title: Efficacy and safety of catheter-based radiofrequency renal denervation in stented renal arteries.
abstract: BACKGROUND
  In selected patients with hypertension, renal artery (RA) stenting is used to treat significant atherosclerotic stenoses. However, blood pressure often remains uncontrolled after the procedure. Although catheter-based renal denervation (RDN) can reduce blood pressure in certain patients with resistant hypertension, there are no data on the feasibility and safety of RDN in stented RA.
  
  
  RESULTS
  We report marked blood pressure reduction after RDN in a patient with resistant hypertension who underwent previous stenting. Subsequently, radiofrequency ablation was investigated within the stented segment of porcine RA, distal to the stented segment, and in nonstented RA and compared with stent only and untreated controls. There were neither observations of thrombus nor gross or histological changes in the kidneys. After radiofrequency ablation of the nonstented RA, sympathetic nerves innervating the kidney were significantly reduced, as indicated by significant decreases in sympathetic terminal axons and reduction of norepinephrine in renal tissue. Similar denervation efficacy was found when RDN was performed distal to a renal stent. In contrast, when radiofrequency ablation was performed within the stented segment of the RA, significant sympathetic nerve ablation was not seen. Histological observation showed favorable healing in all arteries.
  
  
  CONCLUSIONS
  Radiofrequency ablation of previously stented RA demonstrated that RDN provides equally safe experimental procedural outcomes in a porcine model whether the radiofrequency treatment is delivered within, adjacent, or without the stent struts being present in the RA. However, efficacious RDN is only achieved when radiofrequency ablation is delivered to the nonstented RA segment distal to the stent.
authors.affiliation: From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M., B.C., D.L., M.B.); Medtronic Cardiovascular, Santa Rosa, CA (S.T., J.R., D.S.-J., R.J.M.); Klinik für Kardiologie & Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (T.Z.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.R.-S.). felix.mahfoud@uks.eu.
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.affiliation: From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M., B.C., D.L., M.B.); Medtronic Cardiovascular, Santa Rosa, CA (S.T., J.R., D.S.-J., R.J.M.); Klinik für Kardiologie & Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (T.Z.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.R.-S.).
authors.forename: Stefan
authors.initials: S
authors.lastname: Tunev
authors.affiliation: From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M., B.C., D.L., M.B.); Medtronic Cardiovascular, Santa Rosa, CA (S.T., J.R., D.S.-J., R.J.M.); Klinik für Kardiologie & Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (T.Z.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.R.-S.).
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ruwart
authors.affiliation: From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M., B.C., D.L., M.B.); Medtronic Cardiovascular, Santa Rosa, CA (S.T., J.R., D.S.-J., R.J.M.); Klinik für Kardiologie & Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (T.Z.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.R.-S.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Schulz-Jander
authors.affiliation: From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M., B.C., D.L., M.B.); Medtronic Cardiovascular, Santa Rosa, CA (S.T., J.R., D.S.-J., R.J.M.); Klinik für Kardiologie & Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (T.Z.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.R.-S.).
authors.forename: Bodo
authors.initials: B
authors.lastname: Cremers
authors.affiliation: From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M., B.C., D.L., M.B.); Medtronic Cardiovascular, Santa Rosa, CA (S.T., J.R., D.S.-J., R.J.M.); Klinik für Kardiologie & Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (T.Z.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.R.-S.).
authors.forename: Dominik
authors.initials: D
authors.lastname: Linz
authors.affiliation: From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M., B.C., D.L., M.B.); Medtronic Cardiovascular, Santa Rosa, CA (S.T., J.R., D.S.-J., R.J.M.); Klinik für Kardiologie & Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (T.Z.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.R.-S.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
authors.affiliation: From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M., B.C., D.L., M.B.); Medtronic Cardiovascular, Santa Rosa, CA (S.T., J.R., D.S.-J., R.J.M.); Klinik für Kardiologie & Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (T.Z.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.R.-S.).
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M., B.C., D.L., M.B.); Medtronic Cardiovascular, Santa Rosa, CA (S.T., J.R., D.S.-J., R.J.M.); Klinik für Kardiologie & Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (T.Z.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.R.-S.).
authors.forename: Krishna
authors.initials: K
authors.lastname: Rocha-Singh
authors.affiliation: From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M., B.C., D.L., M.B.); Medtronic Cardiovascular, Santa Rosa, CA (S.T., J.R., D.S.-J., R.J.M.); Klinik für Kardiologie & Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (T.Z.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.R.-S.).
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.affiliation: From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (F.M., B.C., D.L., M.B.); Medtronic Cardiovascular, Santa Rosa, CA (S.T., J.R., D.S.-J., R.J.M.); Klinik für Kardiologie & Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany (T.Z.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and Prairie Heart Institute at St. John's Hospital, Springfield, IL (K.R.-S.).
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Melder
mesh_terms: D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D017115:Catheter Ablation / Q000009:adverse effects; D004195:Disease Models, Animal; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000098:blood supply* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000378:metabolism; D012077:Renal Artery / Q000294:innervation*; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D034421:Sus scrofa; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013564:Sympathetic Nervous System / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D009638:Norepinephrine
keywords: hypertension resistant to conventional therapy; renal artery obstruction; renovascular hypertension