Abstract
Local vascular injury is detectable with optical coherence tomography (OCT) after catheter-based renal denervation (RDN). However, it is unclear whether the number and type of vascular lesions or the number of ablation points could affect blood pressure (BP) reduction. The aim of the study was to assess the impact of vascular injury induced by RDN detected with OCT and the number of ablation points on BP response after 1, 3 and 6 months. RDN was either performed with a Simplicity catheter or an EnligHTNTM multielectrode basket followed by OCT. BP was recorded prospectively as office measurement and 24-hour ambulatory blood pressure monitoring (24-h ABPM) at each time point. Correlations between type and number of vascular lesions, as well as ablation points, on BP reduction were performed. Out of 16 patients, two were lost to BP follow-up. We documented a BP reduction at 1, 3 and 6 months in both office and 24-h ABPM. The Δmean office systolic BP (SBP) reduction was -18.75 ± 24.55 mm Hg, -20.58 ± 16.92 mm Hg and -18.75 ± 29.39 mm Hg, respectively, and the Δmean 24h-ABPM SBP reduction was -6.50 ± 23.45 mm Hg, -16.88 ± 26.64 mm Hg and -13.89 ± 21.20 mm Hg, respectively. The number of vascular lesions did not correlate with office and 24h-SBP and diastolic BP reduction. However, there was a correlation between ablation points and office Δmean SBP reduction at 6 months (p <0.02). Our study demonstrates for the first time that the number and type of vascular lesions as assessed with OCT did not predict the success of BP reduction after RDN. However, we observed a substantial decrease in office SBP in relation to the number of ablation points at 6 months.
Highlights
Renal sympathetic denervation (RDN) is a catheter-based procedure which has been established after first randomised trials as a treatment option for patients with resistant hypertension [1]
Our study demonstrates for the first time that the number and type of vascular lesions as assessed with optical coherence tomography (OCT) did not predict the success of blood pressure (BP) reduction after renal denervation (RDN)
The total amount of all vascular lesions including the combination of oedema, thrombus formation, dissections and spasms did not reveal any correlation to BP reduction at 1, 3 and 6 months follow-up
Summary
Renal sympathetic denervation (RDN) is a catheter-based procedure which has been established after first randomised trials as a treatment option for patients with resistant hypertension [1]. Given the conflicting results from previous studies and SYMPLICITY HTN-3 trial the predicted response and success after RDN with respect to blood pressure (BP) reduction is still unknown [3,4,5] In this context, there are no data as to whether the number or type of vascular lesions, irrespective of ablation points, could potentially affect the results for BP reduction. OCT offers a technique with the immense advantage of creating high-resolution images allowing accurate tissue characterisation, and the spatial resolution is approximately 10-fold higher than intravascular ultrasound (IVUS) [8] Vascular damage such as vessel wall oedema, a common side effect of RDN, may reflect the effectiveness of renal
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