Release date: 2016-06-24 Source: Medical Pulse
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A study published in the European Journal of Interventional Therapy found that ultrasound renal sympathectomy seems to be a safe and effective treatment option for patients with refractory hypertension who are not responding to radiofrequency renal sympathectomy.
The investigators evaluated 24 patients with refractory hypertension who underwent ultrasound renal sympathectomy (October 2013 to April 2015) who did not respond to radiofrequency renal sympathectomy. The definition of refractory hypertension is that 24-hour ambulatory blood pressure monitoring (ABPM) still indicates an average inter-day systolic blood pressure ≥140 mmHg after ≥3 drug treatments. The patients in the cohort are mainly male, with an average age of 63 years, moderate cardiovascular risk. . The average patient used nearly 6 antihypertensive drugs, of which about 3 had reached the maximum tolerated dose.
The patient completed some assessments at baseline, including medication history, current medication, clinical exams, laboratory tests, and 24-hour ABPM. The patient had been treated with radiofrequency renal sympathectomy, but ABPM indicated no response within 6 months after the first treatment. At 15.3 months after the first treatment, the patient underwent ultrasound surgery (PARADISE percutaneous renal sympathectomy). Subjects were followed up for the first time after completing the first treatment until the sixth month after the second treatment.
The primary effective endpoint was the change in daytime systolic blood pressure 24 hours after treatment with ultrasound renal sympathectomy.
Radiofrequency ablation removal requires an increase in contrast dose (94.8 mL vs. 67.1 mL; P = .04) and longer operative time (85.3 min vs. 59.3 min; P < .01). The fluoroscopy time of the two procedures was similar; the maximal vascular diameter of the left renal artery in the renal sympathectomy was 6.8 mm, and the maximum diameter of the right renal artery was 6.5 mm. There was at least one renal artery ≥ 5.5 mm in the subjects, of which 44/48 renal artery diameters were ≥ 5.5 mm. There were no patient deaths or neurological complications, renal function changes and other serious events.
After radiofrequency renal sympathectomy, ABPM suggested that the mean systolic blood pressure decreased from 161.7 mmHg at baseline to 158.5 mmHg, whereas the mean inter-day systolic blood pressure decreased after 3 months after ultrasound renal sympathectomy. To 150.5 mmHg, it decreased to 151.6 mmHg at 6 months (P < .01). Post hoc analysis revealed the following changes in the subject's 24-hour systolic blood pressure: baseline vs radiofrequency renal sympathectomy, P = .87; baseline vs 3 months after ultrasound, P = .02; baseline vs ultrasound therapy 6 After month, P = .02. The mean inter-day systolic blood pressure also changed: radiofrequency renal sympathectomy after treatment vs. ultrasound renal sympathetic nerve removal 3 months after treatment, P = .13; radiofrequency treatment vs ultrasound 6 renal sympathectomy after treatment Month, P = .18; 3 months after ultrasound treatment vs 6 months, P = 1.
Non-response or relapse of the disease after treatment with renal sympathectomy in patients with refractory hypertension is a therapeutic problem in clinical practice because patients who choose this type of interventional therapy are rare. Doctors need to be carefully evaluated before considering repeated interventions. Ultrasound renal sympathectomy has overcome some of the deficiencies of previous generation technologies, such as energy delivery.
Compiled from: Ultrasound renal sympathetic denervation shows promise for resistant hypertension. Healio. June 22, 2016
Width
Length
Thickness
Color
Material
Temperature Range
Elongation
White
Butyl
-40 ℃-100℃
