title: Renal denervation beyond the bifurcation: The effect of distal ablation placement on safety and blood pressure.
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.
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Martine M A
authors.initials: MM
authors.lastname: Beeftink
authors.affiliation: Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Wilko
authors.initials: W
authors.lastname: Spiering
authors.affiliation: Department of Cardiology, Isala Hospital, Zwolle, the Netherlands.
authors.forename: Mark R
authors.initials: MR
authors.lastname: De Jong
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.affiliation: Department of Nephrology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.affiliation: Department of Cardiology, Isala Hospital, Zwolle, the Netherlands.
authors.forename: Arif
authors.initials: A
authors.lastname: Elvan
authors.affiliation: Department of Internal Medicine, Isala Hospital, Zwolle, the Netherlands.
authors.forename: Jan-Evert
authors.initials: JE
authors.lastname: Heeg
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: Voskuil
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension; D007668:Kidney / Q000294:innervation* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012077:Renal Artery / Q000601:surgery*; D013562:Sympathectomy / Q000379:methods*
keywords: hypertension-general; optimized treatment; renal denervation