Renal Artery Variations in Patients With Mild-to-Moderate Hypertension From the RADIANCE-HTN SOLO Trial
Kintur Sanghvi, Yale Wang, Joost Daemen, Anthony Mathur, Ajay Jain, Suhail Dohad, Marc Sapoval, Michel Azizi, Felix Mahfoud, Philipp Lurz, Jeremy Sayer, Terry Levy, Ronald Zagoria, Andreas M Loening, Leslie Coleman, David Craig, Meital Horesh-Bar, Ajay J Kirtane, Kintur Sanghvi, Yale Wang, Joost Daemen, Anthony Mathur, Ajay Jain, Suhail Dohad, Marc Sapoval, Michel Azizi, Felix Mahfoud, Philipp Lurz, Jeremy Sayer, Terry Levy, Ronald Zagoria, Andreas M Loening, Leslie Coleman, David Craig, Meital Horesh-Bar, Ajay J Kirtane
Abstract
Purpose: To assess the variability of renal artery (RA) anatomy and presence of RA-pathology in patients with mild-to-moderate hypertension enrolled in the RADIANCE-HTN SOLO trial.
Background: RADIANCE-HTN SOLO was a multicenter, international, blinded, randomized, sham-controlled trial evaluating ultrasound-based endovascular renal denervation (RDN) in patients with mild-to-moderate hypertension while off antihypertensive medications.
Methods: Eligible subjects had pre-randomization renal CT- or MR- angiography (CTA, MRA) to confirm anatomic suitability and to define RA ablation sites. All images were sent for independent review for evaluation of RA anatomy and other vascular pathology.
Results: A total of 324 patients underwent RA imaging (282 CTA and 42 MRA). Of those, 178 had simple anatomy with a single left and single right RA with mean diameters of 5.4 ± 0.9 and 5.1 ± 0.8 mm and mean lengths of 40.0 ± 12.9 and 52.0 ± 13.1 mm, respectively. Twenty-seven patients (8.3%) had unilateral or bilateral dual RAs with mean diameters of 4.0 ± 0.9 mm on the left and 3.9 ± 0.9 mm on the right. Forty percent (129/324) of patients had at least 1 accessory RA, with mean accessory diameters of 2.4 ± 0.8 mm on the left and 2.3 ± 0.8 mm on the right. Twenty-eight patients (8.6%) had at least 1 short (<25 mm) main RA. Incidental findings included: 9 patients (2.8%) with atherosclerotic RA stenosis ≥30%, 9 patients (2.8%) with fibromuscular dysplasia of RA and 2 patients (0.6%) with kidney and adrenal gland tumors.
Conclusions: Pre-procedure CTA or MRA imaging is a valuable aid in assessing RA anatomy prior to RDN because of variable RA anatomy. CTA or MRA may detect RA lesions, and renal or adrenal tumors which may need additional workup prior to consideration of RDN.
Clinical trial registration: ClinicalTrials.gov NCT02649426.
Keywords: Angiography; Hypertension; Imaging; Renal denervation.
Conflict of interest statement
Declaration of competing interest Dr. Sanghvi has received grant support and personal fees from ReCor Medical and Medtronic; and has received grant support from CSI. Dr. Wang declarations of interest: none. Dr. Daemen has received grant support from ReCor Medical, Medtronic, Boston Scientific, Abbott Vascular, Acist Medical, AstraZeneca, Pie Medical, and Pulse Cath; and has received personal fees from ReCor Medical, Medtronic, Acist Medical, Boston Scientific, Pie Medical, Siemens and Pulse Cath. Dr. Mathur declarations of interest: none. Dr. Jain declarations of interest: none. Dr. Dohad declarations of interest: none. Dr. Sapoval declarations of interest: none. Dr. Azizi has received research grants from the French Ministry of Health, Quantum Genomics, and the European Horizon 2020 program; has received grant support and nonfinancial support from ReCor Medical and Idorsia; and has received personal fees from CVRx, Astra Zeneca, Alnylam Pharmaceutical, and Poxel Pharma. Dr. Mahfoud is supported by Deutsche Gesellschaft für Kardiologie, and Deutsche Forschungsgemeinschaft (SFB TRR 219); and has received grant support and personal fees from ReCor Medical, Medtronic, Berlin Chemie, Bayer, and Boehringer Ingelheim. Dr. Lurz has received grant support and personal fees from ReCor Medical, Edwards, and Abbott and personal fees from Medtronic and Occlutech. Dr. Sayer declarations of interest: none. Dr. Levy declarations of interest: none. Dr. Zagoria has received consulting fees from ReCor Medical. Dr. Loening has received consulting fees from ReCor Medical and grant funding from GE Healthcare and NIH. Dr. Coleman is an employee of ReCor Medical. Mr. Craig is an employee of ReCor Medical. Mrs. Horesh-Bar is an employee of ReCor Medical. Dr. Kirtane reports Institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, ReCor Medical. In addition to research grants, institutional funding includes fees paid to Columbia University and/or Cardiovascular Research Foundation for speaking engagements and/or consulting. Personal: Consulting: Neurotronic; Travel Expenses/Meals from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, ReCor Medical, Chiesi, OpSens, Zoll, and Regeneron. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.
Source: PubMed