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Endovascular radiofrequency renal denervation in treating refractory arterial hypertension: a preliminary experience

Sistema di denervazione renale endovascolare a radiofrequenza nel trattamento dell’ipertensione arteriosa resistente a terapia farmacologica: esperienza preliminare

  • Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

This study was done to investigate the efficacy and safety of percutaneous renal denervation with the Symplicity catheter for reducing blood pressure in patients with essential hypertension resistant to medical therapy (systolic blood pressure >160 mmHg despite the use of three or more antihypertensive drugs, including a diuretic).

Materials and methods

In September 2010, five patients affected by essential hypertension resistant to medical therapy were treated. All patients were studied by computed tomography angiography (CTA) of the renal arteries before the procedure and underwent follow-up at 30 and 60 days with colour Doppler ultrasound (CDUS) with evaluation of resistive index, glomerular filtration rate (GFR), 24-h blood pressure and serum catecholamine concentration. Student’s t test was used to assess the effectiveness of the procedure in lowering blood pressure.

Results

In treated patients, mean blood pressure at baseline was 171/100 mmHg [standard deviation (SD)±8/10]; mean GFR was 91.6 ml/min/1.73 m2 (SD±15). Blood pressure after the procedure was reduced by −18/−5 and −13/−10 mmHg at 30 and 60 days, respectively, with a mean medication reduction of 3.6. No complications occurred during the intra- or periprocedural period or during short-term follow-up.

Conclusions

The Symplicity system proved to be efficacious and without serious adverse events in reducing blood pressure and antihypertensive medication use in patients affected by essential hypertension resistant to medical therapy. Although encouraging, our data are preliminary and need to be validated by larger prospective randomised studies.

Riassunto

Obiettivo

Scopo del presente studio è stato valutare l’efficacia e la sicurezza della procedura di simpaticectomia renale percutanea a radiofrequenza mediante catetere Symplicity nel ridurre la pressione arteriosa sistemica in pazienti con ipertensione essenziale resistenti alla terapia farmacologica convenzionale (pressione sistolica>160 mmHg con 3 o più farmaci antiipertensivi, incluso diuretico).

Materiali e metodi

Nel mese di settembre 2010, sono stati trattati 5 pazienti affetti da ipertensione arteriosa essenziale non rispondenti a terapia. È stata eseguita angio-tomografia computerizzata (TC) delle arterie renali pre-procedurale e follow-up a 30 e 60 giorni con eco-color Doppler, valutazione degli indici di resistenza, del filtrato glomerulare, monitoraggio della pressione arteriosa nelle 24 ore e misurazione della catecolaminemia. L’analisi dei dati è stata effettuata mediante il test t di Student.

Risultati

I valori pressori medi basali della popolazione erano 171/100 mmHg [deviazione standard (DS)±8/10], con filtrato glomerulare medio di 91,6 ml/min/1,73 m2 (DS±15). Il decremento pressorio medio post-procedurale è stato di −18/−5 mmHg e −13/−10 mmHg a 30 e 60 giorni con riduzione media di 3,6 farmaci. Non vi sono state complicanze intra-/peri-procedurali e nel successivo follow-up a breve termine.

Conclusioni

Il sistema Symplicity si è dimostrato efficace nel ridurre i livelli pressori e la somministrazione dei farmaci anti-ipertensivi, in assenza di evidenti eventi avversi. Nonostante incoraggianti premesse, sarà necessario validare i preliminari dati ottenuti mediante più ampi studi prospettici randomizzati.

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Authors and Affiliations

  1. Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Policlinico Universitario “ Tor Vergata ”, Viale Oxford 81, 00133, Roma, Italy

    G. Simonetti, A. Spinelli, R. Gandini, V. Da Ros, E. Gaspari & I. Coco

  2. Unità di Nefrologia, Dipartimento di Medicina Interna, Fondazione Policlinico Universitario “ Tor Vergata ”, Viale Oxford 81, 00133, Roma, Italy

    M. De Francesco, D. Santucci, N. Di Daniele & R. Lauro

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  1. G. Simonetti
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  2. A. Spinelli
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  3. R. Gandini
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  4. V. Da Ros
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  5. E. Gaspari
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  6. I. Coco
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  7. M. De Francesco
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  8. D. Santucci
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  9. N. Di Daniele
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  10. R. Lauro
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Correspondence to A. Spinelli.

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Simonetti, G., Spinelli, A., Gandini, R. et al. Endovascular radiofrequency renal denervation in treating refractory arterial hypertension: a preliminary experience. Radiol med 117, 426–444 (2012). https://doi.org/10.1007/s11547-011-0766-6

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  • DOI: https://doi.org/10.1007/s11547-011-0766-6

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