Renal denervation (RDN) is a promising device-based interventional therapy for resistant hypertension. Currently, the femoral artery is the most widely used access site for RDN. However, this approach is difficult or impossible to perform a successful RDN procedure in certain patients with aorto-iliac occlusive disease, an acute angle between the infrarenal aorta and the renal arteries, or severe tortuosity of the abdominal aorta and/or iliac arteries because ablation catheter is hardly engaged into renal artery, hardly rotated, and hardly touched on the targeting wall of ablation site. Such ineligible anatomy for transfemoral access is not unusual, and was encountered in 10%-20% of the cases who underwent RDN in our cohort. Although it is a fact, the SYMPLICITY-HTN3 trial did not mention how many cases had such ineligible anatomy for transfemoral access, which might have a significant effect on the result. Transradial renal nerve ablation by a specialized catheter may change the conclusion of the SYMPLICITY-HTN3 trial.
Moreover, compared to femoral access, the advantages of radial access include substantial reduction in access site-related vascular complications, shorter bed confinement and hospital stay, and lower health care costs. However, due to the unavailability of longer radiofrequency ablation catheter in many countries, RDN via radial access has not been possible in most patients. Here, Dong and Jiang, et al described 5 successful cases using a new radiofrequency ablation catheter designed for transradial RDN (Iberis Catheter: 155 cm; AngioCare, Shanghai, China) to evaluate technical feasibility and short-term outcomes of transradial RDN. This preliminary study revealed that transradial RDN is technically feasible, safe, and effective for the treatment of resistant hypertension, especially where a femoral approach may not be possible.
Xiongjing JIANG, MD
Dept. of Cardiology,
Fuwai Hospital, National Center for Cardiovascular Disease,
Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
Read entire article at:
- Dong H, Jiang X, Liang T, et al. Transradial Renal Denervation for the Treatment of Resistant Hypertension. J Invasive Cardiol. 2014 Jul;26(7):322-7.
- de Araújo Gonçalves P, Teles RC, Raposo L. Catheter-based renal denervation for resistant hypertension performed by radial access. J Invasive Cardiol. 2013 Mar;25(3):147-9.
- Musashi M1, Inoue N, Meguro T. Complex renal artery aneurysm: successful exclusion with balloon-expandable covered stent. J Invasive Cardiol. 2013 Nov;25(11):612-4.
- Su CS, Liu TJ, Tsau CR, et al. The feasibility, safety, and mid-term outcomes of concomitant percutaneous transluminal renal artery stenting in acute coronary syndrome patients at high clinical risk of renal artery stenosis. J Invasive Cardiol. 2013 May;25(5):212-7.