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Bilateral superselective adrenal artery embolization for bilateral primary aldosteronism: a novel approach in an efficacy and safety proof-of-principle trial

Hypertension Research volume 48, pages 189–199 (2025)Cite this article

Abstract

Superselective adrenal artery embolization (SAAE) offers a novel approach for treating primary aldosteronism (PA). In this study, we aimed to assess the efficacy and safety of SAAE for the treatment of PA based on the lateralization results obtained from adrenal vein sampling (AVS).In this prospective study, we enrolled 40 patients with PA who underwent SAAE. The patients were categorized into two groups, unilateral PA and bilateral PA, based on AVS results. Clinical parameters and biochemical markers were assessed at 3 and 12 months postoperatively. The primary outcomes were changes in blood pressure and defined daily dose (DDD) of antihypertensive medications compared to baseline. Thirty-eight patients achieved technical success, with favorable clinical and biochemical efficacy rates. At three months postoperatively, the clinical efficacy rates were 79.2% and 78.6% for the UPA and BPA groups, respectively. At 12 months, the rates were 83.3% and 71.4%, respectively. Both groups exhibited a significant decrease in average blood pressure at 3 and 12 months compared with baseline (P < 0.001), and there was also a notable reduction in DDD (P < 0.05). At three months, the biochemical efficacy rates were 61.9% and 58.3% in the UPA and BPA groups, respectively. Due to loss to follow-up, biochemical indicators were not assessed at 12 months postoperatively. No severe adverse reactions occurred during or after SAAE. Patients with both UPA and BPA can benefit from SAAE. The superiority of bilateral adrenal artery embolization in the treatment of BPA over unilateral adrenal artery embolization requires further investigation.

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Acknowledgements

We thank He-Xuan Zhang (Army Specialty Medical Center, Army Medical University, Chongqing, China) for his guidance and advice on our adrenal artery embolization efforts. We thank Guo-Shu Wang (The First Affiliated Hospital of Chongqing Medical University, Chongqing, China) for his guidance in the imaging of the re-adrenal gland.

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Author notes

  1. These authors contributed equally: Xin Li, Rui Feng, Rui Xiang.

Authors and Affiliations

  1. Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Xin Li, Rui Feng, Rui Xiang, Yong-peng Zhao, Ping Tang, Zhong Zuo, Dian-Sa Gao, Peng Pu, Yue-Ming Chen, Jie Chen, Feng-Jie Lv, Ling Wang, Hong Zhao, Qiu-Yue Shi, Yu-Tian He, Nouman Ali Khan, Jing Chang & Min Mao

  2. Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Li Tao

  3. Library of the First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Qin Lou

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Correspondence to Jing Chang or Min Mao.

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Li, X., Feng, R., Xiang, R. et al. Bilateral superselective adrenal artery embolization for bilateral primary aldosteronism: a novel approach in an efficacy and safety proof-of-principle trial. Hypertens Res 48, 189–199 (2025). https://doi.org/10.1038/s41440-024-01881-7

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