消融高血壓完

經(jīng)導(dǎo)管射頻消融治療高血壓研究進(jìn)展郭志福第二軍醫(yī)大學(xué)?

長(zhǎng)海醫(yī)院?

心內(nèi)科我國(guó)患病率最高的慢性疾病總死亡的第一位危險(xiǎn)因素高度致殘率高血壓的危害三高：患病率高；死亡率高；致殘率高三低：知曉率低；治療率低；控制率低原則上終身治療高血壓的治療腎交感神經(jīng)活動(dòng)在高血壓中的作用腎交感神經(jīng)活動(dòng)renalsympatheticnerveactivity，RSNA腎小管水鈉重吸收腎素釋腎血管阻力腎交感傳入神經(jīng)將腎臟感受器的反射信號(hào)傳導(dǎo)至中樞再由腎交感傳出神經(jīng)調(diào)節(jié)血壓變化腎交感神經(jīng)活動(dòng)腎交感神經(jīng)活動(dòng)內(nèi)臟神經(jīng)切除術(shù)：只切除內(nèi)臟附近的交感神經(jīng)交感神經(jīng)切除術(shù)：切除胸腔和腰部全部交感神經(jīng)、內(nèi)臟交感神經(jīng)及腹腔神經(jīng)節(jié)對(duì)控制惡性高血壓是有效圍手術(shù)期死亡率很高，常伴有體位性低血壓，暈厥，腸道、膀胱功能異常，陽(yáng)痿甚至行走困難等并發(fā)癥腎交感神經(jīng)活動(dòng)人類腎交感神經(jīng)由胸10至腰1脊髓發(fā)出經(jīng)腹神經(jīng)叢沿腎動(dòng)脈到達(dá)腎臟末梢分布在腎動(dòng)脈血管外膜并釋放去甲腎上腺素腎交感神經(jīng)活動(dòng)經(jīng)導(dǎo)管腎交感神經(jīng)射頻消融術(shù)？(catheter-basedrenalsympatheticdenervation，CRSD）經(jīng)導(dǎo)管腎交感神經(jīng)射頻消融治療高血壓first-in-manstudySchlaichMP,etal.NEnglJMed,2009;361:932–34.first-in-manstudy59-year-oldmalepatientessentialhypertensionresistanttopharmacologictreatmentsevendifferentantihypertensivedrugsrenalsympathetic-nerveablationSchlaichMP,etal.NEnglJMed,2009;361:932–34.first-in-manstudySchlaichMP,etal.NEnglJMed,2009;361:932–34.safetyandproof-of-principle

cohortstudyKrumH,etal.Lancet,2009;373:1275–81.safetyandproof-of-principle

cohortstudyKrumH,etal.Lancet,2009;373:1275–81.50patientsenrolledTreatmenteligibilitydeterminedbyangiographicevaluationofrenalarteryanatomy5patientsnottreated45patientstreated41withfollow-upavailableat1month2losttofollow-up39withfollow-upavailableat3months26withfollow-upavailableat6months20withfollow-upavailableat9months9withfollow-upavailableat12months5withfollow-upavailableat1month5withfollow-upavailableat3months5withfollow-upavailableat6months2withfollow-upavailableat9monthsKeyInclusionCriteriaOfficeSBP≥160mmHgdespite3+anti-hypertensivemedications(includingdiuretic),orconfirmedintolerancetomedicationseGFR(MDRDformula)of≥45mL/min/1.73m2PrimaryEndpointsPeri-proceduralandlong-termsafetyOfficebloodpressurelevelsKrumH,etal.Lancet,2009;373:1275–81.safetyandproof-of-principle

cohortstudysafetyandproof-of-principle

cohortstudysafetyandproof-of-principle

cohortstudyDisablestherenallnervesviathe

deliveryofRFenergyReducebotheferentt&aferentt

sympatheticefecttsA45-minuteprocedureCEMarkKrumH,etal.Lancet,2009;373:1275–81.safetyandproof-of-principle

cohortstudyReleasedEnergymaximum8WattTemperaturebetween40-75°Thegeneratorautomaticallyswitchofiftemperatureishigherthan75°Energyapplicationupto5xforeachrenal

artery,dependsonlengthoftherenalarteryAmountoftime2minutesper1energy

applicationKrumH,etal.Lancet,2009;373:1275–81.safetyandproof-of-principle

cohortstudysafetyandproof-of-principle

cohortstudysafetyandproof-of-principle

cohortstudysafetyandproof-of-principle

cohortstudysafetyandproof-of-principle

cohortstudysafetyandproof-of-principle

cohortstudysafetyandproof-of-principle

cohortstudyAcutePost-TreatmentBaseline5WeekFollow-Upsafetyandproof-of-principle

cohortstudyAcutePost-TreatmentBaseline5WeekFollow-Upsafetyandproof-of-principle

cohortstudy30-Day60-Day180-DayProceduretime:median38(IQR34-48)minutesTreatmentdeliveredwithoutcomplicationin43/451renalarterydissectionduringcatheterdelivery(beforeRFenergyapplication)1femoralpseudoaneurysm,manuallyreducedwithoutfurthersequelaeNolong-termvascularcomplicationsobserved18patientshadangiogramsat14-30dayspost-6-monthspost-:14hadMRA,17hadCTAKrumH,etal.Lancet,2009;373:1275–81.safetyandproof-of-principle

cohortstudysafetyandproof-of-principle

cohortstudyKrumH,etal.Lancet,2009;373:1275–81.OfficeBPsafetyandproof-of-principle

cohortstudyKrumH,etal.Lancet,2009;373:1275–81.RenalFunctionNorepinephrineDataTheSymplicity

HTN-1TrialTwo-YearDurabilityofBPReductionwith

Catheter-basedRenalSympatheticDenervationExpandedcohortofpatients(n=153)24-monthfollow-upTheSymplicity

HTN-1TrialBilateraltreatment;averageof4ablationsperartery38minutemedianproceduretimeNodevicemalfunctionsTreatmentdeliveredwithoutcomplicationin97%(149/153)1renalarterydissectionduringcatheterplacement,priortoRFdelivery,stentedwithoutfurthersequelae3accesssitecomplications,treatedwithoutfurthersequelaeNoRFtreatmentrelatedvascularcomplicationsStablerenalfunction,Noorthostatichypotension,NoelectrolytedisturbancesTwodeathswithinthefollow-upperiod;bothunrelatedtothedeviceortherapyTheSymplicity

HTN-1TrialTheSymplicity

HTN-2TrialSymplicityHTN-2Investigators.Lancet,2010;376:1903-9.TheSymplicity

HTN-2TrialInternational,multi-center,prospective,randomized,controlledstudy190patientsenrolledin24centersinEurope,Australia,&NewZealand6-monthfollow-upSymplicityHTN-2Investigators.Lancet,2010;376:1903-9.KeyInclusionCriteriabilateralsinglemainrenalarteryof>20mmlength&4mmdiameterPrimaryEndpointAutomatedofficesystolicBPchangeSecondaryEndpointsAcute&chronicproceduralsafety,cardiovasculareventsthrough6M,othermeasuresofBPreductionat6MSymplicityHTN-2Investigators.Lancet,2010;376:1903-9.TheSymplicity

HTN-2TrialSymplicityHTN-2Investigators.Lancet,2010;376:1903-9.TheSymplicity

HTN-2TrialSymplicityHTN-2Investigators.Lancet,2010;376:1903-9.TheSymplicity

HTN-2Trial6-MonthOfficeBPSymplicityHTN-2Inve