A. Calhoun, D. Jones, S. Textor, et al., American Heart Association Professional Education Committee, Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research, Circulation 117 (2008) 510-526. Go to original source... Go to PubMed...
    4. G.F. DiBonna, Sympathetic nervous system and the kidney in hypertension, Current Opinion in Nephrology and Hypertension 11 (2002) 197-200. Go to original source... Go to PubMed...
    5. R.H. Smithwick, Hypertensive vascular disease; results of and indications for splanchnicectomy, Journal of Chronic Diseases 1 (1955) 477-496. Go to original source... Go to PubMed...
    6. M.P. Schlaich, P.A. Sobotka, H. Krum, et al., Renal sympathetic-nerve ablation for uncontrolled hypertension, New England Journal of Medicine 361 (2009) 932-934. Go to original source... Go to PubMed...
    7. H. Krum, M. Schlaich, R. Whitbourn, et al., Catheter-based renal sympathetic denervation for resistant hypertension: a multicenter safety and proof-of-principle cohort study, Lancet 373 (2009) 1275-2781. Go to original source... Go to PubMed...
    8. M.D. Esler, H. Krum, P.A. Sobotka, et al., Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial, Lancet 376 (2010) 1903-1909. Go to original source...
    9. Symplicity HTN-1 Investigators, Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months, Hypertension 57 (2011) 911-917. Go to PubMed...
    10. M.P. Schlaich, R.E. Schmieder, G. Bakris, et al., International expert consensus statement: percutaneous transluminal renal denervation for the treatment of resistant hypertension, Journal of the American College of Cardiology 62 (2013) 2031-2045. Go to original source... Go to PubMed...
    11. C. Scheurig-Muenkler, W. Weiss, E. Foert, et al., Renal denervation for refractory hypertension - technical aspects, complications and radiation exposure, RöFo 6 (2013) 550-557. Go to original source... Go to PubMed...
    12. J. Vaclavik, M. Taborsky, D. Richter, Unilateral catheter-based renal sympathetic denervation in resistant arterial hypertension shows no blood pressure-lowering effect, Clinical and Experimental Hypertension 35 (2013) 192-194. Go to original source... Go to PubMed...
    13. L. Armaganijan, R. Staico, A. Abizaid, et al., Unilateral renal artery sympathetic denervation may reduce blood pressure in patients with resistant hypertension, Journal of Clinical Hypertension 15 (2013) 606. Go to original source... Go to PubMed...
    14. J.G. Whayne, S. Nath, D.E. Haines, Microwave catheter ablation of myocardium in vitro, assessment of the characteristics of tissue heating and injury, Circulation 89 (1994) 2390-2395. Go to original source... Go to PubMed...
    15. W.C. Ko, S.K. Huang, J.L. Lin, et al., New method for predicting efficiency of heating by measuring bioimpedance during radiofrequency catheter ablation in humans, Journal of Cardiovascular Electrophysiology 12 (2001) 819-823. Go to original source... Go to PubMed...
    16. M.K. Rippy, D. Zarins, N.C. Barman, et al., Catheter-based renal sympathetic denervation: chronic preclinical evidence for renal artery safety, Clinical Research in Cardiology 100 (2011) 1095-1101. Go to original source... Go to PubMed...
    17. H. Eklöf, H. Ahlström, A. Magnusson, et al., A prospective comparison of duplex ultrasonography, captopril renography, MRA, and CTA in assessing renal artery stenosis, Acta Radiologica 47 (2006) 764-774. Go to original source... Go to PubMed...
    18. O. Vonend, G. Antoch, L.C. Rump, D. Blondin, Secondary rise in blood pressure after renal denervation, Lancet 380 (2012) 778. Go to original source... Go to PubMed...
    19. B. Kaltenbach, D. Id, J.C. Franke, et al., Renal artery stenosis after renal sympathetic denervation, Journal of the American College of Cardiology 60 (2012) 2694-2695. Go to original source... Go to PubMed...
    20. C. Templin, M. Jaguszewski, R. Ghadri, et al., Vascular lesions induced by renal nerve ablation as assessed by optical coherence tomography: pre-and post-procedural comparison with the Simplicity(R) catheter system and the EnligHTNTM multi-electrode renal denervation catheter, European Heart Journal 34 (2013) 2141-2148. Go to original source... Go to PubMed...
    21. J.A. Ormiston, T. Watson, N. van Pelt, et al., First-in-human use of the OneShotTM renal denervation system from Covidien, EuroIntervention 22 (2013) 1090-1094. Go to original source... Go to PubMed...
    22. http://clinicaltrials.gov/ct2/show/NCT01541865?term=reduce-HTN&rank=1.
    23. T. Mabin, M. Sapoval, V. Cabane, et al., First experience with endovascular ultrasound renal denervation for the treatment of resistant hypertension, EuroIntervention 15 (2012) 57-61. Go to original source... Go to PubMed...
    24. P.M. Consigny, D. Davalian, R. Donn, et al., Chemical renal denervation in the rat, CardioVascular and Interventional Radiology 37 (2014) 218-223. Go to original source... Go to PubMed...
    25. T.A. Fischell, F. Vega, N. Raju, et al., Ethanol-mediated perivascular renal sympathetic denervation: preclinical validation of safety and efficacy in a porcine model, EuroIntervention 20 (2013) 140-147. Go to original source... Go to PubMed...
    26. J. Brinkmann, K. Heusser, B.M. Schmidt, et al., Catheter based renal nerve ablation and centrally generated sympathetic activity in difficult-to-control hypertensive patients: prospective case series, Hypertension 60 (2012) 1485-1490. Go to original source... Go to PubMed...
    27. A. Persu, Y. Jin, M. Azizi, et al., Blood pressure changes after renal denervation at 10 European Expert Centers, Journal of Q3 Human Hypertension (2014), http://dx.doi.org/10.1038/jhh.2013.88 (in press). Go to original source... Go to PubMed...
    28. A. Persu, M. Azizi, M. Burnier, et al., Residual effect of renal denervation in patients with truly resistant hypertension, Hypertension 62 (2013) 450-452. Go to original source... Go to PubMed...
    29. http://www.tctmd.com/show.aspx?id=123265.

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