Renal denervation first in ‰ÛÏTop 10 Medical Innovations for 2012‰Û list

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The Cleveland Clinic Medical Innovations Summit for cardiovascular technologies has identified the Top 10 Medical Innovations for 2012, ie, the up-and-coming technologies that will have the biggest impact on healthcare in 2012. Topping the list is catheter-based renal denervation to control resistant hypertension.

Catheter-based renal denervation for reduction of blood pressure in patients with treatment-resistant hypertension has seized the first place on a “Top 10 Medical Innovations List”. Resistant hypertension (typically defined as high blood pressure that does not respond to medical treatment and remains above 160mmHg despite lifestyle changes and administration of an optimal three-drug regimen that must include a diuretic) is a major health problem, the list finds.


 

At the CIRSE conference in Munich in September 2011, Marc Sapoval, Paris, France, described the technique of renal denervation as radiofrequency ablation using an endovascular approach. “In brief, the Symplicity catheter (from Ardian/Medtronic) is introduced into each renal artery via femoral access. Discrete, low power radiofrequency ablation of two minutes each are applied to obtain up to six ablations, separated both longitudinally and rotationally within each renal artery. During ablation, the catheter system monitors tip temperature and impedance, altering radiofrequency energy delivery in response to a pre-determined algorithm,” he said.

 


Sapoval pointed out that caution had to be exercised when dealing with certain anatomical conditions: severe renal artery stenosis; presence of a renal stent; severe atheromatous aortic lesions and the presence of an abdominal aortic aneurysm. “While these situations may not entirely rule out renal denervation, they would definitely call for enhanced caution and even clearer assessment of the risk-benefit ratio,” he noted.

 


Sapoval noted that the Symplicity catheter had not been tested in vessels smaller than 4mm, and is indicated only for vessels of this diameter or larger. “Also unilateral treatment is technically possible, but there is less evidence backing this approach,” he noted.

 


Sapoval said that patients with suboptimal anatomy that excluded them from randomised arms of the HTN-2 study were treated in a registry, the results of which might aid in understanding the effect of renal denervation in non-standard anatomies.

 


In the recent Symplicity HTN-2 study of 106 adults with resistant hypertension, the first human randomised controlled trial of renal denervation, 54 patients received oral medications and 52 underwent renal denervation. After six months, 39% of patients receiving renal denervation reached target blood pressure and, overall, 50% of patients showed a measurable benefit from the intervention.

 


Systolic blood pressure fell an average of 32mmHg and diastolic blood pressure fell an average of 12mmHg and the effects lasted at least two years. Patients in the control group who took anti-hypertensive medications alone had blood pressures that did not vary from baseline.

 


Information presented on the‰ÛöCleveland Clinic Innovations website notes that not only is renal denervation a new treatment avenue that causes significant drops in blood pressure, it has also shown promising results for treating chronic kidney disease, insulin resistance, and heart failure.

 


Spiral CT for early detection of lung cancer

 


Coming close on its heels of real denervation in second place is spiral CT scans for early detection of lung cancer. The introduction of low-radiation-dose spiral computed tomography (spiral CT) scan generates a series of detailed cross-sectional images of the lungs that are used to create a three-dimensional image. These scans can not only identify tumours earlier, but also identify them when the tumours are smaller and more treatable by surgery.

 


Third, fourth and fifth on the list are a concussion management system for athletes, medical apps for mobile devices and increasing discovery with next-generation gene sequencing.

 


Embolization device for large, wide-necked aneurysms

 


An embolization device which has been cleared by the FDA in the USA to treat complex brain aneurysms came in the sixth place. The Pipeline Embolization Device (from ev3/Covidien) is a flexible mesh tube made of platinum and nickel-cobalt chromium alloy that blocks off large, giant, or wide-necked aneurysms in the internal carotid artery. Such aneurysms are some of the most complex and dangerous and have remained a significant unmet clinical need. The Pipeline Embolization Device also reduces the chance of rupture and eliminates the need for invasive surgery.

 


The other Top 10 Innovations include an active bionic prosthesis and wearable robotic devices in seventh place, harnessing big data to improve healthcare in eight place, a novel diabetes therapy, SGLT2 inhibitors in ninth place and genetically modified mosquitoes to reduce the threat of disease, in 10th place.