Initial Experience with Renal Denervation for the Treatment of Resistant Hypertension - The Utility of Novel Anesthetics and Metaiodobenzylguanidine Scintigraphy (MIBG)



Antonios Ziakas1, *, Dimitrios Petroglou1, Efstratios Moralidis2, Konstantinos Tsioufis3, Mihalis Doumas4, Elena Argiriadou5, Christos Savopoulos6, Stavros Hadjimiltiades1, Ioannis Stiliadis1, Antonios Kouparanis1, Sotirios Katranas1, Leonidas Lillis1, Athanasios Koutsakis1, Haralambos Karvounis1
1 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
2 2nd Department of Nuclear Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
3 1st Department of Cardiology, National and Capodistrian University of Athens, Ippokrateion University Hospital, Athens, Greece
4 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Ippokrateion University Hospital, Thessaloniki, Greece
5 Department of Anesthesia and Intensive Care Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
6 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece


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© Ziakas et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kyriakidi 1, 546 36 Thessaloniki, Greece; Tel: 0030-2310- 993565; Fax: 0030-2310-992563; Email: tonyziakas@hotmail.com


Abstract

Background:

The Symplicity-HTN 3 trial failed to show significant difference in blood pressure (BP) lowering between patients undergoing catheter-based renal denervation (RDN) and the sham-procedure arm of the study. However, there is still optimism about the role of RDN in the treatment of resistant hypertension, because identification of patients with increased sympathetic activity thus being good RDN responders, improvements in the RDN procedure and new technology RDN catheters are all expected to lead to better RDN results. We present our initial experience with RDN for the treatment of resistant hypertension, and the utility of novel anesthetics and cardiac 123I-metaiodobenzylguanidine scintigraphy (123I-MIBG).

Methods and Results:

Seven patients with resistant hypertension underwent RDN and were followed up for 6 months. MIBG was performed before RDN, in order to estimate sympathetic activity and predict the response to RDN. All patients were sedated with dexmedetomidine and remifentanil during RDN. All patients tolerated the procedure well, were hemodynamically stable and their peri-procedural pain was effectively controlled. A median of 7.6 ± 2.1 and 6 ± 1.4 ablations were delivered in the right and left renal artery respectively, making an average of 6.8 burns per artery. No peri-procedural or late complications - adverse events (local or systematic) occurred. At 6 months, mean reduction in office BP was -26.0/-16.3 mmHg (p=0.004/p=0.02), while mean reduction in ambulatory BP was -12.3/-9.2 mmHg (p=0.118/p=0.045). One patient (14.3%) was a non-responder. None of the cardiac 123I-MIBG imaging indexes(early and late heart-to-mediastinum (H/M) count density ratio, washout rate (WR) of the tracer from the myocardium) were different between responders and non-responders.

Conclusion:

Patients with resistant hypertension who underwent RDN in our department had a significant reduction in BP 6 months after the intervention. 123I-MIBG was not useful in predicting RDN response. Dexmedetomidine and remifentanil provided sufficient patient comfort during the procedure, allowing an adequate number of ablations per renal artery to be performed, and this could probably lead to improved RDN results.

Keywords: Dexmedetomidine, Remifentanil, Renal Denervation, Resistant Hypertension.