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Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria

OBJECTIVE: The aim of this study was to describe the renal arteries of humans in vivo, as precisely as possible, and to formulate an expected value for the exclusion of renal denervation due to the anatomical situation based on the criteria of the Symplicity HTN trials. DESIGN AND SETTING: In a retr...

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Autores principales: Schönherr, Elisabeth, Rehwald, Rafael, Nasseri, Parinaz, Luger, Anna K, Grams, Astrid E, Kerschbaum, Julia, Rehder, Peter, Petersen, Johannes, Glodny, Bernhard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716171/
https://www.ncbi.nlm.nih.gov/pubmed/26729385
http://dx.doi.org/10.1136/bmjopen-2015-009351
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author Schönherr, Elisabeth
Rehwald, Rafael
Nasseri, Parinaz
Luger, Anna K
Grams, Astrid E
Kerschbaum, Julia
Rehder, Peter
Petersen, Johannes
Glodny, Bernhard
author_facet Schönherr, Elisabeth
Rehwald, Rafael
Nasseri, Parinaz
Luger, Anna K
Grams, Astrid E
Kerschbaum, Julia
Rehder, Peter
Petersen, Johannes
Glodny, Bernhard
author_sort Schönherr, Elisabeth
collection PubMed
description OBJECTIVE: The aim of this study was to describe the renal arteries of humans in vivo, as precisely as possible, and to formulate an expected value for the exclusion of renal denervation due to the anatomical situation based on the criteria of the Symplicity HTN trials. DESIGN AND SETTING: In a retrospective cohort study, the renal arteries of 126 patients (57 women, 69 men, mean age 60±17.2 years (CI 57.7 to 63.6)) were segmented semiautomatically from high-contrast CT angiographies. RESULTS: Among the 300 renal arteries, there were three arteries with fibromuscular dysplasia and one with ostial renal artery stenosis. The first left renal artery was shorter than the right (34±11.4 mm (CI 32 to 36) vs 45.9±15 mm (CI 43.2 to 48.6); p<0.0001), but had a slightly larger diameter (5.2±1.4 mm (CI 4.9 to 5.4) vs 4.9±1.2 mm (CI 4.6 to 5.1); p>0.05). The first left renal arteries were 1.1±0.4 mm (CI 0.9 to 1.3), and the first right renal arteries were 0.3±0.6 mm (CI 0.1 to 0.5) thinner in women than in men (p<0.05). Ostial funnels were up to 14 mm long. The cross-sections were elliptical, more pronounced on the right side (p<0.05). In 23 cases (18.3%), the main artery was shorter than 2 cm; in 43 cases (34.1%), the diameter was not >4 mm. Some 46% of the patients, or 58.7% when variants and diseases were taken into consideration, were theoretically not suitable for denervation. CONCLUSIONS: Based on these precise measurements, the anatomical situation as a reason for ruling out denervation appears to be significantly more common than previously suspected. Since this can be the cause of the failure of treatment in some cases, further development of catheters or direct percutaneous approaches may improve success rates.
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spelling pubmed-47161712016-01-31 Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria Schönherr, Elisabeth Rehwald, Rafael Nasseri, Parinaz Luger, Anna K Grams, Astrid E Kerschbaum, Julia Rehder, Peter Petersen, Johannes Glodny, Bernhard BMJ Open Renal Medicine OBJECTIVE: The aim of this study was to describe the renal arteries of humans in vivo, as precisely as possible, and to formulate an expected value for the exclusion of renal denervation due to the anatomical situation based on the criteria of the Symplicity HTN trials. DESIGN AND SETTING: In a retrospective cohort study, the renal arteries of 126 patients (57 women, 69 men, mean age 60±17.2 years (CI 57.7 to 63.6)) were segmented semiautomatically from high-contrast CT angiographies. RESULTS: Among the 300 renal arteries, there were three arteries with fibromuscular dysplasia and one with ostial renal artery stenosis. The first left renal artery was shorter than the right (34±11.4 mm (CI 32 to 36) vs 45.9±15 mm (CI 43.2 to 48.6); p<0.0001), but had a slightly larger diameter (5.2±1.4 mm (CI 4.9 to 5.4) vs 4.9±1.2 mm (CI 4.6 to 5.1); p>0.05). The first left renal arteries were 1.1±0.4 mm (CI 0.9 to 1.3), and the first right renal arteries were 0.3±0.6 mm (CI 0.1 to 0.5) thinner in women than in men (p<0.05). Ostial funnels were up to 14 mm long. The cross-sections were elliptical, more pronounced on the right side (p<0.05). In 23 cases (18.3%), the main artery was shorter than 2 cm; in 43 cases (34.1%), the diameter was not >4 mm. Some 46% of the patients, or 58.7% when variants and diseases were taken into consideration, were theoretically not suitable for denervation. CONCLUSIONS: Based on these precise measurements, the anatomical situation as a reason for ruling out denervation appears to be significantly more common than previously suspected. Since this can be the cause of the failure of treatment in some cases, further development of catheters or direct percutaneous approaches may improve success rates. BMJ Publishing Group 2016-01-04 /pmc/articles/PMC4716171/ /pubmed/26729385 http://dx.doi.org/10.1136/bmjopen-2015-009351 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Renal Medicine
Schönherr, Elisabeth
Rehwald, Rafael
Nasseri, Parinaz
Luger, Anna K
Grams, Astrid E
Kerschbaum, Julia
Rehder, Peter
Petersen, Johannes
Glodny, Bernhard
Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria
title Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria
title_full Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria
title_fullStr Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria
title_full_unstemmed Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria
title_short Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria
title_sort retrospective morphometric study of the suitability of renal arteries for renal denervation according to the symplicity htn2 trial criteria
topic Renal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716171/
https://www.ncbi.nlm.nih.gov/pubmed/26729385
http://dx.doi.org/10.1136/bmjopen-2015-009351
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