TCT CONNECT-420 Microdissection of the Human Renal Nervous System: Implications for Performing Renal Denervation Procedures

Renal Denervation in Hypertensive Patients

“…Still, the work of Garcia Touchard et al 9 needs further validation. First, though it is unlikely that many research groups will be able and willing to replicate such a tedious study, it would be of interest to see whether the findings of the Spanish group 9 apply indifferently to subjects from different ethnic origins, with or without resistant hypertension, cardiovascular, and renal comorbidities. Second, it may be of interest to look retrospectively for a correlation between the ratio length main renal artery/length ostium-hilum, as a proxy for the presence of LAN/VLAN and blood pressure decrease after RDN in existing clinical studies.…”

“…In this context, the anatomic study of Garcia Touchard et al 9 published in this issue of Hypertension could open new pathways to improve selection of patients and results of RDN. The authors meticulously dissected renal nerves of 60 kidneys from 30 randomly selected cadavers and carefully described their origin and trajectory.…”

“…If the latter is impossible to achieve, RDN may not be the preferred treatment option for these patients. From a research-and-development perspective, and in view of the high prevalence of LAN and VLAN, the work of Garcia Touchard et al 9 also highlights the critical importance to develop catheters small enough to reach such branches. Nevertheless, even this may not provide a technical solution for all cases, as some of nerves really land very distally, that is, in segmental branches.…”

“…Nevertheless, even this may not provide a technical solution for all cases, as some of nerves really land very distally, that is, in segmental branches. 9 Another way to circumvent the problem could be to use ethanol-based RDN, 10 as ethanol diffusion may allow reaching LAN and VLAN, thus allowing a more complete denervation of distal arterial branches. This theoretical advantage nevertheless remains to be demonstrated.…”

“…Another remarkable lesson of the study of Garcia Touchard et al 9 is that we have still to learn from anatomy and that dissection is not obsolete and should remain part of the medical curriculum. Else, someday, despite all sophisticated computer-based medical imaging, we may be unable to address important medical and research questions.…”