Related Experiment Video
Updated: Jan 11, 2026

Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension
Published on: June 6, 2025
Carbon Dioxide Angiography-Guided Ultrasound Renal Denervation in Refractory Hypertension With Chronic Kidney Disease
Mohamad Bahrou1, Ahmed Shahab2, Rami Al-Ayyubi2
1Department of Medicine, Internal Medicine Residency Training Program, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
Background:
Renal denervation (RDN) is an emerging therapy for resistant hypertension. However, use of iodinated contrast during the procedure raises concern for contrast-induced kidney injury in patients with chronic kidney disease (CKD). Carbon dioxide (CO2) angiography may provide a safer alternative.
Case Summary:
An 85-year-old man with stage 3a CKD and refractory hypertension despite 5 medications underwent ultrasound-guided RDN (uRDN). After minimal iodinated contrast for access confirmation, CO2 angiography was used to visualize the bilateral renal arteries and guide ablation. Three ablations were delivered to each artery, and the procedure was uneventful. At 5-week follow-up, serum creatinine improved (1.3 mg/dL), and antihypertensive therapy was reduced from 5 to 3 agents.
Discussion:
CO2 angiography allows safe renal artery visualization without nephrotoxic exposure, making it particularly valuable in CKD patients where contrast-induced injury is a concern.
Take-Home Message:
CO2-guided uRDN is a safe, non-nephrotoxic option for refractory hypertension in patients with CKD.
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