PP.34.08

Abstract

Objective: To evaluate the effect of transcatheter renal denervation (TRD) on presence and severity of pathological structural changes of a brain assessed by MRI in resistant hypertensive patients. Design and method: Forty three resistant hypertensive patients aged between 30–80 years were included in the study. TRD was performed as bilateral endovascular radiofrequency ablation of neural pathways adjacent to renal artery. Detailed clinical investigation, 24-h ABPM and brain MRI were performed in all patients at baseline and 6 months after TRD. The study endpoints were changes in presence and severity of leucoaraiosis (LA), liquorodynamic disturbance, lacuna infarcts (LI), focal white matter lesions (FWML) and also of their integrating index graded 0–4 in accordance with a number of these phenomena simultaneously presented in a patient (index of structural hypertensive encephalopathy). Results: Pathological structural brain changes were detected in all patients. Periventricular leucoaraiosis was found in 39 (90.7%) patients. Of these, leucoaraiosis I grade was found in 7 (17.9%) patients, II grade - in 22 (56.4%) patients, III grade - in 10 patients (25.6%). Lacunae were found in 12 (27.9%) patients and focal white matter lesions - in 43 (100%) patients. According to the changes of systolic blood pressure after TRD all patients were divided in 2 groups: responders (I group, 53.5%) and non-responders (II group, 46.5%). The severity of LA decreased by 8.6% in responders. Also in this group the number of patients without liquorodynamics disturbances increased by 30.0%, subarachnoid space of the frontal and parietal areas of the brain decreased by 12 %, linear sizes of lateral brain ventricles decreased by 3–5 %, integrating index of structural hypertensive encephalopathy decreased by 5.8% while LI and FWML did not change. There was no change in structural brain damages after TRD in non-responders. Conclusions: Our study demonstrates that effective TRD is associated with a decrease in the severity of leucoaraiosis and liquorodynamic disturbance of the brain in patients with resistant hypertension.