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Imaging strategies for safety surveillance after renal artery denervation

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Abstract

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.

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Acknowledgements

Jessica Dries-Devlin, PhD, CMPP, of Medtronic, provided editorial assistance under the direction of the authors.

Funding

The SPYRAL OFF MED Study, described in this review, was funded by Medtronic (Santa Rosa, CA).

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Authors and Affiliations

  1. Renal, Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Debbie L. Cohen, Sidney A. Cohen & Raymond R. Townsend

  2. Harvard Medical School, Boston, MA, USA

    Ido Weinberg & Jeffrey J. Popma

  3. Vascore, Boston, MA, USA

    Ido Weinberg & Gail Hadley

  4. Atlantic Health System, Morristown, NJ, USA

    Seth Uretsky

  5. BAIM Institute for Clinical Research, Boston, MA, USA

    Jeffrey J. Popma & Alexandra Almonacid

  6. Medtronic, Santa Rosa, CA, USA

    Jeffrey J. Popma & Sidney A. Cohen

Authors
  1. Debbie L. Cohen
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  2. Ido Weinberg
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  3. Seth Uretsky
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  4. Jeffrey J. Popma
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  6. Gail Hadley
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  7. Sidney A. Cohen
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  8. Raymond R. Townsend
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Corresponding author

Correspondence to Debbie L. Cohen.

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Conflict of interest

Dr. DL Cohen: site PI for Symplicity HTN3, SPYRAL on MED and Spyral off med studies, Radiance study, Dr. Weinberg: consulting for Magneto Thrombectomy Solutions, Dr. Uretsky: none, Dr. Popma: employee and shareholder of Medtronic, Dr. Almonacid: Institutional Grants: Boston Scientific, Medtronic, Abbott Vascular, COOK, Terumo. Dr. Alexandra Almonacid-Popma receives no personal fees. Her spouse joined Medtronic as an employee after completion of the angiographic methodology for the RDN Spyral ON and OFF studies but prior to this publication. Ms. Hadley: none, Dr. SA Cohen: employee and shareholder of Medtronic. Dr. Townsend: medtronic Consultant; UpToDate Contributor, NIH Grants, AXIO DSMB Member, Regeneron Consultant; Ionis Consultant.

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Cohen, D.L., Weinberg, I., Uretsky, S. et al. Imaging strategies for safety surveillance after renal artery denervation. Clin Res Cardiol 110, 609–619 (2021). https://doi.org/10.1007/s00392-021-01819-w

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  • DOI: https://doi.org/10.1007/s00392-021-01819-w

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