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EuroIntervention : Journal of EuroPCR... Sep 2023Ultrasound and radiofrequency renal denervation (RDN) have been shown to safely lower blood pressure (BP) in hypertension. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Ultrasound and radiofrequency renal denervation (RDN) have been shown to safely lower blood pressure (BP) in hypertension.
AIMS
The TARGET BP OFF-MED trial investigated the efficacy and safety of alcohol-mediated renal denervation (RDN) in the absence of antihypertensive medications.
METHODS
This randomised, blinded, sham-controlled trial was conducted in 25 centres in Europe and the USA. Patients with a 24-hour systolic BP of 135-170 mmHg, an office systolic BP 140-180 mmHg and diastolic BP ≥90 mmHg on 0-2 antihypertensive medications were enrolled. The primary efficacy endpoint was the change in mean 24-hour systolic BP at 8 weeks. Safety endpoints included major adverse events up to 30 days.
RESULTS
A total of 106 patients were randomised; the baseline mean office BP following medication washout was 159.4/100.4±10.9/7.0 mmHg (RDN) and 160.1/98.3±11.0/6.1 mmHg (sham), respectively. At 8 weeks post-procedure, the mean (±standard deviation) 24-hour systolic BP change was â2.9±7.4 mmHg (p=0.009) versus â1.4±8.6 mmHg (p=0.25) in the RDN and sham groups, respectively (mean between-group difference: 1.5 mmHg; p=0.27). There were no differences in safety events between groups. After 12 months of blinded follow-up, with medication escalation, patients achieved similar office systolic BP (RDN: 147.9±18.5 mmHg; sham: 147.8±15.1 mmHg; p=0.68) with a significantly lower medication burden in the RDN group (mean daily defined dose: 1.5±1.5 vs 2.3±1.7; p=0.017).
CONCLUSIONS
In this trial, alcohol-mediated RDN was delivered safely but was not associated with significant BP differences between groups. Medication burden was lower in the RDN group up to 12 months.
Topics: Humans; Antihypertensive Agents; Hypertension; Kidney; Blood Pressure; Ethanol; Denervation; Sympathectomy; Treatment Outcome; Blood Pressure Monitoring, Ambulatory
PubMed: 37427416
DOI: 10.4244/EIJ-D-23-00088 -
Sexual Medicine Reviews Oct 2022The management of chronic scrotal pain is long and varied, with historical treatment algorithms typically ending with orchiectomy. Microsurgical denervation of the... (Review)
Review
INTRODUCTION
The management of chronic scrotal pain is long and varied, with historical treatment algorithms typically ending with orchiectomy. Microsurgical denervation of the spermatic cord (MDSC) is a testicle-sparing option for patients who have failed conservative treatment options and over its forty-year history has seen many technical refinements.
OBJECTIVES
To review the history and development of MDSC and discuss the outcomes of different surgical techniques.
METHODS
A literature review using PubMed and Google Scholar was conducted to identify studies pertaining to surgical treatment of CSP, MDSC, and outcomes. Search terms included "chronic," "scrotal pain," "orchialgia," "spermatic cord," "denervation," and "microsurgery."
RESULTS
We included 21 case reports and series since the first seminal paper describing MDSC technique in 1978. Additional studies that challenged existing conventions or described novel techniques are also discussed. The current standard procedure utilizes a subinguinal incision and a surgical microscope. Open, robotic, and laparoscopic approaches to MDSC have been described, but access to minimally invasive instruments may be limited outside of developed nations. Pain reduction following preoperative spermatic cord predicts success of MDSC. Methods for identifying and preserving the testicular and deferential arteries vary depending on surgeon preference but appear to have comparable outcomes. Future developments in MDSC involve targeted denervation, minimizing collateral thermal injury, and alternative techniques to visualize arterial supply.
CONCLUSION
For patients suffering from CSP, MDSC is a well-studied technique that may offer appropriately selected patients' relief. Future investigation comparing targeted vs full MDSC as well as in vivo study of new techniques are needed to continue to improve outcomes.
Topics: Male; Humans; Denervation; Spermatic Cord; Testicular Diseases; Genital Diseases, Male; Pelvic Pain
PubMed: 37051952
DOI: 10.1016/j.sxmr.2021.11.005 -
Physical Medicine and Rehabilitation... Nov 2021The innervation of the hip joint has been investigated for over 200 years by anatomists and clinicians. Knowledge of the distribution and location of these nerves... (Review)
Review
The innervation of the hip joint has been investigated for over 200 years by anatomists and clinicians. Knowledge of the distribution and location of these nerves relative to anatomic landmarks visible with image guidance is important for optimizing nerve blocks and radiofrequency ablation procedures. In this article, the innervation of the anterior and posterior hip joint is reviewed, focusing on the source of articular branches, their course, termination, and relationship to anatomic landmarks. The innervation of the hip joint is multifaceted, with articular nerves originating from many sources in close proximity to and distant from the hip joint.
Topics: Anatomic Landmarks; Hip Joint; Humans; Musculoskeletal Physiological Phenomena; Nerve Block
PubMed: 34593140
DOI: 10.1016/j.pmr.2021.05.009 -
MMW Fortschritte Der Medizin Mar 2023
Topics: Humans; Blood Pressure; Denervation
PubMed: 36826673
DOI: 10.1007/s15006-023-2423-0 -
Nephrology, Dialysis, Transplantation :... Mar 2022Catheter-based renal denervation to reduce high blood pressure (BP) has received well-deserved attention after a recent series of sham-controlled trials reported... (Review)
Review
Catheter-based renal denervation to reduce high blood pressure (BP) has received well-deserved attention after a recent series of sham-controlled trials reported significant antihypertensive efficacy and very favourable tolerability and safety of the intervention. This emerging treatment option is of high relevance to nephrologists. Patients with chronic kidney disease (CKD) are at elevated risk of cardiovascular adverse events and often present with hypertension, which is very difficult to control with medication. Renal denervation promises a new tool to reduce BP and to prevent loss of renal function in this population. The current review considers the role of the kidney and neurohormonal activation in the development of hypertension and the rationale for renal denervation. The current state of the evidence for the effectiveness and tolerability of the procedure is considered from the nephrologists' perspective, with a focus on the potential future role of renal denervation in the management of CKD patients with hypertension.
Topics: Antihypertensive Agents; Blood Pressure; Denervation; Female; Humans; Hypertension; Kidney; Male; Nephrologists; Renal Insufficiency, Chronic; Sympathectomy; Treatment Outcome
PubMed: 33200209
DOI: 10.1093/ndt/gfaa237 -
Journal of the American Heart... Aug 2023BACKGROUND Renal denervation has proven its efficacy to lower blood pressure in comparison to sham treatment in recent randomized clinical trials. Although there is a...
BACKGROUND Renal denervation has proven its efficacy to lower blood pressure in comparison to sham treatment in recent randomized clinical trials. Although there is a large body of evidence for the durability and safety of radiofrequency-based renal denervation, there are a paucity of data for endovascular ultrasound-based renal denervation (uRDN). We aimed to assess the long-term efficacy and safety of uRDN in a single-center cohort of patients. METHODS AND RESULTS Data from 2 previous studies on uRDN were pooled. Ambulatory 24-hour blood pressure measurements were taken before as well as 3, 6, 12, and 24 months after treatment with uRDN. A total of 130 patients (mean age 63±9 years, 24% women) underwent uRDN. After 3, 6, 12, and 24 months, systolic mean 24-hour ambulatory blood pressure values were reduced by 10±12, 10±14, 8±15, and 10±15 mm Hg, respectively, when compared with baseline (<0.001). Corresponding diastolic values were reduced by 6±8, 6±8, 5±9, and 6±9 mm Hg, respectively (<0.001). Periprocedural adverse events occurred in 16 patients, and all recovered without sequelae. CONCLUSIONS In this single-center study, uRDN effectively lowered blood pressure up to 24 months after treatment.
Topics: Humans; Female; Middle Aged; Aged; Male; Hypertension; Blood Pressure; Antihypertensive Agents; Blood Pressure Monitoring, Ambulatory; Renal Artery; Treatment Outcome; Kidney; Sympathectomy; Denervation
PubMed: 37581398
DOI: 10.1161/JAHA.123.030767 -
Long-term efficacy and safety of renal denervation: an update from registries and randomised trials.Blood Pressure Dec 2023
Randomized Controlled Trial
Topics: Humans; Kidney; Hypertension; Denervation; Registries; Treatment Outcome; Sympathectomy; Blood Pressure; Antihypertensive Agents
PubMed: 37804153
DOI: 10.1080/08037051.2023.2266664 -
Praxis Sep 2021
Topics: Blood Pressure; Denervation; Humans; Hypertension; Renal Artery
PubMed: 34521266
DOI: 10.1024/1661-8157/a003741 -
Hypertension Research : Official... Jan 2023
Topics: Antihypertensive Agents; Blood Pressure; Kidney; Blood Pressure Monitoring, Ambulatory; Denervation
PubMed: 36380205
DOI: 10.1038/s41440-022-01109-6 -
Hypertension Research : Official... Jun 2022
Topics: Blood Pressure; Denervation; Humans; Hypertension; Kidney; Patient Preference; Sodium Chloride, Dietary; Stroke; Sympathectomy
PubMed: 35665779
DOI: 10.1038/s41440-022-00915-2