Renal sympathetic denervation using an open-irrigated catheter in 10 patients with confirmed resistant hypertension

Abstract

Purpose: Catheter-based renal sympathetic denervation (RSD) has emerged as an alternative strategy for blood pressure (BP) control in patients with resistant hypertension. Recently an irrigated catheter was evaluated in a proof-of-principle study, but none of the previous studies have confirmed patient resistance with hospitalization. The aim of this study was to assess the efficacy and safety of RSD using an irrigated catheter in patients with drug-resistant hypertension confirmed by pervious hospitalization. Methods: Patients that kept the resistance criteria defined by the 7th Joint after a hospitalization period were referred to RSD. The procedure was carried out in a helicoidally manner using an open-irrigated catheter with a power of 15W, aiming to achieve a 10% impedance drop at each location. Four to 6 lesions (60sec each) were placed in each artery. Patients were followed-up (FU) at 1, 3, and 6 months. Renal artery angiography will be done at 6-months FU. Results: Ten patients (mean age 47.3 yo, 90% female) underwent RSD. The mean hospitalization period was 7 days and the mean number of anti-hypertensive drugs prior to the procedure was 7 (ranging from 4 to 9 drugs). In the mean FU of 3 months, the mean reduction of systolic and diastolic BP were12.5 and 6.2 mmHg, respectively; and the number of drugs required for BP control dropped to a mean of 4.3. Renal artery dissection (caused by the long sheath) occurred in the first case, and it was successfully treated with stent implantation. No subsequent adverse events occurred, suggesting the effects of the learning curve. No complications such as renal artery damage, renal infarction, acute renal failure, thrombus at the electrode tip or pulmonary edema were reported. Six months angiography and BP results are pending. Conclusions: In a mean FU of 3 months, RSD using a open irrigated catheter was safe and feasible in treating confirmed resistant hypertension. Randomized studies are needed to support our results.