Efficacy and safety of 3D reconstruction and basket multi‐electrode renal denervation (RDN) for refractory hypertensive patients with chronic kidney disease

Author:

Cai Han12,Fang Zhoufei2345ORCID,Wu Xiangshu6,Zhou Wei2,Lin Jinxiu12ORCID,Peng Feng12,Su Jinzi12

Affiliation:

1. Department of Cardiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital Fujian Medical University Fuzhou China

2. Fujian Hypertension Research Institute The First Affiliated Hospital of Fujian Medical University Fuzhou China

3. Department of Geriatrics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital Fujian Medical University Fuzhou China

4. Clinical Research Center for Geriatric Hypertension Disease of Fujian province The First Affiliated Hospital of Fujian Medical University Fuzhou China

5. Branch of National Clinical Research Center for Aging and Medicine The First Affiliated Hospital of Fujian Medical University, Fujian Province Fuzhou China

6. The First Clinical Medical College of Fujian Medical University Fuzhou China

Abstract

AbstractRenal Artery Sympathetic Denervation (RDN) can lower blood pressure. Different ablation catheters (single electrode, multi‐electrode) have different scopes of ablation (renal artery main stem and branches). Few studies have compared the advantages and disadvantages of different ablation catheters and different procedures in terms of antihypertensive efficacy. To compare the efficacy and safety of 3D reconstruction radiofrequency ablation (3DRA) and basket multi‐electrode radiofrequency ablation (BMRA) in Renal Artery Sympathetic Denervation. Fifty‐three patients with Refractory hypertension (RHT) were divided into BMRA, (n = 28) and 3DRA(n = 25). BMRA group used a stereobasket multi‐electrode ablation catheter with a controlled ablation temperature of 60°C and an ablation time of 120 s per site. 3DRA group used a NavStar pressure‐monitored perfusion monopolar ablation catheter with a controlled ablation temperature of 40°C, an ablation time of 40 s per site, and an ablation energy of 12 W. Baseline and RDN parameters and complications were compared in both groups. Home and 24 h ambulatory blood pressure, type of anti‐hypertensive medication taken, and serum creatinine were followed up at 1, 3, 6, 12, and 24 months after the RDN. There were no differences in baseline characteristics between the two groups. (23.14 ± 2.00)months of follow‐up in the BMRA group resulted in a total of (25.86 ± 8.61) loci ablation. (19.28 ± 7.40)months of follow‐up in the 3DRA group resulted in a total of (21.04 ± 6.47)loci ablation. Home SBP was significantly lower in both groups at 1 month after RDN treatment compared to baseline(H‐SBP/mmHg: BMRA 149.9 ± 10.59 vs. baseline 168.36 ± 12.76; 3DRA 152.6 ± 14.91 vs. 164.89 ± 12.96, both p < .05). The proportion of people with 24 h ambulatory SBP attainment was significantly higher in both groups and was maintained for 24 months. At each follow‐up time point, there were no differences in home and 24‐h flow SBP, DBP, or Scr between the two groups. There were two cases of severe renal artery complications from implanted vascular stents and one case of femoral artery pseudoaneurysm in the 3DRA group. At follow‐up, 1 (1.9%) patient in the 3DRA group died of unexplained death and 1 (1.9%) patient developed heart failure, and 1 (1.9%) patient in the BMRA group died of unexplained death. Basket multi‐electrode radiofrequency ablation and 3D reconstruction radiofrequency ablation of the renal artery applied to RDN have comparable efficacy in reducing systolic blood pressure.

Publisher

Wiley

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