Catheterbased renal denervation is beneficial for patients with treatmentresistant essential hypertension. Nonadherence to antihypertensive therapy is very common, yet it is difficult. Renal denervation in moderate treatment resistant hypertension. Renal denervation as therapy for hypertension the sympathetic autonomic nervous system modulates cardiovascular physiology via a complex system of central and peripheral neuroendocrine pathways that link the brain, heart, endothelium, nervous system, and kidneys. Apr 26, 20 brandt et al demonstrated that renal denervation in resistant hypertension patients was associated with a regression of left ventricle hypertrophy and an improvement of the diastolic function at 6mo followup visit, compared with the control group. In this work, we present experimental results, which show that lasers are an attractive energy source for renal denervation. Noninvasive renal denervation has the potential to expand patients access to renal denervation while also lowering the cost of. The symplicity renal denervation system is an investigational device. Version 5 renal denervation for resistant hypertension. The field of renal denervation for the treatment of hypertension has undergone a substantial set of dynamics during the past decade. Effects of renal sympathetic denervation on cardiac. Catheterbased sympathetic renal denervation rdn represents a novel approach for the management of trh that has been demonstrated to lower bp by up to 30 mm hg in smallscale clinical trials. Renal denervation for resistant hypertension nhs england.
Rousselle, dvma current status of the renal denervation field the release of unexpected results from the. Renal sympathetic denervation rsd is a catheterbased treatment that targets sympathetic nerve fibers in the renal arterial wall. Renal denervation therapy beyond resistant hypertension. In recent years, catheterbased radiofrequency denervation of the renal arteries has emerged as a potential treatment for resistant hypertension and is already in clinical use in more than 80. Recent technical advances targeting the renal sympathetic nerves, that is, renal denervation therapy rdn and increased sympathetic activity of the carotid sinuses, that is, baroreflex activation therapy, have renewed interest in invasive therapy for resistant hypertension. May 24, 20 the study sponsor, kona medical, also has announced plans to initiate the wave iii study, which will evaluate the safety and efficacy of a fully external noninvasive version of its ultrasoundbased therapy. Renal denervation as adjunctive therapy to cardiac. Endovascular ultrasound renal denervation to treat hypertension. Costeffectiveness of renal denervation therapy for treatment.
Renal denervation catheter ablation of perirenal sympaticus. The initial enthusiasm for this treatment was markedly dampened by the results of the symplicityhtn3 trial, although the transferability of the results into. Therapeutic advances in cardiovascular diseaseadditional. A controlled trial of renal denervation for resistant. Renal denervation lowers blood pressure in hypertensive patients. Wave i study of renal denervation therapy for hypertension. Renal denervation is a minimally invasive catheterbased procedure that delivers energy to the nerves in the kidneys that help regulate blood pressure. Interestingly, a significant decrease in the left ventricular mass was also observed in patients. Renal sympathetic denervation in therapy resistant. Kaltenbach b, franke j, bertog sc, steinberg dh, hofmann i, sievert h. Pdf renal denervation for treatmentresistant hypertension. Renal denervation therapy for hypertension request pdf. Renal sympathetic denervation has been studied as a potential therapeutic option for patients with therapy resistant hypertension.
A perspective on the delivery of renal denervation therapy. Status of renal denervation therapy for hypertension circulation. Renal sympathetic denervation rsdn, is a minimally invasive, endovascular catheter based procedure using radiofrequency ablation or ultrasound ablation aimed at treating resistant hypertension high blood pressure not controlled by medication. Catheter based sympathetic renal denervation rdn therapy is an exciting. The renal sympathetic nervous system has been identified as an attractive therapeutic target. There was a boom of positive observational data but. Brady, ms,a dhanansayan shanmuganayagam, phd,b serge d. Renal sympathetic denervation open access journals. This procedure lowers blood pressure via targeted attenuation of renal sympathetic tone, and it has a favorable safety profile. Renal sympathetic denervation as a new treatment for therapy. May 10, 20 the aim of this study is to assess whether renal denervation rd added to usual care compared to usual care alone reduces blood pressure bp as determined with ambulatory bp monitoring abpm after 6 months in subjects with an average daytime systolic bp of at least 5 mmhg as determined with use of abpm, despite use of three or more bp lowering agents or with documented intolerance or.
A new era of renal denervation trials for patients with. A prime example of imageguided therapy, renal denervation commonly involves the use of a guided catheter that emits a radio frequency toward the intimal walls of the renal artery to ablate the. Interven tional sympathetic renal denervation is safe and ef fective and might be helpful in the management of patients with therapy resistant hypertension and concomitant comorbidities. The enthusiasm for rdn evaporated quickly when a shamcontrolled randomized trial, simplicity htn3 renal denervation in patients with uncontrolled hypertension, showed that rdn was not superior to drug therapy. Renal sympathetic denervation rsd is a novel therapeutic option whereby the renal sympathetic nerves, which lie within and around the wall of the renal arteries, are ablated using a catheter. A perspective on the delivery of renal denervation therapy based on preclinical data armando tellez, md, a,b c krista n. Renal denervation therapy for hypertension circulation. The catheter is into the renal artery and delivers radiofrequency energy to ablate the nerves in the vessel wall that regulate vasoconstriction. Nct01901549 renal denervation in patients after acute coronary syndrome 80 jun 2016 unknown nct02041 renal sympathectomy in heart failure the respecthf study a study of renal denervation for heart failure with preserved ejection fraction 144 dec 2016 unknown nct01522430 denervation of renal sympathetic activity and hypertension study. Renal denervation therapy for resistant hypertension. Resistant hypertension rh is defined as uncontrolled systolic blood pressures bp despite therapy with. Objectives the aim of this multicenter, openlabel trial was to evaluate the safety and efficacy of alcoholmediated renal denervation using a novel catheter system the peregrine system infusion catheter for the infusion of dehydrated alcohol as a neurolytic agent into the renal periarterial space. Renal sympathetic denervation as secondline therapy in mild resistant hypertension. Renal denervation superior to drug therapy in hypertension.
Renal denervation using the vessix renal denervation system for the treatment of hypertension reduce htn. Despite current management, primarily focusing on lifestyle modification and pharmacological therapies, up to a third of patients do not reach current blood pressure bp targets. Two of these trials were proofofconcept trials that evaluated a new approach to catheterbased renal denervation using radiofrequency ablation in individuals with elevated blood pressure both in the absence of medical therapy spyral htnoff med and in the context of stable antihypertensive therapy spyral htnon med. Hypertension remains the leading risk factor for death and disability worldwide1 and affects one in three adults in the uk. In vitro renal denervation using a focused 980nm laser is performed in porcine and ovine renal arteries, where the histochemical analysis show that by 690 alexander et al.
Proceedings from the european clinical consensus conference for. Renal denervation therapy rdt is a relatively new, catheterizationbased intervention to treat patients with refractory hypertension. Renal denervation using focused infrared fiber lasers. Despite current management, primarily focusing on lifestyle modification and pharmacological therapies, up to a third of. Catheterbased renal denervation is intended to lower blood pressure by reducing sympathetic activity through renal nerve ablation. Abstract renal sympathetic denervation has shown promise in treating hypertension resistant to drug therapy. Jul 30, 20 the development of renal denervation therapy the medtronic symplicity catheter was the first renal denervation system to prove in clinical trials the therapy can lower drugresistant hypertension.
The rationale of rdt is the mechanical destruction with high frequency ablation of renal sympathetic fibers, which can be easily accessed via the renal artery. Renal sympathetic denervation in resistant hypertension. Despite widespread use of conventional antihypertensive therapy, which effectively reduces blood pressure in most hypertensive patients, a failure to attain target blood pressure levels in about 10% of patients with arterial hypertension suggests a deficit in present strategies, leaving this patient cohort at high risk of cardiovascular and renal disease. Effectiveness of renal denervation therapy forresistant. Renal denervation in treatmentresistant hypertension. Nhs england will not routinely commission renal denervation for. Background the number of hypertensive patients with uncontrolled blood pressure bp remains. Aug 26, 2016 therefore, catheterinterventional renal sympathetic denervation rdn has been established as a treatment for patients suffering from therapy resistant hypertension in the past decade. This leaves the vessel permanently in the widest open position to allow greater blood flow to the kidneys. Emerging evidence on renal denervation for the treatment of.
Renal hemodynamics and renal function after catheterbased renal sympathetic denervation in patients with resistant hypertension. Nerves in the wall of the renal artery are ablated by applying radiofrequency pulses or ultrasound. Efficacy of catheterbased renal denervation in the absence. By interrupting the sympathetic outflow to the kidneys and brain, rsd could be an attractive treatment option for diseases that are initiated or sustained by an overshooting sympathetic nervous system. Renal denervation as adjunctive therapy to cardiac sympathetic denervation for ablation refractory ventricular tachycardia previous article prospective evaluation of entrainment mapping as an adjunct to newgeneration highdensity activation mapping systems of left atrial tachycardias.
During denervation, a catheter is introduced via the femoral artery and positioned in the renal artery under fluoroscopic guidance. Alcoholmediated renal denervation using the peregrine system. Renal denervation is a minimally invasive endovascular procedure that ablates or disrupts the renal nerves in and around the renal arteries with radiofrequency energy. Renal sympathetic denervation for treatment of resistant. The device design allows for continuous blood flow throughout the treatment, which provides cooling of the artery wall. Reinforce randomized, shamcontrolled, multicenter study the primary efficacy assessment is the mean reduction in average 24hour ambulatory systolic blood pressure asbp at eight weeks post randomization. Renal denervation therapy beyond resistant hypertension ncbi. Early unblinded and essentially uncontrolled trials reported stunning reductions in clinic blood pressure bp following renal denervation in patients with uncontrolled andor treatmentresistant hypertension. Renal denervation is intended to be addon therapy to pharmaceutical treatment. Effects of renal denervation on blood pressure and renal function in the symplicity registry. It is important to note that the term resistant hypertension may include individuals who are. Status of renal denervation therapy for hypertension.