Carotid Body Removal for the Treatment of Resistant Hypertension: a Pilot Study

Study Overview
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Brief Summary
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This is a pilot study to assess the effectiveness, safety and feasibility of carotid body removal in patients with high blood pressure (hypertension) resistant to medical treatment. Patients with high blood pressure are at significant risk of medical complications including stroke and heart disease. The principle research question is whether removal of the carotid body will lead to an improvement in the blood pressure of this patient group.

Official Title
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Carotid Body Removal for the Treatment of Resistant Hypertension: a Pilot Study

Conditions
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Hypertension

Intervention / Treatment
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* Procedure: Carotid body excision


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Resistant HTN criteria with either confirmed sleep disordered breathing. Definition of HTN:Office SBP ≥ 160 mmHg and daytime mean ABPM ≥ 140 mm Hg Definition of sleep disordered breathing: SDB defined as mild to moderate obstructive, central or mixed sleep apnea defined as 5 < AHI < 30 with O2 desaturation not exceeding 80% during the night. Exclusion Criteria: Calculated GFR < 30 Carotid body located outside the defined carotid septum Obstructive carotid atherosclerotic disease Oxygen desaturation at rest below 92% Known structural lung disease (medical interview) Requirement for oxygen therapy to maintain oxygen saturation Patients wish to participate in mountain climbing, skin diving or free diving Pregnancy or anticipation of pregnancy Palliative care/chemotherapy Acute coronary syndrome or unstable angina < 6 months prior to procedure Use of exogenous insulin AND history of hypoglycemic unawareness Stroke or transient ischaemic attack (TIA), or myocardial infarction < 6 months prior to procedure Expected life expectancy less that 24months due to other disease Intravenous drug use Excessive use of alcohol or sedatives (Alcohol intake >28 units/week) Obesity (BMI > 40) Upper airway or facial abnormalities Large neck circumference (>43.2 cm men; >40.6 cm women) Febrile illness within two weeks of participation Unable to attend for follow up appointments at 1, 3 and 6 months post operatively.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Carotid body excision<br>Patients undergoing the carotid body excision to test the hypothesis that carotid body excision is sufficient to attain target blood pressure. | Procedure: Carotid body excision<br>* This surgery does not involve any study drug or investigational device. The carotid body will be removed by the so called 'lateral approach' or a combined 'lateral and medial approach'. In all cases the target area was defined as the tissue in between the ECA and ICA, up to 5-6mm above the bifurcation point of the common carotid artery into the ECA and ICA. In a lateral approach the carotid bifurcation is not turned. A combined approach includes usually dissection of the superior thyroid vessel and turning of the carotid bifurcation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of Blood Pressure | Change from Baseline Blood Pressure at 3 months | 3 months |