Deborah Heart & Lung Center, Brown Mills, NJ, USA.
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Cardiovasc Revasc Med. 2022 Jun;39:58-65. doi: 10.1016/j.carrev.2021.09.008. Epub 2021 Sep 30.
To assess the variability of renal artery (RA) anatomy and presence of RA-pathology in patients with mild-to-moderate hypertension enrolled in the RADIANCE-HTN SOLO trial.
RADIANCE-HTN SOLO was a multicenter, international, blinded, randomized, sham-controlled trial evaluating ultrasound-based endovascular renal denervation (RDN) in patients with mild-to-moderate hypertension while off antihypertensive medications.
Eligible subjects had pre-randomization renal CT- or MR- angiography (CTA, MRA) to confirm anatomic suitability and to define RA ablation sites. All images were sent for independent review for evaluation of RA anatomy and other vascular pathology.
A total of 324 patients underwent RA imaging (282 CTA and 42 MRA). Of those, 178 had simple anatomy with a single left and single right RA with mean diameters of 5.4 ± 0.9 and 5.1 ± 0.8 mm and mean lengths of 40.0 ± 12.9 and 52.0 ± 13.1 mm, respectively. Twenty-seven patients (8.3%) had unilateral or bilateral dual RAs with mean diameters of 4.0 ± 0.9 mm on the left and 3.9 ± 0.9 mm on the right. Forty percent (129/324) of patients had at least 1 accessory RA, with mean accessory diameters of 2.4 ± 0.8 mm on the left and 2.3 ± 0.8 mm on the right. Twenty-eight patients (8.6%) had at least 1 short (<25 mm) main RA. Incidental findings included: 9 patients (2.8%) with atherosclerotic RA stenosis ≥30%, 9 patients (2.8%) with fibromuscular dysplasia of RA and 2 patients (0.6%) with kidney and adrenal gland tumors.
Pre-procedure CTA or MRA imaging is a valuable aid in assessing RA anatomy prior to RDN because of variable RA anatomy. CTA or MRA may detect RA lesions, and renal or adrenal tumors which may need additional workup prior to consideration of RDN.
ClinicalTrials.gov NCT02649426.
评估 RADIANCE-HTN SOLO 试验中轻度至中度高血压患者的肾动脉 (RA) 解剖结构和 RA 病变的变异性。
RADIANCE-HTN SOLO 是一项多中心、国际、盲法、随机、假对照试验，评估了在轻度至中度高血压患者停用抗高血压药物时基于超声的血管内肾去神经支配 (RDN)。
合格的受试者在随机分组前进行肾 CT 或磁共振血管造影 (CTA、MRA)，以确认解剖结构合适，并确定 RA 消融部位。所有图像均发送进行独立审查，以评估 RA 解剖结构和其他血管病理学。
共 324 例患者进行了 RA 成像 (282 例 CTA 和 42 例 MRA)。其中，178 例具有简单的解剖结构，单侧或双侧存在单根左、右 RA，左、右 RA 的平均直径分别为 5.4±0.9mm 和 5.1±0.8mm，平均长度分别为 40.0±12.9mm 和 52.0±13.1mm。27 例患者 (8.3%) 存在单侧或双侧双 RA，左侧平均直径为 4.0±0.9mm，右侧平均直径为 3.9±0.9mm。40% (129/324) 的患者至少存在 1 条副 RA，左侧平均副 RA 直径为 2.4±0.8mm，右侧平均副 RA 直径为 2.3±0.8mm。28 例患者 (8.6%) 至少存在 1 条主 RA 短 (<25mm)。偶然发现包括：9 例患者 (2.8%) 存在≥30%的动脉粥样硬化性 RA 狭窄，9 例患者 (2.8%) 存在 RA 纤维肌性发育不良，2 例患者 (0.6%) 存在肾和肾上腺肿瘤。
在进行 RDN 之前，CTA 或 MRA 术前成像可作为评估 RA 解剖结构的有价值的辅助手段，因为 RA 解剖结构多变。CTA 或 MRA 可能会发现 RA 病变以及肾脏或肾上腺肿瘤，在考虑 RDN 之前，这些病变可能需要进一步检查。
ClinicalTrials.gov NCT02649426。
