Franco Rabbia1, Elisa Testa2, Chiara Fulcheri3, Elena Berra1, Silvia Di Monaco1, Michele Covella1, Marco Pappaccogli1, Silvia Monticone1, Renato Rosiello4, Denis Rossato5, Franco Veglio1. 1. Hypertension Unit AOU Città della Salute e della Scienza, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy. 2. Internal Medicine, Ospedale Santa Croce e Carle, Cuneo, Italy. 3. Hypertension Unit AOU Città della Salute e della Scienza, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy. chiara.fulcheri@gmail.com. 4. Hemodynamic Laboratory, Cardio-Thoracic-Vascular Department, Azienda Ospedaliera "Carlo Poma", Mantua, Italy. 5. Radiology Unit AOU Città della Salute e della Scienza, Department of Medical Sciences, University of Torino, Turin, Italy.
Abstract
INTRODUCTION: Recent anatomical and clinical studies have led to the hypothesis that in several cases of failure of response to renal denervation (RDN), the procedure has not been technically correct. AIM: To perform procedural reassessment in patients with true resistant hypertension who underwent RDN. METHODS: We retrospectively reassessed the procedural technique of RDN in 10 true resistant hypertensive patients, comparing the sites of renal ablations with the knowledge of animal and human post mortem evidences. Procedural ablation technique was assessed in terms of number of ablations for each renal artery and site of ablation (quadrant and distance from renal ostium) by using the radiologic images of each RDN and the number of radiofrequency ablation attempts documented in the reports of each denervation session. RESULTS: 10 patients were studied, 9 denervated with Simplicity monoelectrode catheter, 1 with multielectrode balloon technique. Responders to the procedure underwent more ablations and particularly at least a quadrant ablation in one of the kidney arteries, >2 ablations in Dorsal plus Ventral quadrants and in 67% of then >10 ablations were done in superior inferior and ventral quadrants. CONCLUSION: This study confirms the importance of a well knowledge of renal artery anatomy and underlines the relevance of the choice of ablation sites in order to obtain a successful RDN procedure.
INTRODUCTION: Recent anatomical and clinical studies have led to the hypothesis that in several cases of failure of response to renal denervation (RDN), the procedure has not been technically correct. AIM: To perform procedural reassessment in patients with true resistant hypertension who underwent RDN. METHODS: We retrospectively reassessed the procedural technique of RDN in 10 true resistant hypertensivepatients, comparing the sites of renal ablations with the knowledge of animal and human post mortem evidences. Procedural ablation technique was assessed in terms of number of ablations for each renal artery and site of ablation (quadrant and distance from renal ostium) by using the radiologic images of each RDN and the number of radiofrequency ablation attempts documented in the reports of each denervation session. RESULTS: 10 patients were studied, 9 denervated with Simplicity monoelectrode catheter, 1 with multielectrode balloon technique. Responders to the procedure underwent more ablations and particularly at least a quadrant ablation in one of the kidney arteries, >2 ablations in Dorsal plus Ventral quadrants and in 67% of then >10 ablations were done in superior inferior and ventral quadrants. CONCLUSION: This study confirms the importance of a well knowledge of renal artery anatomy and underlines the relevance of the choice of ablation sites in order to obtain a successful RDN procedure.
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