title: Renal denervation using an irrigated catheter in patients with resistant hypertension: a promising strategy?
abstract: BACKGROUND
  Systemic hypertension is an important public health problem and a significant cause of cardiovascular mortality. Its high prevalence and the low rates of blood pressure control have resulted in the search for alternative therapeutic strategies. Percutaneous renal sympathetic denervation emerged as a perspective in the treatment of patients with resistant hypertension.
  
  
  OBJECTIVE
  To evaluate the feasibility and safety of renal denervation using an irrigated catheter.
  
  
  METHODS
  Ten patients with resistant hypertension underwent the procedure. The primary endpoint was safety, as assessed by periprocedural adverse events, renal function and renal vascular abnormalities at 6 months. The secondary endpoints were changes in blood pressure levels (office and ambulatory monitoring) and in the number of antihypertensive drugs at 6 months.
  
  
  RESULTS
  The mean age was 47.3 (± 12) years, and 90% of patients were women. In the first case, renal artery dissection occurred as a result of trauma due to the long sheath; no further cases were observed after technical adjustments, thus showing an effect of the learning curve. No cases of thrombosis/renal infarction or death were reported. Elevation of serum creatinine levels was not observed during follow-up. At 6 months, one case of significant renal artery stenosis with no clinical consequences was diagnosed. Renal denervation reduced office blood pressure levels by 14.6/6.6 mmHg, on average (p = 0.4 both for systolic and diastolic blood pressure). Blood pressure levels on ambulatory monitoring decreased by 28/17.6 mmHg (p = 0.02 and p = 0.07 for systolic and diastolic blood pressure, respectively). A mean reduction of 2.1 antihypertensive drugs was observed.
  
  
  CONCLUSIONS
  Renal denervation is feasible and safe in the treatment of resistant systemic arterial hypertension. Larger studies are required to confirm our findings.
authors.forename: Luciana
authors.initials: L
authors.lastname: Armaganijan
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Staico
authors.forename: Aline
authors.initials: A
authors.lastname: Moraes
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
authors.forename: Dalmo
authors.initials: D
authors.lastname: Moreira
authors.forename: Celso
authors.initials: C
authors.lastname: Amodeo
authors.forename: Márcio
authors.initials: M
authors.lastname: Sousa
authors.forename: Flávio
authors.initials: F
authors.lastname: Borelli
authors.forename: Dikran
authors.initials: D
authors.lastname: Armaganijan
authors.forename: J Eduardo
authors.initials: JE
authors.lastname: Sousa
authors.forename: Amanda
authors.initials: A
authors.lastname: Sousa
mesh_terms: D000328:Adult; D000792:Angiography; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D017115:Catheter Ablation / Q000379:methods*; D003404:Creatinine / Q000097:blood; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000601:surgery*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000294:innervation; D015203:Reproducibility of Results; D013562:Sympathectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003404:Creatinine