title: Initial Experience with Renal Denervation for the Treatment of Resistant Hypertension - The Utility of Novel Anesthetics and Metaiodobenzylguanidine Scintigraphy (MIBG).
abstract: BACKGROUND
  The Symplicity-HTN 3 trial failed to show significant difference in blood pressure (BP) lowering between patients undergoing catheter-based renal denervation (RDN) and the sham-procedure arm of the study. However, there is still optimism about the role of RDN in the treatment of resistant hypertension, because identification of patients with increased sympathetic activity thus being good RDN responders, improvements in the RDN procedure and new technology RDN catheters are all expected to lead to better RDN results. We present our initial experience with RDN for the treatment of resistant hypertension, and the utility of novel anesthetics and cardiac (123)I-metaiodobenzylguanidine scintigraphy ((123)I-MIBG).
  
  
  RESULTS
  Seven patients with resistant hypertension underwent RDN and were followed up for 6 months. MIBG was performed before RDN, in order to estimate sympathetic activity and predict the response to RDN. All patients were sedated with dexmedetomidine and remifentanil during RDN. All patients tolerated the procedure well, were hemodynamically stable and their peri-procedural pain was effectively controlled. A median of 7.6 ± 2.1 and 6 ± 1.4 ablations were delivered in the right and left renal artery respectively, making an average of 6.8 burns per artery. No peri-procedural or late complications - adverse events (local or systematic) occurred. At 6 months, mean reduction in office BP was -26.0/-16.3 mmHg (p=0.004/p=0.02), while mean reduction in ambulatory BP was -12.3/-9.2 mmHg (p=0.118/p=0.045). One patient (14.3%) was a non-responder. None of the cardiac (123)I-MIBG imaging indexes(early and late heart-to-mediastinum (H/M) count density ratio, washout rate (WR) of the tracer from the myocardium) were different between responders and non-responders.
  
  
  CONCLUSIONS
  Patients with resistant hypertension who underwent RDN in our department had a significant reduction in BP 6 months after the intervention. (123)I-MIBG was not useful in predicting RDN response. Dexmedetomidine and remifentanil provided sufficient patient comfort during the procedure, allowing an adequate number of ablations per renal artery to be performed, and this could probably lead to improved RDN results.
authors: 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors: Antonios
authors: A
authors: Ziakas
authors: 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors: Dimitrios
authors: D
authors: Petroglou
authors: 2nd Department of Nuclear Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors: Efstratios
authors: E
authors: Moralidis
authors: 1st Department of Cardiology, National and Capodistrian University of Athens, Ippokrateion University Hospital, Athens, Greece.
authors: Konstantinos
authors: K
authors: Tsioufis
authors: 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Ippokrateion University Hospital, Thessaloniki, Greece.
authors: Mihalis
authors: M
authors: Doumas
authors: Department of Anesthesia and Intensive Care Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors: Elena
authors: E
authors: Argiriadou
authors: 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors: Christos
authors: C
authors: Savopoulos
authors: 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors: Stavros
authors: S
authors: Hadjimiltiades
authors: 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors: Ioannis
authors: I
authors: Stiliadis
authors: 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors: Antonios
authors: A
authors: Kouparanis
authors: 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors: Sotirios
authors: S
authors: Katranas
authors: 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors: Leonidas
authors: L
authors: Lillis
authors: 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors: Athanasios
authors: A
authors: Koutsakis
authors: 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors: Haralambos
authors: H
authors: Karvounis
keywords: Dexmedetomidine; Remifentanil; Renal Denervation; Resistant Hypertension