Deutsches Herzzentrum und 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
EuroIntervention. 2013 May;9 Suppl R:R89-95. doi: 10.4244/EIJV9SRA15.
Endovascular renal denervation techniques have been clinically adopted for the treatment of resistant arterial hypertension with great success. Despite the favourable early results achieved with this technology, a clear understanding of the pathophysiology underlying this novel treatment is lacking. In addition, non-responsiveness to renal denervation remains a nidus for treatment failure in distinct patients. In search of meaningful surrogate parameters relating to treatment responsiveness, the current article reviews the existing knowledge on renal nerve anatomy, changes occurring after denervation and procedural parameters collected during denervation. From preclinical experience, the most reliable morphological parameter reflecting successful renal denervation is the presence of axonal degeneration. Most procedural and clinical parameters need extended investigation before adopting them as potential surrogate parameters for successful renal denervation. As a consequence, there is an imperative need for dedicated research revealing the pathophysiology of renal denervation procedures. In this regard, close co-operation of engineers, researchers and clinicians is warranted to turn renal denervation into a milestone treatment of arterial hypertension.
血管内去肾神经术已被临床用于治疗难治性动脉高血压，并取得了巨大成功。尽管这项技术的早期结果令人满意，但对这种新疗法的病理生理学基础仍缺乏清晰的认识。此外，去肾神经术的无反应性仍然是某些患者治疗失败的根源。为了寻找与治疗反应相关的有意义的替代参数，本文综述了目前关于肾神经解剖、去神经后发生的变化以及去神经过程中收集的程序参数的知识。从临床前经验来看，反映去肾神经术成功的最可靠形态学参数是轴突变性。大多数程序和临床参数在被采纳为成功去肾神经术的潜在替代参数之前，需要进一步的研究。因此，迫切需要开展专门的研究来揭示去肾神经术的病理生理学。在这方面，工程师、研究人员和临床医生之间的密切合作是必要的，以使去肾神经术成为治疗动脉高血压的一个里程碑。
