Mid-Term Vascular Safety of Renal Denervation Assessed by Follow-up MR Imaging
Mid-Term Vascular Safety of Renal Denervation Assessed by Follow-up MR Imaging
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DOI：
10.1007/s00270-015-1192-2
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发表时间：
2016-03
影响因子：
2.9
通讯作者：
A. Schmid;R. Schmieder;M. Lell;R. Janka;R. Veelken;R. Schmieder;M. Uder;C. Ott
中科院分区：
文献类型：
--
作者：
A. Schmid;R. Schmieder;M. Lell;R. Janka;R. Veelken;R. Schmieder;M. Uder;C. Ott
背景/目的肾去神经支配术（RDN）成为治疗难治性高血压（TRH）患者降低血压（BP）的一种治疗选择。然而，人们对RDN后晚期肾动脉狭窄或血栓栓塞的发生率表示担忧。因此，本研究的目的是进行一项关于中期肾动脉血管完整性和肾实质灌注的前瞻性临床试验，在基于导管的RDN后的随访中通过磁共振成像（MRI）进行评估。Palo Alto，CA）。在RDN后中位11个月（四分位距6-18个月）时在1.5T MR单元上进行随访MRI。将高分辨率MR血管造影（MRA）和MRI结果与RDN时获得的肾动脉基线数字血管造影进行比较。在不确定性（N= 2）的情况下，导管血管造影repeated.ResultsBoth办公室和24小时动态血压显着降低6个月和12个月后RDN。RDN后6个月和12个月肾功能无变化。在所有患者中，MRA排除了新发或进展的既存低级别肾动脉狭窄以及射频消融部位的局灶性动脉瘤。在没有患者的新的节段性灌注不足，在任何肾脏被检测到在MRI上。ConclusionsNo血管或实质并发症后，射频为基础的RDN检测到在51例随访MRI。
Background/AimsRenal denervation (RDN) emerged as a treatment option for reducing blood pressure (BP) in patients with treatment-resistant hypertension (TRH). However, concerns have been raised regarding the incidence of late renal artery stenosis or thromboembolism after RDN. The goal of the current study was, therefore, to conduct a prospective clinical trial on the mid-term vascular integrity of the renal arteries and the perfusion of the renal parenchyma assessed by magnetic resonance imaging (MRI) in the follow-up after catheter-based RDN.MethodsIn our single-centre investigator initiated study, 51 patients with true TRH underwent catheter-based RDN using the Symplicity FlexTMcatheter (Medtronic Inc., Palo Alto, CA). Follow-up MRI was performed at a median of 11 months (interquartile range 6–18 months) after RDN on a 1.5T MR unit. High-resolution MR angiography (MRA) and MRI results were compared to the baseline digital angiography of renal arteries obtained at time of RDN. In case of uncertainties (N= 2) catheter angiography was repeated.ResultsBoth office and 24-h ambulatory BP were significantly reduced 6 and 12 months after RDN. Renal function remained unchanged 6 and 12 months after RDN. In all patients, MRA excluded new or progression of pre-existing low grade renal artery stenosis as well as focal aneurysms at the sites of radiofrequency ablation. In none of the patients new segmental perfusion deficits in either kidney were detected on MRI.ConclusionsNo vascular or parenchymal complications after radiofrequency-based RDN were detected in 51 patients followed up by MRI.