Alexander Nahler

Predictors of response to renal denervation for resistant arterial hypertension: a single center experience.

Background: Renal denervation (RDN) has been shown to reduce blood pressure in patients with resistant arterial hypertension (RAH). We aimed to investigate predictors for response to RDN. Methods: Patients suffering from RAH underwent RDN after exclusion of secondary causes of hypertension. Ambulatory blood pressure measurement (ABPM) for 24 h was performed at baseline, 6 and 12 months after RDN. Response was defined as a at least 5 mmHg 24 h SBP drop at 6 months. A linear regression model was used to analyze an association between baseline variables and response to RDN. Results: In total, 45.6% of patients were responders to RDN. In those, there was a significant reduction in ABPM values at 6 and 12 months (12 months: 24 h SBP: −17.2 ± 9.0 mmHg, P < 0.01; 24 h DBP: −9.0 ± 11.6 mmHg, P < 0.01). Per 10 mmHg increase in baseline 24 h SBP, there was a 5.5 mmHg 24 h SBP reduction at 6 months. Per kg/m2 increase in BMI, 24 h SBP increased by 0.7 mmHg at 6 months. Per increment in antihypertensive drugs used at baseline, there was a 2.7 mmHg 24 h SBP reduction at 6 months. Conclusion: Out of a wide range of baseline variables, elevated systolic ABPM values, BMI and the number of antihypertensive drugs used were associated with response. One has to consider the Hawthorne effect, the regression to the mean phenomenon, the actual effect of sympathetic denervation and the interaction of therapy modification when interpreting data from RDN registries without a control arm.

Effects of Renal Denervation on Ambulatory Blood Pressure Measurements in Patients With Resistant Arterial Hypertension

The sympathetic nervous system is an important factor in hypertension. In patients suffering from resistant hypertension, transfemoral renal sympathetic denervation (RDN) reduces office blood pressure (BP) values.

Subcutaneous Double "Purse String Suture"-A Safe Method for Femoral Vein Access Site Closure after Leadless Pacemaker Implantation.

Leadless cardiac pacemaker (LCP) requires large‐caliber venous sheaths for device placement. Sheath sizes for these procedures vary from 18‐ to 23‐French (F). The most common complications are hematomas, pseudoaneurysms, and arteriovenous fistulas. Complete and secure closure of the venous access is an important step at the end of such a procedure.

Individual-patient visit-by-visit office and ambulatory blood pressure measurements over 24 months in patients undergoing renal denervation for hypertension☆

BACKGROUND Renal denervation (RDN) is a promising treatment option in addition to medical antihypertensive treatment in patients suffering from resistant hypertension. Despite the growing interest in RDN, only few long-term results are published so far. METHODS We systematically investigated the effects of RDN on ABPM in a consecutive series of patients with resistant hypertension out to 24 months. Office BP measurements and ABPM assessment were offered at 3, 6, 12 and 24 months. The patients with an average systolic BP reduction of more than 10 mmHg in office BP 6months after RDN were classified as responders. Additional to this classical responder concept, we categorized response to RDN by an individual-patient visit-by-visit evaluation of office BP and 24-hour-BP, separately. RESULTS We included 32 patients. In 21 patients (65.6%) we found a mean systolic BP reduction >10 mmHg in office BP six months after RDN. These patients were classified as responders. In responders, mean office BP dropped from 175.3 ± 15.9/96 ± 14.2 mmHg to 164.8 ± 24.4/93.2 ± 10.4 mmHg (p=0.040/p=0.323) and mean 24-h BP in ABPM decreased from 146.8 ± 17.0/89.1 ± 11 mmHg to 136.8 ± 15.0/83.2 ± 10.7 mmHg after 24 months (p=0.034/p=0.014). Additionally, we performed a visit-by-visit evaluation of all patients and results were divided in larger-than-median and smaller-than-median response. By this evaluation, we found a high variation of office BP reductions and the 24-hour BP results demonstrated a significant BP reduction in patients with larger-than-median response, which sustained over the 24 months of follow-up. CONCLUSIONS In contrast to the observed variation of office BP measurements, ABPM demonstrated a reproducible and sustained significant BP reduction in patients with larger-than-median response to RDN.

Influence of pseudo-resistance on the effect of renal denervation on 24-hour ambulatory blood pressure levels.

Renal denervation (RDN) is a promising treatment option in addition to medical antihypertensive treatment in patients suffering from resistant hypertension. Despite the growing interest in RDN, the negative result of the Symplicity HTN‐3 trial led to a debate on the efficacy of RDN.

Economic assessment of traditional surgical intervention versus use of a new innovative radiofrequency based surgical system in device replacements

Introduction Intra-operative complications like mechanical damages to the leads, infections and hematomas during generator replacements of implantable pacemakers and defibrillators contribute to additional costs for hospitals. The aim of this study was to evaluate operation room use, costs and budget impact of generator replacements using either a traditional surgical intervention (TSI) with scissors, scalpel and electrocautery vs. a new radiofrequency energy based surgical system, called PEAK PlasmaBladeTM (PPB). Materials and methods We conducted a retrospective analysis of a population including 508 patients with TSI and 254 patients with PPB who underwent generator replacement at the Kepler University Hospital in Linz or the St. Josef Hospital in Braunau, Austria. The economic analysis included costs of resources used for intra-operative complications (lead damages) and of procedure time for TSI vs. PPB. Results Proportion of males, mean age and type of generator replaced were similar between the two groups. Lead damages occurred significantly more frequent with TSI than with PPB (5.3% and 0.4%; p< 0.001) and the procedure time was significantly longer with TSI than with PPB (47.9±24.9 and 34.1±18.1 minutes; p<0.001). Shorter procedure time and a lower rate of lead damages with PPB resulted in per patient cost savings of €81. Based on estimated 2,700 patients annually undergoing generator replacement in Austria, the use of PPB may translate into cost savings of €219,600 and 621 saved operating facility hours. Conclusion PPB has the potential to minimize the risk of lead damage with more efficient utilization of the operating room. Along with cost savings and improved quality of care, hospitals may use the saved operating room hours to increase the number of daily surgeries.

Erratum to: Peri-interventional neurological complication rates in patients undergoing carotid artery stenting depend on the side of the stenosis treated

CAS has emerged as an alternative to carotid endarterectomy for the treatment of significant carotid artery stenosis. We investigated if the side of the stenosis treated has an influence on the neurological outcome of our patients. CAS was performed in 1124 patients at our center. The left carotid artery (group L) was intervened in 557 and the right carotid artery (group R) in 567 patients. Data of both patient groups were analyzed with respect to the total rate of peri-interventional ischemic cerebral events, defined as transient ischemic attacks, minor and major strokes, respectively. The total peri-interventional ischemic cerebral event rate was 10.1% in group L and 6.7% in group R (p = 0.042), respectively. The routine use of a filter wire resulted in a significant reduction of complication rates in group L (from 14.7 to 7.1%; p = 0.005) but not in group R (from 7.8 to 6.0%; p = 0.505). Ischemic cerebral events did not differ between group L and R, when only patients in whom a filter wire was used were analyzed (7.1% in group L and 6.0% in group R, p = 0.174). Peri-interventional ischemic cerebral complication rates in patients undergoing CAS differ with respect to the side treated. This may be due to a more frequent plaque mobilization caused by the guiding catheter.

Myocardial infarction with proximal occlusion of the left anterior descending coronary artery in a 22-year-old patient with polycythaemia vera

In this article, we report on a 22-year-old patient with myocardial infarction, which was the initial manifestation of polycythaemia vera. The awareness of myeloproliferative disorders as possible underlying disease - especially in young patients presenting with myocardial infarction - is crucial for clinical management, as a missed diagnosis can worsen the patients further prognosis.

Acute Coronary Syndrome in a Patient with a Single Coronary Artery

Coronary anomalies are rare congenital abnormalities and are often associated with complex congenital heart diseases and manifest in infancy or childhood. Single coronary artery arising from the sinus of Valsalva supplying the entire heart is one of these congenital anomalies. The prevalence is reported to be approximately 0.3 to 2.0% of the general population, mostly clinically asymptomatic and with good prognosis. However, in some cases this anomaly can present as acute coronary syndrome in adults. Literature reports of patients with both a single coronary artery and an acute coronary syndrome are sparse, and percutaneous coronary interventions in such cases are technically challenging. We report a case of a patient with a single coronary artery suffering from an acute coronary syndrom who underwent complex bifurcational percutaneous intervention and provide a review of the literature.

Anti-Inflammatory Effects and Prediction of Blood Pressure Response by Baseline Inflammatory State in Catheter-Based Renal Denervation.

This retrospective analysis aimed to examine off‐target effects on inflammatory and renal function parameters in n=78 subsequent patients treated with renal denervation (RDN) for resistant hypertension. Ambulatory and office blood pressure (ABP/OBP), serum creatinine, glomerular filtration rate (GFR), cystatin C, C‐reactive protein (CRP), interleukin‐6 (IL‐6), and white blood cell count (WBC) were assessed before, 6 and 12 months after RDN. ABP was significantly reduced by −8.2/−3.8 mm Hg (P=.002/.021) at 1 year after RDN, while an initial OBP reduction was not sustained during follow‐up. IL‐6 levels significantly decreased by −0.5 pg/mL (P=.042) and by −1.7 pg/mL (P<.001) at 6 and 12 months, baseline IL‐6 levels possibly predicting ABP response to RDN (r=−0.295; P=.020). Concurrently, leukocyte count was reduced by −0.5 × 103/μL (P=.017) and −0.8 × 103/μL (P<.001), respectively. Serum creatinine and GFR remained unchanged, but we observed a significant increase in cystatin C by 0.04 mg/L (P=.026) and 0.14 mg/L (P<.001) at 6 and 12 months after the intervention.