denervacion renal en hipertension resistente
DESCRIPTION
Como la denervacion renal sirve para tratar hipertensos severosTRANSCRIPT
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DENERVACION RENALPERCUTANEA E HIPERTENSION ARTERIAL RESISTENTE
Dr. Daniel MenesesIV Congreso Nacional de Nefrologia 2013
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¿Dr. Meneses Usted cree queLe estamos ganando la
Batalla a la hipertensiónArterial ?
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NOP
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Kearney PM, et al. J Hypertens. 2004; 22:11-19.
Fracaso del Tratamiento conMúltiples Drogas
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Que es Hipertensión Resistente?
Calhoun DA, et al. Circulation. 2008;117:e510-e526. Mancia G, et al. Eur Heart J. 2007;28:1462-1536
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Date of download: 6/15/2013
Copyright © The American College of Cardiology. All rights reserved.
From: Renal Denervation for Hypertension
J Am Coll Cardiol Intv. 2012;5(3):249-258. doi:10.1016/j.jcin.2011.12.011
The Renal SNSNTS = solitary tract nucleus; PVN = paraventricular nucleus; RVLM = rostral ventrolateral medulla.
Figure Legend:
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Hipertonía simpática es común en Muchos tipos de hipertensión
Adapted from Smith P, et al. Am J Hypertens. 2004; 17:217-222.
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Activación RenalSimpática en pacienteshipertensos
Esler et M al. Clin Exp Hyper 1984
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Hypertension. 2009;54:1195-1201.
Concepto de Denervación Renal
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simpatectomía quirúrgica
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Anatomía de la Arteria Renal
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Distribución de Nervios Simpáticos en Arterias Renales
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Optimizando el Contacto: Impedancia
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Sistema de Denervación Simplicity
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Zona de Tratamiento
M. Mazor, TCT 2012
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M. Joner, TCT 2012
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M. Joner, TCT 2012
Morfología Nervios
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First-in-Man (AU)
Series of Pilot Studies(EU, US & AU)
Symplicity HTN-2Initial RCT(EU & AU)
SYMPLICITY HTN-3US Pivotal Trial (US)
Global SYMPLICITY Registry
(Approved Regions)
Expand HTN Indication(Approved Regions)
Post-Market Registry(US) SYMPLICITY HF
Symplicity HTN-1
Pilot Studies inNew Indications
(Approved Regions)
Trials under way
SYMPLICITY Clinical Trial Program follows over 5000 patients across multiple indications
c
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Medtronic
Estudios Preclinicos de Seguridad y Eficacia
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Symplicity HTN-1 Investigators, Hypertension 2011
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Cambio de la Presión Arterial en 36 meses
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Respondedores PAS menor o igual a 10 mm Hg
Schlaich M, TCT 2012
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• Purpose: To demonstrate the effectiveness of catheter-based renal denervation for reducing blood pressure in patients with uncontrolled hypertension in a prospective, randomized, controlled, clinical trial
• Patients: 106 patients randomized 1:1 to treatment with renal denervation vs. control
• Clinical Sites: 24 centers in Europe, Australia, & New Zealand (67% were designated hypertension centers of excellence)
36
Symplicity HTN-2
Symplicity HTN-2 Investigators. Lancet. 2010;376:1903-1909.
Lancet. 2010;376:1903-1909.
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SIMPLICITY -2
Symplicity HTN-2 Investigators, Lancet 2010
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Simplicity-2
Symplicity HTN-2 Investigators, Lancet 2010
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Seguimiento a 6 meses
Symplicity HTN-2 Investigators, Lancet 2010
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Características del Procedimiento
Symplicity HTN-1 Investigators, Hypertension 2011
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Cambios de la Presión Arterial
Symplicity HTN-2 Investigators, Lancet 2010
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Symplicity HTN-2 Investigators, Lancet 2010
Función Renal en 24 meses
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Symplicity HTN-2 Investigators, Lancet 2010
Seguridad Post-Procedimiento
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Vonend et al, Lancet 2012
Caso: HTA Post-Procedimiento
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Ott et al, Clin J Am Soc Nephrol 2013
Perfusión Renal después del Procedimiento19 pacientes
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Índice Renal Resistivo post-procedimiento
RRI = (V max sys – V max endiast) / V max sys
Mahfoud et al, Hypertension 2012
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Excreción de Albumina Urinaria post-procedimiento
Mahfoud et al, Hypertension 2012
Normal: <20 mg/l, microalbuminuria: 20-200 mg/l, macroalbuminuria: >200 mg/l
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La Hipertensión es Solo el Comienzo…..
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Cambios en glicemia post-procedimiento
Mahfoud F et al., Circulation 2011
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En Insuficiencia CardiacaDatos Preliminares
REACH-Pilot, Davies JE, Francis DP et al. IJC 2012 OLOMOUC I Study, ESC 2012
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En Apnea del Sueño
Witkowski A et al, Hypertension 2011
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Numero de Procedimientos
11
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CONCLUSIONES1. La Hipertensión Arterial Resistente es una condición de difícil manejo clínico y de alta morbi-mortalidad.2. La eliminación de los nervios simpáticos renales produce una caída sostenida de la presión a lo largo de tres años.3. La denervación renal por vía percutánea es un procedimiento seguro y efectivo para eliminar los nervios simpáticos renales.4. Disponemos de los recursos para iniciar nuestra propia experiencia nacional.
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Muchas Gracias