Renal Artery Variations in Patients With Mild-to-Moderate Hypertension From the RADIANCE-HTN SOLO Trial.

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.

• Authors: 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
• Journal: Cardiovascular revascularization medicine : including molecular interventions (Cardiovasc Revasc Med) Vol. 39 Pg. 58-65 (06 2022) ISSN: 1878-0938 [Electronic] United States
• PMID: 34620570 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antihypertensive Agents

Topics

• Antihypertensive Agents (therapeutic use)
• Blood Pressure
• Humans
• Hypertension
• Kidney
• Renal Artery (diagnostic imaging)
• Sympathectomy (adverse effects, methods)