Author + information
- Cinzia Moncalvo1,
- Vincenzo Puma1,
- Giuseppe Celano2,
- Angelo Laurenza1,
- Giuseppe Carosio1 and
- Paolo Cioffi1
In our center 11 patients (3 women. Average age 59.4 ± 16 years) affected by resistant hypertension were submitted to transcatheter renal denervation (TREND) between November 2011 and June 2013. 6 patients presented signs of hypertensive vascular damage. The patients were taking an average of 4 antihypertensive drugs in dosage ceiling, including a diuretic. The values of mean arterial pressure were: 176/98 ± 17/14 mmHg.
4 of the 11 patients were treated with the Ardian Simplicity System, the other 7 with the system EnlingHTN. For all patients we used the femoral arterial access. All patients were treated with double antiplatelet therapy for 3/6 months after the procedure. 4 patients had complex renal anatomy: 2 patients presented superior polar arteries and 2 early bifurcation (proximal segment length <10 mm), all of them had a diameter > 4 mm.
All patients were treated successfully. Patients with superior polar arteries and/or early bifurcations developed arterial spasm on polar arteries or on post-bifurcation branches, the spasm was attenuated but not completely solved at the end of the procedure. Follow up: CT angiography showed no vascular complications also in patients with complex renal anatomy. Renal function remained stable. The average ambulatory pressure was reduced to 150/94 ± 10/8 mmHg after one month and 117/69 ± 11/9 mmHg after one year. After 6 months 10 of the 11 patients presented a reduction of about 27/10 mmHg in blood pressure. 1 patient was hospitalized for hypertensive crisis 7 months after the procedure, blood pressure values normalized after about a year and are still stable. All patients have progressively reduced the number of antihypertensive drugs (1-2 vs 4 or more pre trend). The evaluation of patients with complex renal vascular anatomy has documented at 6 months a marked reduction in blood pressure (115/60 ± 12/10 mmHg) and in the number of drugs taken.
Our experience confirms that trend is an effective procedure in the treatment of hypertensive patients refractory to medical therapy. The presence of arterial spasm, considered a reversible periprocedural complication, in fact seems to be associated to a greater effectiveness of the treatment.