Sebastian Ewen asks questions to Stefan C. Bertog, first author of Renal denervation: tips and tricks to perform a technically successful procedure, article published in EuroIntervention Journal Supplement on Resistant Hypertension Treatments, May 2013.
To most practitioners involved in catheter-based interventions, percutaneous renal sympathetic denervation is not technically challenging. However, under specific clinical circumstances (e.g., renal insufficiency) or when faced with more complex abdominal aortic anatomy (e.g., tortuosity) some procedural tips may come in handy. Here we review the equipment, antiplatelet and anticoagulant strategy as well as the procedural technique, including tips and tricks for the successful performance of catheter-based renal denervation. Among other topics, carbon dioxide angiography and brachial artery access are discussed.
Sebastian Ewen: Do you routinely administer an intra-arterial vasodilator during the renal denervation procedure to avoid spasms?
Stefan C. Bertog: I do not routinely administer vasodilator therapy prior to RF application.
Sebastian Ewen: How do you proceed with accessory arteries?
Stefan C. Bertog: Accessory renal arteries are denervated if anatomical and device characteristics allow. Using the Symplicity system, accessory arteries down to 3.5 mm are denervated. With other systems, e.g. Vessix, renal accessories with diameters of down to 3.0 mm are denervated.
Sebastian Ewen: Where do you see benefit for a radial approach for renal denervation?
Stefan C. Bertog: I do not see a benefit in radial approach with the exception of cases when femoral access is not available (e.g. bilateral severe peripheral arterial disease) or in cases of severe infrarenal/iliac tortuosity or very inferior renal artery take-off that may be difficult to cannulate from the femoral approach. One potential disadvantage of radial approach is respiratory and cardiac (aortic arch) motion which may cause RF catheter instability.
Sebastian Ewen: Do you perform a renal denervation proximal to a renal artery stent or do you prefer a single side procedure on the other side?
Stefan C. Bertog: Performing denervation proximal to a renal artery stent would be very rare given that most renal artery stenoses (and stents) are located at the ostium or proximal segment. Therefore, I cannot remember a case of denervation proximal to a renal stent. However, I would attempt bilateral renal denervation including those with renal artery stents. The RF application would be outside of the stented segment.
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