Renal sympathetic denervation (RDN) has been largely studied, but the still poor knowledge of the nerves distribution in the thickness of renal artery could lead to procedural inefficacy, that, as recently suggested by some experimental studies, could explain unsatisfactory response to renal denervation. Recent evidences show that proportion of fibers available for RDN is small in proximal portion of renal artery but increases towards its distal part. Our aim was to assess whether in clinical practice there were differences in effectiveness between make ablations only at the level of the main arterial trunk or even at the level of peripheral branches.Design and Method:
A total of 12 consecutive patients with resistant hypertension were included. The first 5 patients were treated with unipolar catheter; for the last 7 patients, the multi-electrode catheter was used. The first group (A) was treated with 4 to 5 ablation points for artery in the main trunk only. The second group (B) was treated with 10 to 14 ablation points for artery distributed among the main trunk plus distal branches. Office BP and ABPM was measured at baseline, 1, 3, 6 and 12 months after RDN.Results:
Office and 24-hours SBP and DBP decreased at 1, 3, 6 and 12 months in all 12 patients. While office SBP decreased in Group A likewise in the Group B (−24 and −22 mmHg, respectively; Fig.1), the reduction in office DBP was stronger in Group B than Group A (−23 vs −14 mmHg). Similarly, Group B 24-hours SBP and DBP values decreased more than in Group A (A: −12/−6, B: −19/−10, mmHg).Conclusions:
Our data confirm the results of recent studies and suggest that ablation of main trunk plus distal branch of the artery may be more effective in reducing BP in clinical practice as much as shown in controlled clinical studies.