Transcatheter Renal Sympathetic Denervation: Chasing a Chimera or a Matter of Technological Improvements?

Laparoscopic-based perivascular unilateral renal sympathetic nerve denervation for treating resistant hypertension: a case report

“…We also stripped off the tissue around the renal arteries to separate and expose the renal artery, which may also destroy most of the renal nerves distributed in the adventitia. This has been confirmed in a study conducted on beagles [8,9]. Moreover, direct stimulation using RF energy as well as the use of catheter and wire on the arterial intima may cause intimal injury and/or thrombosis [10,11], which may trigger the progression of atherosclerosis.…”

Renal sympathetic denervation: Ashes to ashes or rebirth from the ashes?

“…Regarding the latter, a post‐hoc analysis of the study revealed that the majority of patients received 4‐6 ablations per artery, and of major importance only 19 participants received a circumferential ablation of both renal arteries . Of note, blood pressure response was associated with the number of ablations, and patients receiving more than 14 ablations experienced a sufficient systolic blood pressure reduction (office: 14 mm Hg; ambulatory: 7 mm Hg), thus underlining the importance of adequate renal denervation . It is noteworthy that the study by Denegri and colleagues actually duplicates the findings of the post‐hoc analysis of Symplicity‐3, because for a similar number of ablations an identical blood pressure reduction is achieved.…”

Renal Sympathetic Denervation: Hibernation or Resurrection?

“…From the clinical point of view, the most significant aspect of renal nerve anatomy regards the distance of sympathetic fibers from the lumen and the relative distribution of sympathetic fibers at the proximal and distal segments of the renal arteries [6]. Earlier autopsy studies reported that almost all sympathetic fibers are found between 0.5 and 2.5 mm from the lumen wall, and 90% are within 2 mm from the lumen [7], thus allowing for effective injury with transcatheter radiofrequency techniques.…”