Prairie Education and Research Cooperative

Les Catacombes and Notre Dame de Paris: two places that hold my most vivid memories of Paris, but these two places are also inextricably related. Notre Dame de Paris was built from limestone extracted from mines beneath Paris–mines that eventually became the ossuaries known today as the Catacombes. In depleting stone from the ground, cavernous and cathedrallike spaces were created beneath Paris while a cathedral rose toward the heavens on the Île de la Cité. In a way, two cathedrals were built: one a negative image of the other above. Dess(o)us Paris captures the duality of these opposite cathedrals, with the first movement relating to the Catacombes, and the second to Notre Dame de Paris. The depiction of the Catacombes draws upon their original role as limestone mines, particularly upon the gradual depletion of minerals from the earth. “130 Pas Au-Dessus” is a passacaglia, divided into five sections. In each section, the ground bass is presented in its entirety but loses a tone with each sectional repetition. In the first section there is only one repetition and one tone lost. But in the final section, five repetitions strip the ground bass down to three pitches left to echo in the cavernous space that remains. “La Cathédrale Au-Dessous” draws from my own personal experience with Notre Dame de Paris, conveying a vague narrative. The music begins around the pavilion of the cathedral, bells ringing in the background. Tonal grounding is abandoned as the listener spirals up the unending stairs to the bell towers, eventually emerging into the exuberance and awe of Paris from above. The amazement, however, succumbs to fear after making the mistake of peering down the height of the bell tower. A sudden bout of acrophobia sends the listener in a frenzy back down the spiral staircase to the pavilion, where the music regains its composure as the last bursts of gold, orange, and crimson fade to the purples and blues of dusk.

Hypertension represents a significant global public health concern, contributing to vascular and renal morbidity, cardiovascular mortality, and economic burden. The opportunity to influence clinical outcomes through hypertension management is therefore paramount. Despite adherence to multiple available medical therapies, a significant proportion of patients have persistent blood pressure elevation, a condition termed resistant hypertension. Recent recognition of the importance of the renal sympathetic and somatic nerves in modulating blood pressure and the development of a novel procedure that selectively removes these contributors to resistant hypertension represents an opportunity to provide clinically meaningful benefit across wide and varied patient populations. Early clinical evaluation with catheter-based, selective renal sympathetic denervation in patients with resistant hypertension has mechanistically correlated sympathetic efferent denervation with decreased renal norepinephrine spillover and renin activity, increased renal plasma flow, and has demonstrated clinically significant, sustained reductions in blood pressure. The SYMPLICITY HTN-3 Trial is a pivotal study designed as a prospective, randomized, masked procedure, single-blind trial evaluating the safety and effectiveness of catheter-based bilateral renal denervation for the treatment of uncontrolled hypertension despite compliance with at least 3 antihypertensive medications of different classes (at least one of which is a diuretic) at maximal tolerable doses. The primary effectiveness endpoint is measured as the change in office-based systolic blood pressure from baseline to 6 months. This manuscript describes the design and methodology of a regulatory trial of selective renal denervation for the treatment of hypertension among patients who have failed pharmacologic therapy.

To evaluate the procedural safety and filter efficiency of Lumen Biomedical FiberNet® embolic protection system in conjunction with primary stenting of ostial atherosclerotic renal artery lesions. There is limited data regarding the utility of distal embolic protection devices in renal artery angioplasty and stenting. Patients with angiographically severe (≥70%) renal artery stenosis were prospectively enrolled if one or more inclusion criteria met: resistant hypertension, progressive chronic kidney disease, unexplained heart failure, or flash pulmonary edema. Patients underwent renal artery angioplasty and stenting with utilization of the Lumen Biomedical FiberNet® EPS. The protection devices and aspirate were analyzed for degree of atheromatous particles. Procedural safety and clinical outcomes were assessed through 6 months. Twenty patients were prospectively enrolled at five centers; average age 73.8 (±9.5) years, mean baseline eGFR 60.8 cm(3) min(-1). Twenty-five renal artery stenting procedures were performed. Device and procedural success were achieved in 100% of cases. All patients tolerated the procedure without any adverse events. Embolic debris was captured in all cases. Debris analysis of the distal protection system displayed an average post procedure atheroma area of 51.31 mm(2). There was no clinical evidence of peripheral atheroembolization through 30-days follow-up. No subjects progressed to temporary or permanent renal replacement therapy. Favorable trends in blood pressure control were observed at 6 months. The Lumen Biomedical FiberNet® embolic protection system is a safe and feasible method to prevent atheroembolization associated with angioplasty and stenting of renal artery ostial lesions.