Anatomical and procedural determinants of catheter-based renal denervation.
OBJECTIVE
Catheter-based renal sympathetic denervation (RDN) can reduce blood pressure (BP) and sympathetic activity in certain patients with uncontrolled hypertension. Less is known about the impact of renal anatomy and procedural parameters on subsequent BP response.


METHODS
A total of 564 patients with resistant hypertension underwent bilateral RDN in 9 centers in Europe and Australia using a mono-electrode radiofrequency catheter (Symplicity Flex, Medtronic). Anatomical criteria such as prevalence of accessory renal arteries (ARA), presence of renal artery disease (RAD), length, and diameter were analyzed blinded to patient's characteristics.


RESULTS
ARA was present in 171 patients (30%), and RAD was documented in 71 patients (13%). On average 11±2.7 complete 120-s ablations were performed, equally distributed on both sides. After 6months, BP was reduced by 19/8mmHg (p<0.001 for both). Change of systolic blood pressure (SBP) was not related to the presence of ARA (-18 vs. -20mmHg; p=NS) or RAD (-16 vs. -20mmHg; p=NS). Patients with a bilateral diameter≤4mm had a more pronounced reduction of SBP compared to patients with a unilateral diameter≤4mm or a bilateral diameter>4mm (-29 vs. -26 vs. -17mmHg; p<0.001). Neither the length of the renal artery nor the number of RF ablations influenced BP reduction after 6months.


CONCLUSIONS
The diameter of renal arteries correlated with SBP change after RDN at 6-month follow-up. Change of SBP was not related to the lengths of the renal artery, presence of ARA, RAD, or the number of RF ablations delivered by a mono-electrode catheter.
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. Electronic address: Sebastian.Ewen@uks.eu.
Sebastian
S
Ewen
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Christian
C
Ukena
Kardiologie, Universitäres Herzzentrum, Universitätsspital, Zürich, Switzerland.
Thomas Felix
TF
Lüscher
Kardiologie, Asklepios Klinik St. Georg, Hamburg, Germany.
Martin
M
Bergmann
Department of Nephrology, University Medical Center, Utrecht, the Netherlands.
Peter J
PJ
Blankestijn
Medizinische Klinik III, Universitätsklinikum Heidelberg, Germany.
Erwin
E
Blessing
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Bodo
B
Cremers
Medizinische Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinikum, Gießen, Germany.
Oliver
O
Dörr
Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia.
Dagmara
D
Hering
Kardiologie, Asklepios Klinik St. Georg, Hamburg, Germany.
Lukas
L
Kaiser
Medizinische Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinikum, Gießen, Germany.
Holger
H
Nef
Angiologie, Universitätsherzzentrum, Bad Krozingen, Germany.
Elias
E
Noory
Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia.
Markus
M
Schlaich
Galway University Hospitals, Ireland.
Faisal
F
Sharif
Kardiologie, Universitäres Herzzentrum, Universitätsspital, Zürich, Switzerland.
Isabella
I
Sudano
Medizinische Klinik III, Universitätsklinikum Heidelberg, Germany.
Britta
B
Vogel
Department of Cardiology, University Medical Center, Utrecht, the Netherlands.
Michiel
M
Voskuil
Angiologie, Universitätsherzzentrum, Bad Krozingen, Germany.
Thomas
T
Zeller
Institute for Medical Engineering and Science, MIT, Cambridge MA and Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Abraham R
AR
Tzafriri
Institute for Medical Engineering and Science, MIT, Cambridge MA and Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Elazer R
ER
Edelman
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Lucas
L
Lauder
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Bruno
B
Scheller
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Michael
M
Böhm
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Felix
F
Mahfoud
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001315:Australia; D001794:Blood Pressure / Q000187:drug effects; D017115:Catheter Ablation; D004351:Drug Resistance; D005060:Europe; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012077:Renal Artery / Q000002:abnormalities* / Q000294:innervation*; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000150:complications* / Q000000981:diagnostic imaging
D000959:Antihypertensive Agents
Ablation; Accessory renal artery; Diameter; Renal artery stenosis