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高血压患者经导管肾动脉去神经支配的血管解剖学适宜性。

Anatomical eligibility of the renal vasculature for catheter-based renal denervation in hypertensive patients.

机构信息

Department of Cardiology, Bern University Hospital, Bern, Switzerland.

Department of Cardiology, Bern University Hospital, Bern, Switzerland.

出版信息

JACC Cardiovasc Interv. 2014 Feb;7(2):187-192. doi: 10.1016/j.jcin.2013.10.013. Epub 2014 Jan 15.

Abstract

OBJECTIVES

This study sought to determine the vascular anatomical eligibility for catheter-based renal artery denervation (RDN) in hypertensive patients.

BACKGROUND

Arterial hypertension is the leading cardiovascular risk factor for stroke and mortality globally. Despite substantial advances in drug-based treatment, many patients do not achieve target blood pressure levels. To improve the number of controlled patients, novel procedure- and device-based strategies have been developed. RDN is among the most promising novel techniques. However, there are few data on the vascular anatomical eligibility.

METHODS

We retrospectively analyzed 941 consecutive hypertensive patients undergoing coronary angiography and selective renal artery angiography between January 1, 2010, and May 31, 2012. Additional renal arteries were divided into 2 groups: hilar (accessory) and polar (aberrant) arteries. Anatomical eligibility for RDN was defined according to the current guidelines: absence of renal artery stenosis, renal artery diameter ≥4 mm, renal artery length ≥20 mm, and only 1 principal renal artery.

RESULTS

A total of 934 hypertensive patients were evaluable. The prevalence of renal artery stenosis was 10% (n = 90). Of the remaining 844 patients without renal artery stenosis, 727 (86%) had nonresistant hypertension and 117 (14%) had resistant hypertension; 62 (53%) of the resistant hypertensive and 381 (52%) of the nonresistant hypertensive patients were anatomically eligible for sympathetic RDN.

CONCLUSIONS

The vascular anatomical eligibility criteria of the current guidelines are a major limiting factor for the utilization of RDN as a therapeutic option. Development of new devices and/or techniques may significantly increase the number of candidates for these promising therapeutic options.

摘要

目的

本研究旨在确定高血压患者行导管相关性肾动脉去神经术(RDN)的血管解剖学适应证。

背景

动脉高血压是全球范围内导致中风和死亡的首要心血管风险因素。尽管在药物治疗方面取得了重大进展,但许多患者仍无法达到目标血压水平。为了增加血压得到控制的患者数量,已开发出一些新的基于手术和器械的策略。RDN 是最有前途的新技术之一。然而,关于血管解剖学适应证的数据很少。

方法

我们回顾性分析了 2010 年 1 月 1 日至 2012 年 5 月 31 日期间接受冠状动脉造影和选择性肾动脉造影的 941 例连续高血压患者。额外的肾动脉分为 2 组:肾门(副)动脉和极(异常)动脉。根据目前的指南,将 RDN 的解剖学适应证定义为:无肾动脉狭窄、肾动脉直径≥4mm、肾动脉长度≥20mm、仅 1 支主肾动脉。

结果

共有 934 例高血压患者可进行评估。肾动脉狭窄的患病率为 10%(n=90)。在无肾动脉狭窄的其余 844 例患者中,727 例(86%)为非耐药性高血压,117 例(14%)为耐药性高血压;耐药性高血压患者中 62 例(53%)和非耐药性高血压患者中 381 例(52%)解剖学上适合进行交感神经 RDN。

结论

当前指南的血管解剖学适应证标准是将 RDN 作为治疗选择的一个主要限制因素。开发新的器械和/或技术可能会显著增加这些有前途的治疗选择的候选人数。

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