CardioVascular and Interventional Radiology

, Volume 39, Issue 2, pp 251–260

Renal Sympathetic Denervation by CT-Guided Ethanol Injection: A Phase II Pilot Trial of a Novel Technique

  • J. Ricke
  • M. Seidensticker
  • S. Becker
  • J. Schiefer
  • I. Adamchic
  • K. Lohfink
  • M. Kandulski
  • A. Heller
  • P. R. Mertens
Clinical Investigation

Abstract

Objectives

CT-guided ethanol-mediated renal sympathetic denervation in treatment of therapy-resistant hypertension was performed to assess patient safety and collect preliminary data on treatment efficacy.

Materials and Methods

Eleven patients with therapy-resistant hypertension (blood pressure of >160 mmHg despite three different antihypertensive drugs including a diuretic) and following screening for secondary causes were enrolled in a phase II single arm open label pilot trial of CT-guided neurolysis of sympathetic renal innervation. Primary endpoint was safety, and secondary endpoint was a decrease of the mean office as well as 24-h systolic blood pressure in follow-up. Follow-up visits at 4 weeks, 3, and 6 months included 24-h blood pressure assessments, office blood pressure, laboratory values, as well as full clinical and quality of life assessments.

Results

No toxicities ≥3° occurred. Three patients exhibited worsened kidney function in follow-up analyses. When accounting all patients, office systolic blood pressure decreased significantly at all follow-up visits (maximal mean decrease −41.2 mmHg at 3 months). The mean 24-h systolic blood pressure values decreased significantly at 3 months, but not at 6 months (mean: −9.7 and −6.3 mmHg, respectively). Exclusion of five patients who had failed catheter-based endovascular denervation and/or were incompliant for antihypertensive drug intake revealed a more pronounced decrease of 24-h systolic blood pressure (mean: −18.3 and −15.2 mmHg at 3 and 6 months, p = 0.03 and 0.06).

Conclusion

CT-guided sympathetic denervation proved to be safe and applicable under various anatomical conditions with more renal arteries and such of small diameter.

Keywords

Therapy-resistant arterial hypertension Sympathetic nerves Vasotonus CT-guided ablation 

Supplementary material

270_2015_1261_MOESM1_ESM.pdf (77 kb)
Supplementary material 1 (PDF 76 kb)

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2015

Authors and Affiliations

  • J. Ricke
    • 1
    • 3
  • M. Seidensticker
    • 1
    • 3
  • S. Becker
    • 1
    • 2
  • J. Schiefer
    • 2
  • I. Adamchic
    • 1
  • K. Lohfink
    • 1
  • M. Kandulski
    • 2
  • A. Heller
    • 2
  • P. R. Mertens
    • 2
  1. 1.Department of Radiology and Nuclear Medicine, Universitätsklinikum Magdeburg AöROtto-von-Guericke University MagdeburgMagdeburgGermany
  2. 2.Department of Nephrology and Hypertension, Diabetes and EndocrinologyUniversitätsklinikum Magdeburg AöRMagdeburgGermany
  3. 3.Deutsche Akademie für MikrotherapieMagdeburgGermany

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