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

Abstract

Background: Transcatheter adrenal ablation as an alternative treatment for primary aldosteronism(PA) patients is still controversial and the outcomes varies widely in existing studies. The aim of this meta-analysis is to evaluate the result of adrenal ablation and estimate effectiveness and safety of this therapy method. Methods: A comprehensive search was performed across Pubmed, Embase and Cochrane Library databases for studies published up to October 2022. The outcomes analyzed were the combined clinical success rate, biochemical success rate and complication rate, which was employed with a random-effects model. Results: Five studies comprising 234 PA patients were included in the study. The combined clinical success rate was 74% (95% CI: 69%-79%) and the bichemical success rate was 74%(95%CI: 53%-95%). Subgroup analysis showed that the combined clinical success rate from Unilateral PA (72%, 95%CI: 46%-98%) was similar to the rate from Unilateral+bilateral(73%, 95%CI :52.0%-94.0%) and the clinical success rate of PASO subgroup(78%, 95%CI: 66.0%-89.0%) was higher than the rate of other criteria(51%, 95%CI: 40.0%-63.0%). The combined complication rate of mild fever was 23% (95% CI: 12%- 33%), back pain was 84% (95% CI: 77%- 91%) and pleural effusion was 9% (95%CI: 0% -18%). All complications disappeared within one week after the procedure. There were no late complications or ablation-related deaths. Conclusions: The transcatheter adrenal ablation for PA patients is safe and has a relatively high clinical success rate. Currently, this approach is suitable for PA patients unwilling to accept surgery and long-term mineralocorticoid receptor antagonists(MRAs) treatment. Systematic Review Registration: INPLASY, identifier 2022110076