Rabbia Franco, Testa Elisa, Fulcheri Chiara, Berra Elena, Di Monaco Silvia, Covella Michele, Pappaccogli Marco, Monticone Silvia, Rosiello Renato, Rossato Denis, Veglio Franco
Hypertension Unit AOU Città della Salute e della Scienza, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy.
Internal Medicine, Ospedale Santa Croce e Carle, Cuneo, Italy.
High Blood Press Cardiovasc Prev. 2017 Jun;24(2):187-192. doi: 10.1007/s40292-017-0197-0. Epub 2017 Apr 3.
Recent anatomical and clinical studies have led to the hypothesis that in several cases of failure of response to renal denervation (RDN), the procedure has not been technically correct.
To perform procedural reassessment in patients with true resistant hypertension who underwent RDN.
We retrospectively reassessed the procedural technique of RDN in 10 true resistant hypertensive patients, comparing the sites of renal ablations with the knowledge of animal and human post mortem evidences. Procedural ablation technique was assessed in terms of number of ablations for each renal artery and site of ablation (quadrant and distance from renal ostium) by using the radiologic images of each RDN and the number of radiofrequency ablation attempts documented in the reports of each denervation session.
10 patients were studied, 9 denervated with Simplicity monoelectrode catheter, 1 with multielectrode balloon technique. Responders to the procedure underwent more ablations and particularly at least a quadrant ablation in one of the kidney arteries, >2 ablations in Dorsal plus Ventral quadrants and in 67% of then >10 ablations were done in superior inferior and ventral quadrants.
This study confirms the importance of a well knowledge of renal artery anatomy and underlines the relevance of the choice of ablation sites in order to obtain a successful RDN procedure.
最近的解剖学和临床研究提出了一种假设，即在一些肾去神经支配（RDN）治疗反应失败的病例中，该手术在技术上并不正确。
对接受RDN治疗的真性难治性高血压患者进行手术重新评估。
我们回顾性地重新评估了10例真性难治性高血压患者的RDN手术技术，将肾脏消融部位与动物和人类尸检证据进行比较。通过使用每次RDN的放射影像以及每次去神经支配手术报告中记录的射频消融尝试次数，从每条肾动脉的消融次数和消融部位（象限以及距肾门的距离）方面评估手术消融技术。
研究了10例患者，9例使用单电极导管进行去神经支配，1例使用多电极球囊技术。手术反应者进行了更多的消融，特别是在其中一条肾动脉中至少进行了一个象限的消融，在背侧加腹侧象限进行了>2次消融，并且67%的患者在上下和腹侧象限进行了>10次消融。
本研究证实了熟知肾动脉解剖结构的重要性，并强调了选择消融部位对于成功进行RDN手术的相关性。
