Abstract
ObjectivesRenal sympathetic denervation has been studied as a potential therapeutic option for patients with therapy-resistant hypertension; however, a significant proportion of patients do not show a significant reduction in blood pressure and are classified as non-responders. The objective of the present study was to assess whether a redo renal denervation procedure increases response rates.MethodsWe present a case series of three consecutive renal denervation non-responders treated with the multi-electrode radiofrequency St. Jude EnligHTN catheter after an average of 22 months. Patients were followed for 6 months.ResultsMean age was 66 years and two patients were male. Patients were previously treated using either ReCor’s Paradise system, the Vessix V2 system or the Covidien OneShot system. Mean office blood pressure one year after the initial procedure was 187/102 mm Hg with a mean 24 h ambulatory blood pressure of 166/102 mm Hg. All patients underwent a successful redo procedure using the EnligHTN system because of persistent therapy-resistant hypertension. At 6 months a significant drop in both office and ambulatory blood pressure of −27/−6 mm Hg and −15/−13 mm Hg, respectively, was observed. No significant renal artery stenosis was observed at 6 months.ConclusionsIn patients with therapy-resistant hypertension who do not respond to an initial renal denervation procedure, a redo procedure using the St. Jude EnligHTN system may help to significantly improve blood pressure control.
Highlights
Controlling blood pressure in hypertensive patients remains a challenge and treatment targets are frequently not achieved despite multiple antihypertensive drugs [1]
We present a series of three consecutive Renal sympathetic denervation (RDN) non-responders who underwent a second procedure using the generation multi-electrode St
Three consecutive patients who did not show a relevant reduction in both office and ambulatory blood pressure after renal sympathetic denervation because of therapy-resistant hypertension are presented
Summary
Controlling blood pressure in hypertensive patients remains a challenge and treatment targets are frequently not achieved despite multiple antihypertensive drugs [1]. A substantial number of both patient and procedural characteristics have been hypothesised to account for this so-called non-responsiveness [7, 8] While characteristics such as older age and a noncompliant arterial system as well as inadequate renal nerve destruction on treatment with first generation devices are clear, theoretical causes of this non-responsiveness, scientific evidence is still scarce. Previous work has already demonstrated that a higher degree of renal nerve disruption leads to greater inhibition of the sympathetic nerve system [9]. Building further on this hypothesis, performing a redo procedure could theoretically make sense in a proportion of the patients who do not respond to the initial RDN procedure. Apart from one case report on a successful redo procedure using the Symplicity Flex system, and one study on the effect of cryoablation as a second line option in RDN non-responders, no data on the additional effect of a redo RDN procedure on blood pressure reduction are
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
