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. 2017 Apr;19(4):371-378.
doi: 10.1111/jch.12989. Epub 2017 Mar 14.

Renal denervation beyond the bifurcation: The effect of distal ablation placement on safety and blood pressure

Martine M A Beeftink  1 , Wilko Spiering  2 , Mark R De Jong  3 , Pieter A Doevendans  1 , Peter J Blankestijn  4 , Arif Elvan  3 , Jan-Evert Heeg  5 , Michiel L Bots  6 , Michiel Voskuil  1
Affiliations

Renal denervation beyond the bifurcation: The effect of distal ablation placement on safety and blood pressure

Martine M A Beeftink et al. J Clin Hypertens (Greenwich). 2017 Apr.

Abstract

Renal denervation may be more effective if performed distal in the renal artery because of smaller distances between the lumen and perivascular nerves. The authors reviewed the angiographic results of 97 patients and compared blood pressure reduction in relation to the location of the denervation. No significant differences in blood pressure reduction or complications were found between patient groups divided according to their spatial distribution of the ablations (proximal to the bifurcation in both arteries, distal to the bifurcation in one artery and distal in the other artery, or distal to the bifurcation in both arteries), but systolic ambulatory blood pressure reduction was significantly related to the number of distal ablations. No differences in adverse events were observed. In conclusion, we found no reason to believe that renal denervation distal to the bifurcation poses additional risks over the currently advised approach of proximal denervation, but improved efficacy remains to be conclusively established.

Keywords: hypertension-general; optimized treatment; renal denervation.

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Figures

Figure 1
Figure 1
Change in 24‐hour ambulatory blood pressure (BP) monitoring (ABPM) for different renal denervation (RDN) locations. This figure shows the change in 24‐hour systolic (light blue) and diastolic (dark blue) ABPM for the different categories of RDN location. Error bars represent the standard error of the mean. The P value represents the probability value for between‐groups differences obtained by the Jonckheere‐Terpstra test.
Figure 2
Figure 2
Angiography examples of different renal denervation (RDN) locations. Angiographic images of the right (A1, B1, C1) and left (A2, B2, C2) renal artery of three patients demonstrating the different locations of the renal denervation procedures. The white dots represent the location of the ablation points. Patient A was treated proximal to the renal artery bifurcation only (group 1), patient B was treated distal to the bifurcation in one renal artery (group 2), and patient C was treated distal to the bifurcation in both arteries (group 3).
See this image and copyright information in PMC

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