Abstract
Background: Renal Denervation (RDN) is an effective treatment for resistant hypertension. The procedure was done first with a single electrode catheter creating multiple intentionally spaced lesions. The catheter delivers 4-6 radiofrequency (RF) ablations at points distributed along the length of the renal artery. The procedure requires rotation and pull-back of the catheter between each hit. Second generation devices enable multiple simultaneous ablations at different points, allowing a single hit. RF is applied with preprogrammed time and intensity. The system provides same power regardless of catheter size eliminating the need for adjustment of the level. This gives a more predictable lesion pattern with single hit and a shorter time. This may reduce the risk of overheating and clot formation during RF delivery. The effect of RDN on renal blood flow (RBF) and the safety of the two generations of devices haven’t been compared. We report the effect of those devices on RBF by using the method of renal frame count (RFC) Methods: We studied the (RBF) before and after RDN by counting the numbers of frames (fr) on the renal angiogram from a beginning fr to an end fr. Fr1 is the fr that shows both edges of the ostium of the renal artery immediately after contrast injection. The end fr the fr which shows the contrast when it has reached the lateral edge of the renal cortex. RFC was calculated before and immediately after RDN in 10 cases done using 1st generation device. The results were compared with another 10 cases done using 2nd generation device. Results: The mean RFC was 9.28 fr before RDN and increased to 13.71 fr after RDN in the cases that used 1st generation device (p Conclusions: 1st generation device causes significant increase in RFC reflecting deterioration in RBF when compared with 2nd generation. This can be explained by distal embolization due to catheter manipulation and micro clots formation from blood overheating due to loss of direct contact with intima. 1st generation catheters should not be used for RDN.
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