Clinical feasibility and efficacy of renal denervation in hypertensive patients with aortic dissection
C T Lee, L C Wu, S I Lin, K H Chang, C Y Lin, C Y Chien, C T Tsai, Y H LeeAbstract
Background
Uncontrolled hypertension is a key determinant of aortic dissection progression and recurrence. However, optimal blood pressure (BP) control remains challenging despite intensive medical therapy. Renal denervation (RDN) has demonstrated significant BP-lowering effects in randomized trials, but its feasibility and safety in patients with aortic dissection are not well established.
Aims
To evaluate the feasibility, safety, and antihypertensive efficacy of RDN in hypertensive patients with aortic dissection.
Methods
This prospective, single-center observational study enrolled hypertensive patients with prior aortic dissection who underwent RDN between 2017 and 2023. Pre-procedural aortic computed tomography angiography (CTA) was performed to assess renal artery perfusion using the Nagamine classification and to guide vascular access. The safety outcome was the occurrence of major adverse events (MAE) at 12 months. The efficacy outcome was change in office BP and antihypertensive medication burden at 12 months.
Results
Nine patients were included. All RDN procedures achieved technical success without periprocedural complications. No MAE, including death, myocardial infarction, stroke, aortic disease progression, or acute kidney injury, were observed at 12 months. Office systolic BP was significantly reduced (−23.6 ± 12.8 mmHg; p < 0.001), whereas the reduction in diastolic BP was not statistically significant (−5.2 ± 11.7 mmHg; p = 0.218). Antihypertensive medication burden remained unchanged (+0.18 ± 1.16; p = 0.698).
Conclusion
In this small cohort, RDN was feasible and appeared safe in hypertensive patients with aortic dissection, achieving significant BP reduction without evidence of aortic disease progression. Larger, controlled studies are warranted to validate these findings.Graphic abstract