Cardiovascular and interventional radiology · 2026
Efficacy and Safety of Adrenal Artery Embolization for Idiopathic Hyperaldosteronism: A Systematic Review & Meta-Analysis.
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Teixeira Eduardo Germano, Duran Rafael, Barra Filipe, Hezel Iago Maia, Germano Viviane Pinheiro de Oliveira, Rivera Marco, Giancristoforo Bernard Campos Araruna
Аннотация
PURPOSE: To evaluate the efficacy and safety of adrenal artery embolization for idiopathic hyperaldosteronism.
MATERIALS AND METHODS: PubMed, Embase, and Cochrane databases were searched through June 2026. Studies reporting clinical outcomes after adrenal artery embolization for idiopathic hyperaldosteronism were included. Outcomes comprised 24-h ambulatory and home blood pressure, plasma aldosterone and renin, aldosterone-to-renin ratio, serum potassium and cortisol, and safety. Random-effects models and leave-one-out analyses were used.
RESULTS: Four studies including 284 patients allocated to or undergoing adrenal artery embolization were included: outcome-specific sample sizes varied according to data availability. Adrenal artery embolization reduced 24-h systolic blood pressure by 15.31 mmHg and diastolic blood pressure by 10.49 mmHg. Plasma aldosterone decreased by 68.18 pg/mL, the aldosterone-to-renin ratio by 49.03, and serum potassium increased by 0.60 mmol/L. Serum cortisol did not significantly change. Pain and fever occurred in 82.41% (178/216) and 18.98% (41/216) of patients across three studies. Major adverse events occurred in 4.58% (13/284): four strokes (one fatal hemorrhagic, adjudicated unrelated), five hypertensive or severe-hypertension events, one myocardial infarction, one new-onset heart failure, one ventricular tachycardia, and one hypotensive event requiring vasopressors-only three within 1 month.
CONCLUSION: Adrenal artery embolization showed preliminary associations with improved blood pressure and biochemical outcomes without a significant change in serum cortisol. Evidence was predominantly uncontrolled, serious adverse events occurred, and superiority over optimized medical therapy was not established. Randomized trials with standardized techniques and long-term clinical outcomes are required.
LEVEL OF EVIDENCE: Level IV, Systematic Review/Meta-Analysis of predominantly single-arm studies.
MATERIALS AND METHODS: PubMed, Embase, and Cochrane databases were searched through June 2026. Studies reporting clinical outcomes after adrenal artery embolization for idiopathic hyperaldosteronism were included. Outcomes comprised 24-h ambulatory and home blood pressure, plasma aldosterone and renin, aldosterone-to-renin ratio, serum potassium and cortisol, and safety. Random-effects models and leave-one-out analyses were used.
RESULTS: Four studies including 284 patients allocated to or undergoing adrenal artery embolization were included: outcome-specific sample sizes varied according to data availability. Adrenal artery embolization reduced 24-h systolic blood pressure by 15.31 mmHg and diastolic blood pressure by 10.49 mmHg. Plasma aldosterone decreased by 68.18 pg/mL, the aldosterone-to-renin ratio by 49.03, and serum potassium increased by 0.60 mmol/L. Serum cortisol did not significantly change. Pain and fever occurred in 82.41% (178/216) and 18.98% (41/216) of patients across three studies. Major adverse events occurred in 4.58% (13/284): four strokes (one fatal hemorrhagic, adjudicated unrelated), five hypertensive or severe-hypertension events, one myocardial infarction, one new-onset heart failure, one ventricular tachycardia, and one hypotensive event requiring vasopressors-only three within 1 month.
CONCLUSION: Adrenal artery embolization showed preliminary associations with improved blood pressure and biochemical outcomes without a significant change in serum cortisol. Evidence was predominantly uncontrolled, serious adverse events occurred, and superiority over optimized medical therapy was not established. Randomized trials with standardized techniques and long-term clinical outcomes are required.
LEVEL OF EVIDENCE: Level IV, Systematic Review/Meta-Analysis of predominantly single-arm studies.