Renal Denervation in Severe Neurogenic Dysautonomia: The RANSOM Prospective Experience

Severe neurogenic dysautonomia in advanced neurodegenerative disorders is characterized by extreme blood pressure variability, orthostatic instability, and recurrent syncopal events. Therapeutic options are limited, and these patients are commonly excluded from conventional hypertension trials.

We report the first prospective, single-center experience of renal sympathetic denervation in 12 patients with advanced parkinsonian syndromes and severe autonomic dysfunction with marked blood pressure variability. All procedures were successfully performed using a multielectrode radiofrequency catheter without complications. At 6-month follow-up, mean blood pressure values did not significantly change. Nevertheless, 9 patients were classified as responders, 1 as a partial responder, 1 as a nonresponder, and 1 had incomplete 6-month follow-up, based on a pragmatic multidisciplinary clinical assessment integrating syncopal burden, orthostatic tolerance, and patient-reported symptomatic benefit.

Renal denervation was feasible and safe in this frail population. Because the study was small, uncontrolled, and lacked systematic autonomic testing at follow-up, efficacy findings should be considered exploratory and hypothesis-generating.

To the best of our knowledge, this is the first reported prospective experience of renal sympathetic denervation in severe neurogenic sympathetic dysautonomia.

Renal sympathetic modulation may represent a therapeutic option in selected patients with disabling autonomic dysfunction, but controlled studies with objective autonomic assessments are needed.