Renal denervation for hypertension refractory to renal artery stenting

Area of Science:

• Cardiology
• Nephrology
• Interventional Radiology

Background:

• Resistant hypertension poses a significant cardiovascular risk.
• Renal artery stenting is a common treatment for renal artery stenosis.
• Optimal medical therapy and stenting may not fully control blood pressure in some patients.

Purpose of the Study:

• To evaluate the efficacy and safety of radiofrequency (RF)-based renal denervation (RDN) in patients with refractory hypertension after renal artery recanalization and optimal medical therapy.
• To assess the impact of RDN on blood pressure and renal function in this specific patient cohort.

Main Methods:

• A prospective study involving ten patients (mean age 70) with resistant hypertension and prior renal artery stenting.
• RF energy was applied to the native renal artery segments, maintaining a safe distance from stented areas.
• Blood pressure (office and ambulatory), renal function, and renal artery status were monitored for up to 12 months post-RDN.

Main Results:

• Office systolic blood pressure significantly decreased from baseline (190.0 mmHg) to 158.3 mmHg at 12 months post-RDN (p<0.01).
• Ambulatory blood pressure also showed significant reductions at 6 and 12 months.
• No instances of renal artery restenosis, dissection, or aneurysm were reported. Renal function markers remained stable, though urine albumin excretion decreased in some patients.

Conclusions:

• RF-based renal denervation is a safe and effective treatment option for patients with resistant hypertension who have undergone previous renal artery stenting.
• RDN offers a potential therapeutic strategy to further reduce blood pressure in this challenging patient population.