-
Journal of Hypertension Feb 2019
Topics: Denervation; Humans; Hypertension; Kidney
PubMed: 30640879
DOI: 10.1097/HJH.0000000000001993 -
Physical Medicine and Rehabilitation... Feb 2018Facet or zygapophysial joint pain is commonly seen in the aging population. Interventional procedures, such as facet joint nerve blocks, facet intraarticular injections,... (Review)
Review
Facet or zygapophysial joint pain is commonly seen in the aging population. Interventional procedures, such as facet joint nerve blocks, facet intraarticular injections, and radiofrequency denervation, are used for the diagnosis and treatment of axial spinal chronic neck and low back pain. The focus of this article is to understand how radiofrequency denervation works in the cervical and lumbar spine and to be able to properly select appropriate patients who might benefit from this safe and effective procedure.
Topics: Arthralgia; Back Pain; Cervical Vertebrae; Denervation; Humans; Lumbar Vertebrae; Neck Pain; Pain, Referred; Radiofrequency Therapy
PubMed: 29173659
DOI: 10.1016/j.pmr.2017.08.011 -
Hellenic Journal of Cardiology : HJC =... 2020Currently, renal denervation (RDN) has proven its overall procedural and renal safety in registries and trials. Available data, suggest that vascular complications are...
Currently, renal denervation (RDN) has proven its overall procedural and renal safety in registries and trials. Available data, suggest that vascular complications are rather scarce in modern studies using established neuromodulation catheters of different technologies and kidney parameters are mainly maintained stable overtime in RDN patients. Identification of the impact of energy delivery at vascular level by means of advanced methodologies such as optical coherence tomography (OCT) is a meaningful research tool. This accumulation of evidence on the acute and late effects of the procedure in the renal artery tissue especially when a new catheter is tested, as in the present work can further enhance our knowledge on the pathophysiology and clinical outcome of RDN.
Topics: Blood Pressure; Catheter Ablation; Denervation; Humans; Hypertension; Kidney; Renal Artery; Sympathectomy; Treatment Outcome
PubMed: 32916295
DOI: 10.1016/j.hjc.2020.09.002 -
Journal of Hypertension Jul 2018
Topics: Denervation; Vascular Stiffness
PubMed: 29847455
DOI: 10.1097/HJH.0000000000001765 -
Cleveland Clinic Journal of Medicine Sep 2017Despite promising results in initial trials, renal denervation failed to achieve its efficacy end points as a treatment for resistant hypertension in the SYMPLICITY... (Review)
Review
Despite promising results in initial trials, renal denervation failed to achieve its efficacy end points as a treatment for resistant hypertension in the SYMPLICITY HTN-3 trial, the largest trial of this treatment to date (N Engl J Med 2014; 370:1393-1401). Is renal denervation dead, or will future trials and newer technology revive it?
Topics: Blood Pressure; Denervation; Humans; Hypertension; Kidney; Sympathectomy
PubMed: 28885911
DOI: 10.3949/ccjm.84a.14129 -
Spine Nov 2014
Topics: Denervation; Humans; Low Back Pain; Zygapophyseal Joint
PubMed: 25271491
DOI: 10.1097/BRS.0000000000000617 -
Life Sciences Jul 2023Renal denervation (RDNx) is emerging as a promising treatment for cardiovascular disease, yet the underlying mechanisms and contributions of afferent (sensory) and...
Renal denervation (RDNx) is emerging as a promising treatment for cardiovascular disease, yet the underlying mechanisms and contributions of afferent (sensory) and efferent (sympathetic) renal nerves in healthy conditions remains limited. We hypothesize that sympathetic renal nerves contribute to long-term MAP and renal function, whereas afferent renal nerves do not contribute to the maintenance of cardiovascular and renal function. To test this hypothesis, we performed two experiments. In experiment one, we performed total renal denervation (T-RDNx), ablating afferent and sympathetic renal nerves, in normotensive adult SD rats to determine effects on MAP and renal function. Experiment 2 employed a sequential surgical ablation using: (1) afferent targeted renal denervation (A-RDNx), then (2) sympathetic (T-RDNx) denervation to determine the individual contributions to cardiovascular and renal homeostasis. In experiment 1, MAP decreased following T-RDNx and GFR increased. In experiment 2, A-RDNx led to an increase in MAP but did not change renal function. In contrast, T-RDNx decreased MAP and improved renal filtration. Together, these data partially support our hypothesis that renal sympathetic nerves contribute to the chronic regulation of arterial pressure and renal function. Contrary to the hypothesis, A-RDNx produced an increase in MAP without a detected change in renal function. We concluded that renal sympathetic nerves influence MAP and renal function regulation through a well-defined tonic contribution to renal vascular resistance and sodium reabsorption, whereas afferent renal nerves likely contribute to the maintenance of MAP through a tonic sympatho-inhibitory, negative feedback regulation in the normotensive, healthy rat.
Topics: Male; Rats; Animals; Rats, Sprague-Dawley; Hypertension; Kidney; Sympathectomy; Sympathetic Nervous System; Blood Pressure; Denervation
PubMed: 37169146
DOI: 10.1016/j.lfs.2023.121768 -
Reviews in Cardiovascular Medicine 2015Hypertension remains a leading cause of cardiovascular morbidity and mortality worldwide. It is estimated that 12.8% of hypertensive adults have resistant hypertension.... (Review)
Review
Hypertension remains a leading cause of cardiovascular morbidity and mortality worldwide. It is estimated that 12.8% of hypertensive adults have resistant hypertension. The sympathetic nervous system is a well-known contributor to the pathophysiology of resistant hypertension. Renal denervation has emerged as an effective procedure to treat resistant hypertension by blocking the sympathetic nervous system. The medical device industry has developed various catheters in an effort to achieve better denervation in the absence of available testing to document adequate denervation. By adding a sham control group to the study design, researchers found that the results of the Renal Denervation in Patients With Uncontrolled Hypertension study (SYMPLICITY HTN-3) showed that renal denervation was not superior to placebo in decreasing systolic blood pressure. Although SYMPLICITY HTN-3 successfully addressed many issues that might have biased the previously published data, incomplete denervation caused by limited operator experience, catheter design, and the radiofrequency ablation technology may have accounted for the discrepancy of the results. This, along with differences in the study design and population, should direct future renal denervation studies. This article reviews the available literature and proposes future directions for renal denervation studies. It also provides a detailed comparison of the available catheters and their respective clinical data.
Topics: Animals; Blood Pressure; Catheter Ablation; Catheters; Diffusion of Innovation; Equipment Design; History, 20th Century; History, 21st Century; Humans; Hypertension; Kidney; Postoperative Complications; Risk Factors; Sympathectomy; Treatment Outcome
PubMed: 26198558
DOI: 10.3909/ricm0755 -
Journal of Hypertension Jul 2024
Topics: Humans; Kidney; Hypertension; Denervation; Sympathectomy
PubMed: 38818836
DOI: 10.1097/HJH.0000000000003731 -
Future Cardiology Jul 2023Radio frequency-based renal denervation is a safe and effective way of lowering blood pressure, a common condition associated with high cardiovascular risk. Several... (Review)
Review
Radio frequency-based renal denervation is a safe and effective way of lowering blood pressure, a common condition associated with high cardiovascular risk. Several catheters have been developed to administer energy to the renal arteries and their side branches, thereby modulating sympathetic renal activity. The Symplicity Flex™ and Symplicity Spyral™ are first- and second-generation devices, respectively, for radio frequency-based renal denervation. There is a continuous need to further improve and adjust interventional antihypertensive therapies. Several randomized controlled trials have been conducted to investigate the safety and efficacy of these catheters and most were able to show radio frequency-based renal denervation to be feasible, safe and effective in lowering blood pressure in hypertensive patients with and without concomitant antihypertensive medication. Herein, the authors discuss the pathophysiologic concepts of renal denervation and its procedural approaches, report catheter designs, summarize clinical trials outcomes and, finally, discuss real-world evidence.
Topics: Humans; Antihypertensive Agents; Blood Pressure; Sympathectomy; Kidney; Hypertension; Treatment Outcome; Denervation; Catheter Ablation
PubMed: 37791469
DOI: 10.2217/fca-2023-0059