Impact of Renal Pelvic Denervation on Systemic Hemodynamics and Neurohumoral Changes in a Porcine Model.

INTRODUCTION: The blood pressure (BP) response to arterial renal denervation (RDN) is variable. METHODS: This study examined the effectiveness of renal pelvic denervation (RPD) on BP, heart rate (HR), norepinephrine (NE), and histopathology in 42 swine. NE levels were measured immediately, 7, 14, 30, and 90 days after RPD. Intra-arterial BP and HR were measured throughout RPD and after 14 days in 5 swine. RESULTS: During the procedure, RPD immediately reduced systolic BP (-20.6 ± 18.3 mm Hg), diastolic BP (-6.0 ± 8.3 mm Hg), and HR (-5.4 ± 5.6 bpm), which remained decreased at follow-up. The porcine kidneys had a mean NE reduction of 76% directly post procedure and 60% after 7 days, 64% after 14 days, 57% after 30 days, and 65% after 90 days. Histopathological examination confirmed nerve ablation. CONCLUSIONS: These preliminary findings suggest that the renal pelvis nerve ablation is an encouraging target for RDN. Clinical trials are required to test the feasibility of RPD in human hypertension.

Lithotripsy for peripheral artery disease: Encouraging immediate results But show us the money!

Of adults, 12% have PAD, with nearly 30% older than 70 years with the disorder. With obesity, diabetes mellitus, tobacco abuse, hypercholesterolemia, and poorly controlled hypertension, the incidence of PAD continues to increase. Endovascular treatment of femoropopliteal disease has an alarmingly high rate of restenosis, even with new technology with target lesion revascularization rates at 40-60% at 1 year. Intravascular lithotripsy appears to be safe and acutely effective, but there is no long-term data on whether it has a role in effective treatment of PAD.

Belt and suspenders: Why it pays to protect and cover during carotid stenting.

Carotid stenting results show equivalence to carotid endarterectomy. Most patients undergoing carotid intervention are asymptomatic. Using embolic protection with a covered mesh stent shows promise in this first large multicenter study.

Covered stents: A 25-year odyssey.

The concept of the PTFE-covered stent was introduced 25 years ago in the treatment of an aneurysmal vein graft. The study by Pavani et al. represents the largest cohort of patients treated with covered stents for Ellis type 3 perforations. Covered stents are effective in treating coronary perforations and remain an invaluable tool in the cardiac catheterization lab.

PCI on a tear: Not all perforations need coverage.

Coronary perforations are a potentially lethal complication of PCI requiring prompt treatment. The study by Rosseel et al demonstrates no difference in 5-year outcomes in patients with large coronary perforations treated with and without covered stents. Covered stents are effective in treating coronary perforations and are invaluable in the cardiac catheterization lab.

Perforations and how to manage: The coronary interventionalist and peripheral interventionalist working together for a solution.

Perforations can occur in both peripheral and coronary interventional procedures potentially resulting in severe morbidity A readily available therapeutic option to treat perforations should be present in every cath lab that does coronary and peripheral procedures The use of a coagulated thrombus injection can be an effective treatment option, but if a major vessel is affected that must remain patent, one viable option is to administer the patients' own clotted blood to recanalize the vessel without permanent sequelae.

Which embolic protection device is ideal during carotid artery stenting?

Embolic stroke is one of the main risks of carotid artery stenting. The EMBOLDEN trial demonstrates the safety and efficacy of the Gore® embolic filter. There is no clear evidence for the benefit of one filter-type over another. It is important to choose the device with which the interventionalist has significant familiarity.

Is the S.M.A.R.T® stent the smart option to treat femoropopliteal disease?

The femoropopliteal (FP) artery is a common site for endovascular interventions. S.M.A.R.T.® stent is effective in treating FP lesions with results comparable to other treatment options. Without head-to-head randomized controlled trials, the ideal treatment strategy for FP lesions remains unknown.

Back to nature: A more natural alternative to the PTFE covered stent: Twenty-two years in the making.

The introduction of easily deployed covered stents has made PCI safer. The homemade venous and PTFE covered stent were effective but not practical for sealing perforations. The novel pericardial covered stent graft goes back to a more natural covering and is more easily deployed.

ACS Treatment Continues to Improve: But Price Matters.

Over 90% of patients achieve adequate levels of platelet inhibition with both Prasugrel and Ticagrelor. The introduction of Prasugrel was met with some hesitation from physicians because of the significant increase in cost. This pharmaceutically sponsored and authored retrospective study suggests that both agents are effective.