title: Renal denervation for hypertension refractory to renal artery stenting.
abstract: OBJECTIVE
  To investigate the effect of renal denervation (RDN) on blood pressure and renal function in refractory hypertension after renal artery recanalization and optimal medical therapy.
  
  
  METHODS
  Ten patients (6 women; mean age 70.0±5.1 years) with an office systolic blood pressure >160 mmHg despite taking ≥3 antihypertensive drugs and uni- or bilateral renal artery stenting were treated with RDN. Radiofrequency (RF) energy was delivered to the native segment of the artery keeping a 5-mm safe distance from the stented segments. Standardized office (OBP) and ambulatory (ABP) blood pressure measurements, medication, and renal assessment, including renal duplex ultrasound and renal function, were determined at baseline and on follow-up to 12 months.
  
  
  RESULTS
  OBP (systolic/diastolic) at baseline was 190.0±20.4 / 84.2±10.1 mmHg. It decreased to 171.1±28.7* / 82.2±8.7, 165.5±28.4(†) / 76.1±7.4, and 158.3±14.2(†) / 75.5±9.5(†) mmHg (*p<0.001; (†)p<0.01) at 3, 6, and 12 months after RDN, respectively. Average ABP (systolic/diastolic) after 6 and 12 months decreased by -7.6(‡) / -3.1 and -11.3(‡) / -5.1(‡) mmHg ((‡)p<0.05). There was no renal artery (re)stenosis, dissection, or aneurysm within 12 months. Creatinine, cystatin C, and glomerular filtration rate remained unchanged. Urine albumin excretion decreased in 4/10 patients. Renal resistive indices improved in native, but not in stented renal arteries within the follow-up period.
  
  
  CONCLUSIONS
  This proof-of-concept study demonstrates that RF-based RDN can be safely and effectively delivered in patients with resistant hypertension and previous renal artery stenting.
authors.affiliation: Centre of Vascular Medicine: Angiology and Vascular Surgery, Park Hospital Leipzig, Germany.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Bausback
authors.forename: Josef
authors.initials: J
authors.lastname: Friedenberger
authors.forename: Klaus
authors.initials: K
authors.lastname: Hertting
authors.forename: Martin
authors.initials: M
authors.lastname: Werner
authors.forename: Daniela
authors.initials: D
authors.lastname: Branzan
authors.forename: Bruno
authors.initials: B
authors.lastname: Freitas
authors.forename: Michael
authors.initials: M
authors.lastname: Piorkowski
authors.forename: Andrej
authors.initials: A
authors.lastname: Schmidt
authors.forename: Dierk
authors.initials: D
authors.lastname: Scheinert
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D017115:Catheter Ablation / Q000009:adverse effects; D004359:Drug Therapy, Combination; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010865:Pilot Projects; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000294:innervation* / Q000503:physiopathology; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000959:Antihypertensive Agents