Centre of Vascular Medicine: Angiology and Vascular Surgery, Park Hospital Leipzig, Germany.
J Endovasc Ther. 2014 Apr;21(2):181-90. doi: 10.1583/13-4566R.1.
To investigate the effect of renal denervation (RDN) on blood pressure and renal function in refractory hypertension after renal artery recanalization and optimal medical therapy.
Ten patients (6 women; mean age 70.0±5.1 years) with an office systolic blood pressure >160 mmHg despite taking ≥3 antihypertensive drugs and uni- or bilateral renal artery stenting were treated with RDN. Radiofrequency (RF) energy was delivered to the native segment of the artery keeping a 5-mm safe distance from the stented segments. Standardized office (OBP) and ambulatory (ABP) blood pressure measurements, medication, and renal assessment, including renal duplex ultrasound and renal function, were determined at baseline and on follow-up to 12 months.
OBP (systolic/diastolic) at baseline was 190.0±20.4 / 84.2±10.1 mmHg. It decreased to 171.1±28.7* / 82.2±8.7, 165.5±28.4(†) / 76.1±7.4, and 158.3±14.2(†) / 75.5±9.5(†) mmHg (*p<0.001; (†)p<0.01) at 3, 6, and 12 months after RDN, respectively. Average ABP (systolic/diastolic) after 6 and 12 months decreased by -7.6(‡) / -3.1 and -11.3(‡) / -5.1(‡) mmHg ((‡)p<0.05). There was no renal artery (re)stenosis, dissection, or aneurysm within 12 months. Creatinine, cystatin C, and glomerular filtration rate remained unchanged. Urine albumin excretion decreased in 4/10 patients. Renal resistive indices improved in native, but not in stented renal arteries within the follow-up period.
This proof-of-concept study demonstrates that RF-based RDN can be safely and effectively delivered in patients with resistant hypertension and previous renal artery stenting.
探讨肾动脉再通及最佳药物治疗后难治性高血压患者肾去神经支配（RDN）对血压和肾功能的影响。
10 例患者（6 例女性；平均年龄 70.0±5.1 岁）在服用≥3 种降压药物后，诊室收缩压仍>160mmHg，且进行了单侧或双侧肾动脉支架置入术，接受 RDN 治疗。将射频（RF）能量输送至动脉的原生段，与支架段保持 5mm 的安全距离。在基线和 12 个月的随访中，分别测定标准化诊室（OBP）和动态血压（ABP）测量、药物治疗和包括肾双功超声和肾功能在内的肾脏评估。
基线时 OBP（收缩压/舒张压）为 190.0±20.4/84.2±10.1mmHg。它分别降低至 171.1±28.7* / 82.2±8.7、165.5±28.4（†）/76.1±7.4和 158.3±14.2（†）/75.5±9.5（†）mmHg（*p<0.001；（†）p<0.01）在 RDN 后 3、6 和 12 个月时，分别。6 个月和 12 个月后的平均 ABP（收缩压/舒张压）分别下降了-7.6（‡）/ -3.1 和-11.3（‡）/ -5.1（‡）mmHg（（‡）p<0.05）。在 12 个月内，无肾动脉（再）狭窄、夹层或动脉瘤。肌酐、胱抑素 C 和肾小球滤过率保持不变。在 10 例患者中有 4 例的尿白蛋白排泄减少。在随访期间，肾内动脉的肾阻力指数在原生肾动脉中得到改善，但在支架置入的肾动脉中没有改善。
本概念验证研究表明，RF 为基础的 RDN 可安全有效地应用于难治性高血压和先前肾动脉支架置入术的患者。
