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American Journal of Kidney Diseases :... Oct 2022Uncontrolled hypertension persists as an important health issue despite the availability of many medications and nondrug therapies that lower blood pressure.... (Review)
Review
Uncontrolled hypertension persists as an important health issue despite the availability of many medications and nondrug therapies that lower blood pressure. Increasingly, nonadherence to medication is found in approximately 2 of every 5 patients with uncontrolled hypertension. In the search for interventions that lower blood pressure that do not rely on adherence to a regimen requiring daily ingestion of medication or repeated physical activity, device-based methods that denervate the renal arteries have emerged as a potential complement to standard antihypertensive treatments. At least 3 different approaches to renal artery denervation are under active investigation, including the use of radiofrequency energy, ultrasound, or the injection of neurolytic agents into the renal perivascular tissue. In this review, we cover what is currently known about the mechanisms of antihypertensive effects of renal denervation, summarize the efficacy and safety of renal denervation using recent controlled trial publications in a number of hypertensive populations, and conclude with some thoughts about challenges in the field, including the optimization of patient selection for the procedure and what the reader can expect in the near future in this rapidly developing field.
Topics: Antihypertensive Agents; Blood Pressure; Denervation; Humans; Hypertension; Kidney; Renal Artery; Sympathectomy; Treatment Outcome
PubMed: 35598810
DOI: 10.1053/j.ajkd.2022.03.015 -
Current Opinion in Nephrology and... Sep 2023Renal denervation represents a new dimension to hypertension treatment, with multiple device manufacturers seeking premarket FDA approval currently. Interest in the... (Review)
Review
PURPOSE OF REVIEW
Renal denervation represents a new dimension to hypertension treatment, with multiple device manufacturers seeking premarket FDA approval currently. Interest in the efficacy and safety of the treatment has spurred compelling mechanistic studies into the function of renal nerves and downstream impacts of denervation.
RECENT FINDINGS
A trial of the ultrasound Paradise Catheter system (RADIANCE II) found a 6.3 mmHg reduction in SBP relative to sham controls. A trial of the Symplicity Spyral system (SPYRAL HTN-ON MED) found an insignificant reduction in SBP relative to sham controls. Individuals were taking antihypertensive medications during the study, and investigators note the sham group experienced a larger medication burden than the denervated group. Recent preclinical studies have evaluated potential risks of renal denervation, how sympathetic activity broadly is affected, as well as identifying possible biomarkers to identify individuals where denervation would be more successful.
SUMMARY
Studies of renal denervation continue to find a robust antihypertensive effect, especially in studies wherein medications are withdrawn. Further investigation into mechanisms and indicators for usage of the technique will be important in identifying the patient population most likely to benefit from usage of renal denervation.
Topics: Humans; Hypertension; Antihypertensive Agents; Sympathectomy; Kidney; Denervation; Blood Pressure; Treatment Outcome
PubMed: 37530084
DOI: 10.1097/MNH.0000000000000908 -
The Journal of the American Academy of... Jun 2017Wrist denervation for the management of chronic wrist pain is a safe and effective procedure that can delay or eliminate the need for more invasive and kinematically... (Review)
Review
Wrist denervation for the management of chronic wrist pain is a safe and effective procedure that can delay or eliminate the need for more invasive and kinematically compromising salvage procedures. Wrist denervation has become increasingly popular since it was first described in 1959, and the technique has evolved from more extensive denervations to limited single-incision approaches. Many physicians have performed this procedure as a palliative approach to managing chronic wrist pain and as an adjunct to other procedures.
Topics: Arthralgia; Chronic Pain; Denervation; Humans; Wrist; Wrist Joint
PubMed: 28489713
DOI: 10.5435/JAAOS-D-14-00243 -
Current Hypertension Reports Jul 2016SYMPLICITY HTN-3 was a pivotal moment for renal denervation as a treatment option for resistant hypertension. Prior unblinded studies were called into question given the... (Review)
Review
SYMPLICITY HTN-3 was a pivotal moment for renal denervation as a treatment option for resistant hypertension. Prior unblinded studies were called into question given the negative results of the first sham-controlled trial of renal denervation. Reevaluation of the renal denervation procedure demonstrated that a more precise approach was needed to adequately denervate the kidney. This new approach has been implemented in two ongoing clinical trials, one on and one off medications to assess the new procedure's efficacy and safety. These and other ongoing trials will be discussed in the context of older studies in this field. We focus on novel findings published following the release of SYMPLICITY HTN-3 data in early 2014 and look to the future of renal denervation in the treatment of primary hypertension.
Topics: Denervation; Humans; Hyperkalemia; Hypertension, Renal; Kidney; Renin-Angiotensin System; Sodium; Zirconium
PubMed: 27245681
DOI: 10.1007/s11906-016-0666-1 -
Clinical Research in Cardiology :... May 2021Renal denervation has emerged as a safe and effective therapy to lower blood pressure in hypertensive patients. In addition to the main renal arteries, branch vessels... (Review)
Review
Renal denervation has emerged as a safe and effective therapy to lower blood pressure in hypertensive patients. In addition to the main renal arteries, branch vessels are also denervated in more contemporary studies. Accurate and reliable imaging in renal denervation patients is critical for long-term safety surveillance due to the small risk of renal artery stenosis that may occur after the procedure. This review summarizes three common non-invasive imaging modalities: Doppler ultrasound (DUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). DUS is the most widely used owing to cost considerations, ease of use, and the fact that it is less invasive, avoids ionizing radiation exposure, and requires no contrast media use. Renal angiography is used to determine if renal artery stenosis is present when non-invasive imaging suggests renal artery stenosis. We compiled data from prior renal denervation studies as well as the more recent SPYRAL-HTN OFF MED Study and show that DUS demonstrates both high sensitivity and specificity for detecting renal stenosis de novo and in longitudinal assessment of renal artery patency after interventions. In the context of clinical trials DUS has been shown, together with the use of the baseline angiogram, to be effective in identifying stenosis in branch and accessory arteries and merits consideration as the main screening imaging modality to detect clinically significant renal artery stenosis after renal denervation and this is consistent with guidelines from the recent European Consensus Statement on Renal Denervation.
Topics: Computed Tomography Angiography; Denervation; Humans; Hypertension; Magnetic Resonance Angiography; Renal Artery; Renal Artery Obstruction; Sensitivity and Specificity; Ultrasonography, Doppler
PubMed: 33646357
DOI: 10.1007/s00392-021-01819-w -
Techniques in Hand & Upper Extremity... Dec 2022Osteoarthritis of the first carpometacarpal joint is a frequent condition that hand surgeons have to deal with. When conservative measures such as physiotherapy, steroid...
Osteoarthritis of the first carpometacarpal joint is a frequent condition that hand surgeons have to deal with. When conservative measures such as physiotherapy, steroid injections, or splinting fail to alleviate symptoms, trapeziectomy is considered the gold standard for surgical treatment. In the present article, a novel technique is presented to denervate the joint capsule together with the periosteum and the endosteum to address sensory receptors located in these 2 extracapsular structures in the proximity of the first carpometacarpal joint area. Denervation with periosteal resection, apart from being a relatively easy and less aggressive technique compared with trapeziectomy, offers satisfactory pain relief with a faster recovery time.
Topics: Humans; Carpometacarpal Joints; Thumb; Osteoarthritis; Joint Capsule; Denervation
PubMed: 35698307
DOI: 10.1097/BTH.0000000000000389 -
Experimental Physiology Apr 2015What is the topic of this review? Does catheter-based renal denervation effectively denervate the afferent and efferent renal nerves and does reinnervation occur? What... (Review)
Review
What is the topic of this review? Does catheter-based renal denervation effectively denervate the afferent and efferent renal nerves and does reinnervation occur? What advances does it highlight? Following catheter-based renal denervation, the afferent and efferent responses to electrical stimulation were abolished, renal sympathetic nerve activity was absent, and levels of renal noradrenaline and immunohistochemistry for tyrosine hydroxylase and calcitonin gene-related peptide were significantly reduced. By 11 months after renal denervation, both the functional responses and anatomical markers of afferent and efferent renal nerves had returned to normal, indicating reinnervation. Renal denervation reduces blood pressure in animals with experimental hypertension and, recently, catheter-based renal denervation was shown to cause a prolonged decrease in blood pressure in patients with resistant hypertension. The randomized, sham-controlled Symplicity HTN-3 trial failed to meet its primary efficacy end-point, but there is evidence that renal denervation was incomplete in many patients. Currently, there is little information regarding the effectiveness of catheter-based renal denervation and the extent of reinnervation. We assessed the effectiveness of renal nerve denervation with the Symplicity Flex catheter and the functional and anatomical reinnervation at 5.5 and 11 months postdenervation. In anaesthetized, non-denervated sheep, there was a high level of renal sympathetic nerve activity, and electrical stimulation of the renal nerve increased blood pressure and reduced heart rate (afferent response) and caused renal vasoconstriction and reduced renal blood flow (efferent response). Immediately after renal denervation, renal sympathetic nerve activity and the responses to electrical stimulation were absent, indicating effective denervation. By 11 months after denervation, renal sympathetic nerve activity was present and the responses to electrical stimulation were normal, indicating reinnervation. Anatomical measures of renal innervation by sympathetic efferent nerves (tissue noradrenaline and tyrosine hydroxylase) and afferent sensory nerves (calcitonin gene-related peptide) demonstrated large decreases at 1 week postdenervation, but normal levels at 11 months postdenervation. In summary, catheter-based renal denervation is effective, but reinnervation occurs. Studies of central and renal changes postdenervation are required to understand the causes of the prolonged hypotensive response to catheter-based renal denervation in human hypertension.
Topics: Animals; Blood Pressure; Catheters; Humans; Hypertension; Kidney; Sympathectomy; Sympathetic Nervous System
PubMed: 25573386
DOI: 10.1113/expphysiol.2014.079871 -
Heart & Lung : the Journal of Critical... 2022Pulmonary hypertension (pH) is a progressive and fatal disease with poor long-term prognosis and high mortality. Although great progress has been made in current... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pulmonary hypertension (pH) is a progressive and fatal disease with poor long-term prognosis and high mortality. Although great progress has been made in current treatment methods, the survival rate is still poor. Therefore, we need to find an effective treatment for pH.
OBJECTIVE
pH is a type of refractory, progressive, and fatal pulmonary vascular disease which involves a variety of clinical conditions and may complicate most cardiovascular and respiratory diseases. Pulmonary artery denervation (PADN) therapy for pH has become the current trend, but its clinical application still faces a series of problems, and its efficacy remains controversial. The purpose of the study is to evaluate the literature on the effects of PADN for pH.
METHOD
The PubMed, Embase, and Web of Science databases were searched by two researchers until April 9th, 2021. The literature was read and screened, and effective data(6-minute walking distance, cardiac output, mPAP, PVR,Left ventricular end-systolic diameter,Cardiac output,Readmission rate,Mortality,Cardiac function,and so on) was extracted, collated, and analyzed. The literature was managed by Endnote 9.3 software and evaluated by RevMan 5.3 software.
RESULTS
The meta-analysis included five controlled experiments with a total of 339 patients. The literature quality evaluations were all Level B. The meta-analysis results showed that compared with the control group, PADN treatment could improve the 6-minute walking distance of pH patients [WMD = 103.72, 95%CI (49.63, 157.82), P < 0.05], reduce mean pulmonary artery pressure (mPAP) [WMD = -7.26, 95%CI (-10.86, -3.66), P < 0.05], reduce pulmonary vascular resistance (PVR) [WMD = -4.53, 95%CI (-8.23, -0.83), P < 0.05], and improve cardiac output [WMD = 0.48, 95%CI (0.23, 0.73), P < 0.05]. There was no significant effect on the left ventricular end-systolic diameter [WMD = -0.13, 95%CI (-0.49, 0.24), P > 0.05], readmission rate [OR = 0.14, 95%CI (0.01, 1.87), P > 0.05], mortality rate [OR = 0.77, 95%CI (0.22, 2.69), P > 0.05], or cardiac function [OR = 0.32, 95%CI (0.05, 2.10), P > 0.05].
CONCLUSION
PADN is an effective method for the treatment of pH which is worthy of clinical promotion.
Topics: Denervation; Heart; Humans; Hypertension, Pulmonary; Lung; Pulmonary Artery
PubMed: 35144042
DOI: 10.1016/j.hrtlng.2022.01.020 -
Critical Care Nursing Quarterly Feb 1995The denervated heart requires significant changes in planning and implementing care. The loss of direct neural compensation in response to the body's demands is replaced... (Review)
Review
The denervated heart requires significant changes in planning and implementing care. The loss of direct neural compensation in response to the body's demands is replaced by the denervated heart's reliance on preload augmentation to maintain cardiac output, stimulation of cardiac adrenergic receptor sites to promote inotropic and chronotropic responses, and the nurse's knowledge of transplant physiology to choose and administer directacting cardiovascular pharmacologic agents to treat common posttransplant complications and to safely and effectively manage the patient's care.
Topics: Denervation; Heart Transplantation; Hemodynamics; Humans
PubMed: 7866887
DOI: 10.1097/00002727-199502000-00004 -
Developmental Biology Jun 2022It is long-established that innervation-dependent production of neurotrophic factors is required for blastema formation and epimorphic regeneration of appendages in fish...
It is long-established that innervation-dependent production of neurotrophic factors is required for blastema formation and epimorphic regeneration of appendages in fish and amphibians. The regenerating mouse digit tip and the human fingertip are mammalian models for epimorphic regeneration, and limb denervation in mice inhibits this response. A complicating issue of limb denervation studies in terrestrial vertebrates is that the experimental models also cause severe paralysis therefore impairing appendage use and diminishing mechanical loading of the denervated tissues. Thus, it is unclear whether the limb denervation impairs regeneration via loss of neurotrophic signaling or loss of mechanical load, or both. Herein, we developed a novel surgical procedure in which individual digits were specifically denervated without impairing ambulation and mechanical loading. We demonstrate that digit specific denervation does not inhibit but attenuates digit tip regeneration, in part due to a delay in wound healing. However, treating denervated digits with a wound dressing that enhances closure results in a partial rescue of the regeneration response. Contrary to the current understanding of mammalian epimorphic regeneration, these studies demonstrate that mouse digit tip regeneration is not peripheral nerve dependent, an observation that should inform continued mammalian regenerative medicine approaches.
Topics: Amputation, Surgical; Animals; Denervation; Extremities; Mammals; Mice; Wound Healing
PubMed: 35353991
DOI: 10.1016/j.ydbio.2022.03.007