Anatomical eligibility of the renal vasculature for catheter-based renal denervation in hypertensive patients.
OBJECTIVE
This study sought to determine the vascular anatomical eligibility for catheter-based renal artery denervation (RDN) in hypertensive patients.


BACKGROUND
Arterial hypertension is the leading cardiovascular risk factor for stroke and mortality globally. Despite substantial advances in drug-based treatment, many patients do not achieve target blood pressure levels. To improve the number of controlled patients, novel procedure- and device-based strategies have been developed. RDN is among the most promising novel techniques. However, there are few data on the vascular anatomical eligibility.


METHODS
We retrospectively analyzed 941 consecutive hypertensive patients undergoing coronary angiography and selective renal artery angiography between January 1, 2010, and May 31, 2012. Additional renal arteries were divided into 2 groups: hilar (accessory) and polar (aberrant) arteries. Anatomical eligibility for RDN was defined according to the current guidelines: absence of renal artery stenosis, renal artery diameter ≥4 mm, renal artery length ≥20 mm, and only 1 principal renal artery.


RESULTS
A total of 934 hypertensive patients were evaluable. The prevalence of renal artery stenosis was 10% (n = 90). Of the remaining 844 patients without renal artery stenosis, 727 (86%) had nonresistant hypertension and 117 (14%) had resistant hypertension; 62 (53%) of the resistant hypertensive and 381 (52%) of the nonresistant hypertensive patients were anatomically eligible for sympathetic RDN.


CONCLUSIONS
The vascular anatomical eligibility criteria of the current guidelines are a major limiting factor for the utilization of RDN as a therapeutic option. Development of new devices and/or techniques may significantly increase the number of candidates for these promising therapeutic options.
Department of Cardiology, Bern University Hospital, Bern, Switzerland. Electronic address: stefano.rimoldi@insel.ch.
Stefano F
SF
Rimoldi
Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Niklaus
N
Scheidegger
Department of Cardiology, Bern University Hospital, Bern, Switzerland; Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile.
Urs
U
Scherrer
Department of Nephrology, Bürgerspital Solothurn, Solothurn, Switzerland.
Stefan
S
Farese
Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Emrush
E
Rexhaj
Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Aris
A
Moschovitis
Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Stephan
S
Windecker
Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Bernhard
B
Meier
Department of Cardiology, Bern University Hospital, Bern, Switzerland. Electronic address: yves.allemann@insel.ch.
Yves
Y
Allemann
D000368:Aged; D062186:Arterial Pressure; D017763:Autonomic Denervation / Q000009:adverse effects / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D015995:Prevalence; D011859:Radiography; D012077:Renal Artery / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000294:innervation*; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland; D016896:Treatment Outcome
anatomical eligibility; arterial hypertension; renal vascular anatomy; sympathetic renal denervation