Superselective adrenal arterial embolization for idiopathic hyperaldosteronism: 12‐month results from a proof‐of‐principle trial

Abstract

Objectives: This study aimed to assess the safety, blood pressure changes, and biochemical responses of superselective adrenal artery embolization (SAAE) in hypertensive patients with idiopathic hyperaldosteronism (IHA).Background: SAAE is a minimally invasive procedure that has been used to successfully treat aldosterone-producing adenoma. However, its effect for patients with IHA is unevaluated.Methods: A total of 41 hypertensive patients who were diagnosed with IHA and underwent SAAE at the Fuwai Hospital between December 2010 and June 2016 were prospectively enrolled. The blood pressure, antihypertensive medications, plasma aldosterone and potassium levels, and adverse events were assessed. The primary endpoint was the change in home blood pressure at 12 months, compared with baseline.Results: SAAE was technically successful in 39 patients. Postoperatively, home and 24-hr mean blood pressures were reduced by 14/9 and 10/7 mmHg at 1 month, respectively, and by 13/7 and 11/7 mmHg at 12 months, respectively. The number of antihypertensive agents used reduced by 1.0 and 1.1 at 1 month and 12 months, respectively (all p < .001). Compared with baseline (524.0 pmol/L), the standing plasma aldosterone reduced to 293.4 pmol/L at 12 months (p < .001). Serum potassium increased from 3.0 to 4.1 mmol/L while the rate of potassium supplement and mineralocorticoid receptor antagonist use reduced from 87.1 and 89.7%, respectively, to 28.2 and 17.9%, respectively, at 12 months (all p < .001). There were no serious complications in the perioperative and 12-month follow-up periods.Conclusions: SAAE was effective and feasible for IHA treatment, without serious complications, therefore, maybe a potential treatment.

The outcomes of transcatheter adrenal ablation in patients with primary aldosteronism: a systematic review and meta-analysis

“…These articles were excluded for the following reasons: case report ( n = 6), conference abstracts ( n = 4), and overlapping data ( n = 5). Ultimately, five studies comprising 234 PA patients were included in this meta-analysis [ 10 , 11 , 16 – 18 ] (Fig. 1 ).…”

“…Three studies [ 11 , 17 , 18 ] used the Primary Aldosteronism Surgical Outcome (PASO) [ 19 ] as the criterion for clinical success and biochemical success, which included complete and partial success. The remaining two studies [ 10 , 16 ] employed other criteria and lacked data on biochemical success. In the study by Dong, et al [ 10 ], only marked improvement was considered as clinical success because moderate improvement was regarded as no change according to other criteria.…”

“…The remaining two studies [ 10 , 16 ] employed other criteria and lacked data on biochemical success. In the study by Dong, et al [ 10 ], only marked improvement was considered as clinical success because moderate improvement was regarded as no change according to other criteria.…”

“…In the study by Dong, et al [ 10 ], only marked improvement was considered as clinical success because moderate improvement was regarded as no change according to other criteria.…”

“…Past studies have demonstrated promising outcomes for this technique in treating adrenal tumors and hemorrhages [ 8 , 9 ]. Recently, transcatheter adrenal ablation has emerged as a potential alternative treatment for patients with unilateral PA and IHA [ 10 , 11 ].…”