Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland.
Kardiol Pol. 2013;71(2):152-8. doi: 10.5603/KP.2013.0008.
Arterial hypertension is one of the main causes of cardiovascular disease morbidity and overall mortality.
To report the single centre experiences with changes in arterial blood pressure (BP) in patients after intra-arterial application of radiofrequency (RF) energy to cause renal sympathetic efferent and somatic afferent nerve and report vascular and kidney safety in a six month follow up.
Twenty-eight patients, with hypertension despite medical therapy (median age 52.02 years, range 42-72 years) consented to therapeutic renal nerve ablation. SIMPLICITY RF catheters and generator provided by Ardian (currently Medtronic Inc., USA) were used to perform renal artery angiography and ablation.
The mean BP at baseline, and after one month, three months and six months were measured [mm Hg]: systolic 176.6; 162.3 (p = 0.004); 150.6 (p < 0.001); 147.2 (p < 0.001); diastolic 100.2; 90.3 (p < 0.001); 91.79 (p = 0.03); 88.5 (p < 0.001); pulse pressure 76.57; 75.18 (p = NS); 65.80 (p < 0.001); 62.15 (p < 0.001). Neither procedure-related nor therapy-related complications were reported in the six month follow up.
In our cohort of patients, intra-arterial renal nerve denervation was not associated with either vascular or renal complications out to six months. Nerve ablation of renal arteries led to significant reduction of mean values of arterial systolic, diastolic BP and significant reduction of pulse pressure. The Polish experience is not significantly different compared to that reported in the Symplicity I and Symplicity II international cohorts. The long term durability of this therapy and its application to earlier stages of hypertension or other disease states will require further investigation.
动脉高血压是心血管疾病发病率和总体死亡率的主要原因之一。
报告在对肾交感传出和躯体传入神经进行射频（RF）能量内动脉应用后，患者动脉血压（BP）变化的单中心经验，并在 6 个月的随访中报告血管和肾脏安全性。
28 名高血压患者（中位年龄 52.02 岁，范围 42-72 岁）尽管接受了药物治疗，但仍同意进行治疗性肾神经消融。Ardian（现为 Medtronic Inc.，美国）提供的 SIMPLICITY RF 导管和发生器用于进行肾动脉造影和消融。
基线时、术后 1 个月、3 个月和 6 个月的平均 BP[mmHg]分别为：收缩压 176.6；162.3（p=0.004）；150.6（p<0.001）；147.2（p<0.001）；舒张压 100.2；90.3（p<0.001）；91.79（p=0.03）；88.5（p<0.001）；脉压 76.57；75.18（p=NS）；65.80（p<0.001）；62.15（p<0.001）。在 6 个月的随访中，未报告与程序相关或治疗相关的并发症。
在我们的患者队列中，动脉内肾神经去神经支配在 6 个月内既不与血管并发症相关，也不与肾脏并发症相关。肾动脉神经消融导致动脉收缩压、舒张压和脉压的平均值显著降低。波兰的经验与国际 Symplicity I 和 Symplicity II 队列的报告没有显著差异。这种治疗的长期耐久性及其在高血压或其他疾病状态的早期阶段的应用需要进一步研究。
