Endovascular renal artery denervation: why, when, and how?
Endovascular renal artery denervation (ERAD) is a new procedure to reduce renal and systemic sympathetic overactivity in hypertensive patients. The role of sympathetic overactivity is recognized since a long time as being one the contributor of human hypertension. In support of this view, several studies in experimental models of hypertension in animal as well as hypertensive human subjects have demonstrated that sympathetic overactivity plays a central role in hypertension catheter based renal denervation is now possible, and this procedure may provide a useful adjunct for the management of patients with drug-resistant primary hypertension. Following a cohort study, the results of an open label randomized control trial have been published showing very encouraging results. The purpose of this paper is to help interventionalists to better understand the medical and technical issues related to this new intervention. It is most likely that as underlined in a recent editorial several other technical approaches may appear in the future, however because this is the only technique that is available today, we will focus on radiofrequency based technique.
Université Paris Descartes, Hôpital Europeen Georges Pompidou Radiologie Interventionnelle, Paris, France. marc.sapoval2@egp.aphp.fr
Marc
M
Sapoval
Michel
M
Azizi
Guillaume
G
Bobrie
Bernard
B
Cholley
Jean-Yves
JY
Pagny
Pierre-François
PF
Plouin
D000792:Angiography; D017115:Catheter Ablation / Q000379:methods*; D003714:Denervation / Q000379:methods*; D004351:Drug Resistance; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D015641:Radiography, Interventional; D012077:Renal Artery / Q000294:innervation* / Q000503:physiopathology / Q000601:surgery*; D013562:Sympathectomy / Q000379:methods*