Renal artery and parenchymal changes after renal denervation: assessment by magnetic resonance angiography

European Radiology, Mar 2017

Objectives Relatively little is known about the incidence of long-term renal damage after renal denervation (RDN), a potential new treatment for hypertension. In this study the incidence of renal artery and parenchymal changes, assessed with contrast-enhanced magnetic resonance angiography (MRA) after RDN, is investigated. Methods This study is an initiative of ENCOReD, a collaboration of hypertension expert centres. Patients in whom an MRA was performed before and after RDN were included. Scans were evaluated by two independent, blinded radiologists. Primary outcome was the change in renal artery morphology and parenchyma. Results MRAs from 96 patients were analysed. Before RDN, 41 renal anomalies were observed, of which 29 mostly mild renal artery stenoses. After a median time of 366 days post RDN, MRA showed a new stenosis (25–49% lumen reduction) in two patients and progression of pre-existing lumen reduction in a single patient. No other renal changes were observed and renal function remained stable. Conclusions We observed new or progressed renal artery stenosis in three out of 96 patients, after a median time of 12 months post RDN (3.1%). Procedural angiographies showed that ablations were applied near the observed stenosis in only one of the three patients. Key Points • The incidence of vascular changes 12 months post RDN was 3.1%. • No renal vascular or parenchymal changes other than stenoses were observed. • Ablations were applied near the stenosis in only one of three patients.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1007%2Fs00330-017-4770-7.pdf

Renal artery and parenchymal changes after renal denervation: assessment by magnetic resonance angiography

Renal artery and parenchymal changes after renal denervation: assessment by magnetic resonance angiography Margreet F. Sanders 0 1 2 3 5 6 7 8 9 10 12 Pieter Jan van Doormaal 0 1 2 3 5 6 7 8 9 10 12 Martine M. A. Beeftink 0 1 2 3 5 6 7 8 9 10 12 Michiel L. Bots 0 1 2 3 5 6 7 8 9 10 12 Fadl Elmula M. Fadl Elmula 0 1 2 3 5 6 7 8 9 10 12 Jesse Habets 0 1 2 3 5 6 7 8 9 10 12 Frank Hammer 0 1 2 3 5 6 7 8 9 10 12 Pavel Hoffmann 0 1 2 3 5 6 7 8 9 10 12 Lotte Jacobs 0 1 2 3 5 6 7 8 9 10 12 Patrick B. Mark 0 1 2 3 5 6 7 8 9 10 12 Alexandre Persu 0 1 2 3 5 6 7 8 9 10 11 12 13 Jean Renkin 0 1 2 3 5 6 7 8 9 10 11 12 13 Giles Roditi 0 1 2 3 5 6 7 8 9 10 12 Wilko Spiering 0 1 2 3 5 6 7 8 9 10 12 Jan A. Staessen 0 1 2 3 5 6 7 8 9 10 12 Alison H. Taylor 0 1 2 3 5 6 7 8 9 10 12 Willemien L. Verloop 0 1 2 3 5 6 7 8 9 10 12 Eva E. Vink 0 1 2 3 5 6 7 8 9 10 12 Evert-Jan Vonken 0 1 2 3 5 6 7 8 9 10 12 Michiel Voskuil 0 1 2 3 5 6 7 8 9 10 12 Tim Leiner 0 1 2 3 5 6 7 8 9 10 12 Peter J. Blankestijn 0 1 2 3 5 6 7 8 9 10 12 on behalf of the European Network COordinating research on Renal Denervation (ENCOReD) Consortium 0 1 2 3 5 6 7 8 9 10 12 0 Department of Cardiology, University Medical Center Utrecht , Utrecht , The Netherlands 1 Department of Vascular Medicine, University Medical Centre Utrecht , Utrecht , The Netherlands 2 Department of Radiology, University Medical Center Utrecht , Utrecht , The Netherlands 3 Department of Nephrology and Hypertension, University Medical Center Utrecht , PO Box 85500, 3508 GA Utrecht , The Netherlands 4 Peter J. Blankestijn 5 Department of Radiology, Glasgow Royal Infirmary , Glasgow , UK 6 Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow, Scotland , UK 7 Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven , Leuven , Belgium 8 Section for Interventional Cardiology, Department of Cardiology, Oslo University Hospital , Ullevål Oslo , Norway 9 Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium 10 Department of Internal Medicine and Department of Cardiology, Oslo University Hospital , Ullevål Oslo , Norway 11 Cardiology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium 12 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , The Netherlands 13 Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain , Brussels , Belgium Objectives Relatively little is known about the incidence of longterm renal damage after renal denervation (RDN), a potential new treatment for hypertension. In this study the incidence of renal artery and parenchymal changes, assessed with contrast-enhanced magnetic resonance angiography (MRA) after RDN, is investigated. Methods This study is an initiative of ENCOReD, a collaboration of hypertension expert centres. Patients in whom an MRA was performed before and after RDN were included. Scans were evaluated by two independent, blinded radiologists. Primary outcome was the change in renal artery morphology and parenchyma. - Despite promising initial results, the efficacy of renal artery denervation (RDN) for lowering blood pressure (BP) is still subject of discussion [1, 2]. RDN, a relatively new treatment modality for hypertension, is achieved through an endovascular procedure by catheter-based radiofrequency ablation of the renal arteries [1, 3]. Because of the nature of this intervention, there is obvious concern about possible damage to the renal artery and parenchyma. This concern was fuelled by the findings of Templin et al., who analysed the incidence of renal vascular changes before and directly after RDN by optical coherence tomography [4]. In 24 renal arteries the authors observed a high occurrence of vascular changes; 42% of renal arteries showed vasospasm, 13% showed a dissection and there was a significant increase in the occurrence of oedema and thrombi [4]. The clinical significance of these findings is not completely understood. Several case reports demonstrated angiographically documented renal artery stenosis after RDN [5–9]. Also, clinical studies reported on vascular changes as assessed with renal artery imaging before and after RDN [10–18]. Since there is considerable variation across these studies with respect to imaging modality, follow-up time and definitions used for abnormalities, there is a clear need for more detailed information on long-term safety. The present study aimed to investigate the safety of RDN by assessing systematically the incidence of morphological changes in renal arteries and parenchyma after RDN, compared to baseline, using magnetic resonance angiography of the renal arteries and kidneys. Material and methods The present study is an initiative of the European Network COo (...truncated)


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs00330-017-4770-7.pdf

Margreet F. Sanders, Pieter Jan van Doormaal, Martine M. A. Beeftink, Michiel L. Bots, Fadl Elmula M. Fadl Elmula, Jesse Habets, Frank Hammer, Pavel Hoffmann, Lotte Jacobs, Patrick B. Mark, Alexandre Persu, Jean Renkin, Giles Roditi, Wilko Spiering, Jan A. Staessen, Alison H. Taylor, Willemien L. Verloop, Eva E. Vink, Evert-Jan Vonken, Michiel Voskuil, Tim Leiner, Peter J. Blankestijn, on behalf of the European Network COordinating research on Renal Denervation (ENCOReD) Consortium. Renal artery and parenchymal changes after renal denervation: assessment by magnetic resonance angiography, European Radiology, 2017, pp. 1-8, DOI: 10.1007/s00330-017-4770-7