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Renal denervation

Annemiek F Hoogerwaard, Mark R de Jong, Arif Elvan
PURPOSE OF REVIEW: Renal sympathetic denervation (RDN) as treatment option for hypertension has a strong rationale; however, variable effects on blood pressure (BP) have been reported ranging from non-response to marked reductions in BP. The absence of a procedural end point for RDN is one of the potential factors associated with the variable response. Studies have suggested the use of renal nerve stimulation (RNS) to adequately address this issue. This review aims to provide an overview of the clinical and experimental data available regarding the effects of RNS in the setting of RDN...
March 19, 2018: Current Hypertension Reports
Lucas Lauder, Sebastian Ewen, Abraham R Tzafriri, Elazer R Edelman, Bodo Cremers, Saarraaken Kulenthiran, Christian Ukena, Dominik Linz, Ingrid Kindermann, Costas Tsioufis, Bruno Scheller, Michael Böhm, Felix Mahfoud
BACKGROUND/PURPOSE: Catheter-based renal sympathetic denervation (RDN) has been introduced to lower blood pressure (BP) and sympathetic activity in patients with uncontrolled hypertension with at best equivocal results. It has been postulated that anatomic and procedural elements introduce unaccounted variability and yet little is known of the impact of renal anatomy and procedural parameters on BP response to RDN. METHODS/MATERIALS: Anatomical parameters such as length and diameter were analyzed by quantitative vascular analysis and the prevalence of accessory renal arteries and renal artery disease were documented in 150 patients with resistant hypertension undergoing bilateral RDN using a mono-electrode radiofrequency catheter (Symplicity Flex, Medtronic)...
March 2, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Mamoru Tanida, Zhang Tao, Lingling Sun, Jie Song, Wei Yang, Yuichi Kuda, Yasutaka Kurata, Toshishige Shibamoto
NEW FINDINGS: What is the central question of this study? Whether anaphylaxis affects sympathetic outflows to the brown adipose tissue (BAT) and adrenal grand is not known. Moreover, it is unknown whether anaphylaxis affects some brain areas in association with sympathetic regulation. What is the main finding and its importance? We showed that sympathoexcitatory responses to anaphylaxis regionally occurred in the kidney and adrenal grand, but not in the thermogenesis-related BAT. Further, anaphylactic hypotension also caused increase in c-fos immunoreactivity in the hypothalamic and medullary areas...
March 10, 2018: Experimental Physiology
Lukas Stoiber, Felix Mahfoud, Seyedeh Mahsa Zamani, Tomas Lapinskas, Michael Böhm, Sebastian Ewen, Saarraaken Kulenthiran, Markus P Schlaich, Murray D Esler, Tommy Hammer, Knut Haakon Stensæth, Burkert Pieske, Stephan Dreysse, Eckart Fleck, Titus Kühne, Marcus Kelm, Philipp Stawowy, Sebastian Kelle
Renal sympathetic denervation (RDN) is under investigation as a treatment option in patients with resistant hypertension (RH). Determinants of arterial compliance may, however, help to predict the BP response to therapy. Aortic distensibility (AD) is a well-established parameter of aortic stiffness and can reliably be obtained by CMR. This analysis sought to investigate the effects of RDN on AD and to assess the predictive value of pre-treatment AD for BP changes. We analyzed data of 65 patients with RH included in a multicenter trial...
March 8, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Christopher T Banek, Madeline M Gauthier, Daniel C Baumann, Dusty Van Helden, Ninitha Asirvatham-Jeyaraj, Angela Panoskaltsis-Mortari, Gregory D Fink, John W Osborn
Recent preclinical studies show renal denervation (RDNx) may be an effective treatment for hypertension; however, the mechanism remains unknown. We have recently reported total RDNx (TRDNx) and afferent-selective RDNx (ARDNx) similarly attenuated the development of deoxycorticosterone acetate (DOCA)-salt hypertension. Whereas TRDNx abolished renal inflammation, ARDNx had a minimal effect despite an identical anti-hypertensive effect. Although this study established that ARDNx attenuates the development of DOCA-salt hypertension, it is unknown whether this mechanism remains operative once hypertension is established...
March 7, 2018: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
Hsien-Chun Chiu, Chen-Yuan Chiu, Rong-Sen Yang, Ding-Cheng Chan, Shing-Hwa Liu, Chih-Kang Chiang
BACKGROUND: A global consensus on the loss of skeletal muscle mass and function in humans refers as sarcopenia and cachexia including diabetes, obesity, renal failure, and osteoporosis. Despite a current improvement of sarcopenia or cachexia with exercise training and supportive therapies, alternative and specific managements are needed to discover for whom are unable or unwilling to embark on these treatments. Alendronate is a widely used drug for osteoporosis in the elderly and postmenopausal women...
March 6, 2018: Journal of Cachexia, Sarcopenia and Muscle
Mark R de Jong, Annemiek F Hoogerwaard, Ahmet Adiyaman, Jaap Jan J Smit, Anand R Ramdat Misier, Jan-Evert Heeg, Boudewijn A A M van Hasselt, Isabelle C Van Gelder, Harry J G M Crijns, Ignacio Fernández Lozano, Jorge E Toquero Ramos, F Javier Alzueta, Borja Ibañez, José M Rubio, Fernando Arribas, José M Porres Aracama, Josep Brugada, Lluís Mont, Arif Elvan
BACKGROUND: Hypertension is an important, modifiable risk factor for the development of atrial fibrillation (AF). Even after pulmonary vein isolation (PVI), 20-40% experience recurrent AF. Animal studies have shown that renal denervation (RDN) reduces AF inducibility. One clinical study with important limitations suggested that RDN additional to PVI could reduce recurrent AF. OBJECTIVE: The goal of this multicenter randomized controlled study is to investigate whether RDN added to PVI reduces AF recurrence...
February 27, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Zhixin Jiang, Xiujuan Zhou, Chun Chen, Ying Wang, Ping Fang, Jie Geng, Gang Zhang, Qijun Shan
To investigate the efficacy of renal denervation (RDN) on the recurrence of ventricular arrhythmia (VA) in Asian patients with implantable cardioverter defibrillators (ICDs).Eight ICD patients with recurrent VA episodes underwent RDN using an off-the-shelf saline-irrigated catheter. The pre- and postprocedural VA episodes were counted via ICD interrogation. All patients underwent successful RDN without any complications related to radiofrequency catheter ablation. The median follow-up was 15 months (range 6-30), and the median VA episodes per month were significantly reduced from 3...
February 23, 2018: International Heart Journal
Monica Sigovan, Salim Si-Mohamed, Pierre-Yves Courand, Brahim Harbaoui, Marc Sapoval, Sébastien Bros, Philippe C Douek, Pierre Lantelme, Loic Boussel
OBJECTIVES: Endovascular renal denervation (RDN) using catheter-based radiofrequency (RF) ablation has emerged as a potential treatment option for drug-resistant hypertension. Its efficacy is currently under debate. We aimed to evaluate the capability of contrast-enhanced magnetic resonance imaging (MRI) to assess the effects of RDN on the renal arterial wall in patients presenting with drug-resistant hypertension. METHODS: Patients were included prospectively following institutional review board approval and written informed consent...
February 21, 2018: European Radiology
Yusuke Sata, Dagmara Hering, Geoffrey A Head, Antony S Walton, Karlheinz Peter, Petra Marusic, Jaqueline Duval, Rebecca Lee, Louise J Hammond, Elisabeth A Lambert, Gavin W Lambert, Murray D Esler, Markus P Schlaich
BACKGROUND: Renal denervation (RDN) can reduce blood pressure (BP) in patients with resistant hypertension, but less so in patients with isolated systolic hypertension. A possible explanation is that patients with stiffer arteries may have lesser neural contribution to their hypertension. METHOD: We hypothesized that arterial stiffness predicts the response to RDN. From ambulatory BP monitoring (ABPM), ambulatory arterial stiffness index (AASI) was calculated as 1 - the regression slope of DBP versus SBP...
February 20, 2018: Journal of Hypertension
Sundeep Mishra
In the field of medicine and cardiology newer therapy and devices have been launched with a huge promise and a lot of hype. Unfortunately, over the course of time, a good many of them like biovascular scaffold, renal denervation and intra-aortic balloon pump have failed to live up to their initial promise so much so that some of them have been withdrawn. The reason for this downfall may be multifold from incomplete understanding of the patho-physiology of disease, incomplete understanding of mechanism of action of the therapy, in-appropriate application in clinical practice, in-efficient therapy development related to flawed trial design, regulatory impediments placed on the trials or deficits in application of scientific techniques...
January 2018: Indian Heart Journal
Carolina Baraldi A Restini, Alex Ismail, Ramya K Kumar, Robert Burnett, Hannah Garver, Gregory D Fink, Stephanie W Watts
Renal sympathetic activity affects blood pressure in part by increasing renovascular resistance via release of norepinephrine (NE) from sympathetic nerves onto renal arteries. Here we test the idea that adipose tissue adjacent to renal blood vessels, i.e. renal perivascular adipose tissue (RPVAT), contains a pool of NE which can be released to alter renal vascular function. RPVAT was obtained from around the main renal artery/vein of the male Sprague Dawley rats. Thoracic aortic PVAT and mesenteric PVAT also were studied as brown-like and white fat comparators respectively...
February 14, 2018: Vascular Pharmacology
Atsushi Sakaoka, Hisako Terao, Shintaro Nakamura, Hitomi Hagiwara, Toshihito Furukawa, Kiyoshi Matsumura, Kenichi Sakakura
BACKGROUND: Ablation lesion depth caused by radiofrequency-based renal denervation (RDN) was limited to <4 mm in previous animal studies, suggesting that radiofrequency-RDN cannot ablate a substantial percentage of renal sympathetic nerves. We aimed to define the true lesion depth achieved with radiofrequency-RDN using a fine sectioning method and to investigate biophysical parameters that could predict lesion depth. METHODS AND RESULTS: Radiofrequency was delivered to 87 sites in 14 renal arteries from 9 farm pigs at various ablation settings: 2, 4, 6, and 9 W for 60 seconds and 6 W for 120 seconds...
February 2018: Circulation. Cardiovascular Interventions
Jasneet Devgun, Yash B Jobanputra, Michael Arustamyan, Robert Chait, Waqas Ghumman
Heart failure (HF) is the leading cause of hospitalization in the USA. Despite advances in pharmacologic management, the incidence of HF is on the rise and survivability is persistently reduced. Sympathetic overdrive is implicated in the pathophysiology of HF, particularly HF with reduced ejection fraction (HFrEF). Tachycardia can be particularly deleterious and thus has spurred significant investigation to mitigate its effects. Various modalities including vagus nerve stimulation, baroreceptor activation therapy, spinal cord stimulation, renal sympathetic nerve denervation, left cardiac sympathetic denervation, and carotid body removal will be discussed...
February 12, 2018: Heart Failure Reviews
Dominik Linz, Mathias Hohl, Adrian D Elliott, Dennis H Lau, Felix Mahfoud, Murray D Esler, Prashanthan Sanders, Michael Böhm
Renal afferent and efferent sympathetic nerves are involved in the regulation of blood pressure and have a pathophysiological role in hypertension. Additionally, several conditions that frequently coexist with hypertension, such as heart failure, obstructive sleep apnea, atrial fibrillation, renal dysfunction, and metabolic syndrome, demonstrate enhanced sympathetic activity. Renal denervation (RDN) is an approach to reduce renal and whole body sympathetic activation. Experimental models indicate that RDN has the potential to lower blood pressure and prevent cardio-renal remodeling in chronic diseases associated with enhanced sympathetic activation...
February 10, 2018: Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society
Qian Ru Gu, Yang Yang Li, Guo Rong Chen, M J Quinn
In 1937, Drs. Moritz and Oldt described arteriolar injuries in the kidneys (and other viscera) in hypertension, across the age range, in both sexes, and, in different races. This hypothesis proposes that injuries to vasomotor nerves cause the arteriolar injury in the kidney in hypertension, (as well as that in the uterus in preeclampsia). Different patterns of perivascular hyalinisation in different viscera are clues to the varying causes and consequences of arteriolar injury. In the uterus there is a symmetrical, perivascular "halo of hyalinisation" that marks the lines of extension of regenerating, injured nerves to the placental bed, whereas in the kidney there is a disordered and asymmetrical "halo of hyalinisation" where persistent, and recurrent, increases in intravascular pressures interrupt development of regenerating nerves...
February 2018: Medical Hypotheses
Jason D Foss, Jessica Fiege, Yoji Shimizu, John P Collister, Tim Mayerhofer, Laurel Wood, John W Osborn
Hypertension is the leading modifiable risk factor for death worldwide, yet the causes remain unclear and treatment remains suboptimal. Catheter-based renal denervation (RDNX) is a promising new treatment for resistant hypertension, but the mechanisms underlying its antihypertensive effect remain unclear. We recently found that RDNX attenuates deoxycorticosterone acetate-salt hypertension and that this is dependent on ablation of afferent renal nerves and is associated with decreased renal inflammation. To determine if this is common to other models of salt-sensitive hypertension, rats underwent complete RDNX (n = 8), selective ablation of afferent renal nerves (n = 8), or sham denervation (n = 8)...
February 2018: Physiological Reports
Dirk Prochnau, Matthias Hoyme
Electrical storm (ES) represents a critical state of electrical instability. We describe a patient with coronary artery disease, mechanical aortic valve replacement, and reduced left ventricular function with recurrent ICD shocks. Despite medical treatment with beta-blocker and amiodarone, and after successful ablation of different VT morphologies in combination with substrate modification, ES could not be controlled. We performed renal denervation (RDN) to reduce arrhythmic burden. Thereafter, patient remained free from sustained and non-sustained VTs at 6-month follow-up...
January 30, 2018: Journal of Electrocardiology
Caroline B Ferreira, Sergio L Cravo, Sean D Stocker
Obstructive sleep apnea (OSA) is the most common respiratory disturbance of sleep and is closely associated to cardiovascular diseases. In humans, apnea increases respiratory effort and elevates muscle sympathetic nerve activity (SNA), but the primary stimulus for the SNA activation has not been identified. We recently developed a model of apnea in rodents using acute airway obstruction. In this study, we employed this model to test whether the elevation in SNA was mediated by hypoxia, carotid chemoreceptors, or neurotransmission in the nucleus tractus solitarius (NTS)...
February 2018: Physiological Reports
Linn C Dobrowolski, Daan W Eeftinck Schattenkerk, C T Paul Krediet, Peter M Van Brussel, Liffert Vogt, Frederike J Bemelman, Jim A Reekers, Bert-Jan H Van Den Born, Hein J Verberne
BACKGROUND: Catheter-based renal sympathetic denervation (RDN) has been considered a potential treatment for therapy resistant hypertension (RHT). However, in a randomized placebo-controlled trial, RDN did not lead to a substantial blood pressure (BP) reduction. We hypothesized that variation in the reported RDN efficacy might be explained by incomplete nerve disruption as assessed by renal 123I-meta-iodobenzylguanidine (123I-mIBG) scintigraphy. METHODS: In 21 RHT patients (median age 60 years), we performed 123I-mIBG scintigraphy before and 6 weeks after RDN...
January 26, 2018: EJNMMI Research
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