Author + information
- Received December 29, 2012
- Revision received June 7, 2013
- Accepted June 21, 2013
- Published online October 1, 2013.
- Dani Id, MD∗,
- Benjamin Kaltenbach∗,
- Stefan C. Bertog, MD∗,†,
- Marius Hornung, MD∗,
- Ilona Hofmann, MD∗,
- Laura Vaskelyte, MD∗ and
- Horst Sievert, MD∗∗ ()
- ∗CardioVascular Center Frankfurt, Frankfurt am Main, Germany
- †Department of Cardiology, Veterans Affairs Medical Center, Minneapolis, Minnesota
- ↵∗Reprint requests and correspondence:
Prof. Dr. med. Horst Sievert, CardioVascular Center Frankfurt, Seckbacher Landstrasse 65, 60389 Frankfurt, Germany.
Objectives This study sought to assess the efficacy of catheter-based renal sympathetic denervation in patients with accessory renal arteries and to compare the blood pressure (BP)-lowering effect with that observed in patients with bilateral single renal arteries after renal denervation.
Background Catheter-based renal sympathetic denervation causes significant BP reductions in patients with resistant hypertension.
Methods Seventy-four patients were included in this study. Patients were assigned to 2 main groups: a bilateral single renal arteries group I (n = 54) and an accessory renal arteries group II (n = 20). Group II consisted of 9 patients whose accessory renal arteries were all denervated (group IIa), and 11 patients whose accessory renal arteries were not, or only incompletely, denervated (group IIb). The primary endpoint was the change in office systolic BP after 6 months.
Results The procedure was successful in all patients. Group I: mean BP at baseline was 166.2/89.4 ± 20.5/14.6 mm Hg and decreased by −16.6 (p < 0.001)/−6.7 (p = 0.016) ± 16.4/11 mm Hg at 6-month follow-up. Group II: mean BP at baseline was 164.2/89.1 ± 19.9/15.4 mm Hg and decreased by −6.2 (p = 0.19)/−0.2 (p = 0.5) ± 19.7/11.3 mm Hg at 6-month follow-up. Patients in group IIa had an office BP reduction of −8.8 (p = 0.2)/1.1 ± 17.9/10.8 mm Hg and patients in group IIb of −4.1 (p = 0.55)/−1.3 ± 20.8/11.6 mm Hg. Similarly, significant improvements in 24-h mean systolic BP were seen in group I (−8.3 ± 17.4 mm Hg, p < 0.01), whereas none were seen in group II (−3.7 ± 8.3 mm Hg, p = 0.38).
Conclusions BP reduction achieved after renal denervation in patients with accessory renal arteries is less pronounced than in patients with bilateral single renal arteries.
Dr. Sievert has received study honoraria, travel expenses, and consulting fees from Abbott, Access Closure, AGA Medical, Angiomed, Aptus, Arstasis, Atritech, Atrium, Avinger, Bard, Boston Scientific, Bridgepoint, Cardiac Dimensions, CardioKinetix, CardioMEMS, Coherex, Contego, Cardiovascular Systems, Inc., CVRx, Inc., EndoCross, EndoTex, Epitek, ev3, FlowCardia, Gore, Guidant, Guided Delivery Systems, Inc., InSeal Medical, Lumen Biomedical, Heart Leaflet Technologies, Inc., Kensey Nash, Kyoto Medical, Lifetech, Lutonix, Maya Medical, Medinol, Medtronic, Nitinol Medical Therapies, Inc., Nitinol Devices and Components, Inc., OAS Medical, Occlutech, Osprey, Ovalis, Pathway, PendraCare, Percardia, pfm Medical, Recor, ResMed, Rox Medical, Sadra, Sorin, Spectranetics, SquareOne, Trireme, Trivascular, Velocimed, Venus Medical, Veryan, and Vessix; and has stock options in Cardiokinetix, Access Closure, Velocimed, Lumen Biomedical, Coherex, and SMT. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Abbreviations and Acronyms
- blood pressure
- estimated glomerular filtration rate
- Received December 29, 2012.
- Revision received June 7, 2013.
- Accepted June 21, 2013.
- American College of Cardiology Foundation