Percutaneous renal denervation and the second generation EnligHTN System

Hypertension remains a major public health burden despite the plethora of therapeutic agents available for this disorder, compelling innovation of alternate therapies including interventional approaches where necessary. The kidney is a major player in the pathophysiology of this disease with increased sympathetic activity being the key factor in the initiation and maintenance of drug resistant hypertension in many patients. Thus renal denervation targeted at decreasing sympathetic drive is becoming the apparent choice in carefully selected patients with resistant hypertension who have exhausted all medical options. The Symplicity and EnligHTN trials using first and second generation catheters respectively have demonstrated that renal sympathetic denervation results in significant blood pressure reduction. The initial renal denervation catheter used in the Symplicity trial was a single electrode system. Refinement of this process has led to the EnligHTN catheter's design. This is a multielectrode self-expanding nitinol basket that allows the positioning of the thermal injury pattern to be pre-specified and in theory lead to better positioning of the lesions. We present a review of the premise behind renal artery denervation, discuss the data and early technologies focusing on the characteristics and utility of the first multielectrode renal denervation device, the EnligHTN renal denervation catheter.