Interventional procedure overview of percutaneous transluminal renal sympathetic denervation for resistant hypertension

Indications and current treatment

Hypertension is a major risk factor for cardiovascular disease and chronic kidney disease. Hypertension can be primary or secondary. Primary hypertension does not have a single known cause, whereas secondary hypertension develops because of an underlying medical condition or disease. Hypertension is considered resistant if it is not controlled after treatment with at least 3 antihypertensive medications from different classes.

NICE's guideline on hypertension in adults describes diagnosing and managing hypertension, including resistant hypertension. Current treatments for hypertension include lifestyle modifications and antihypertensive medications. Blood pressure and treatment are regularly monitored and treatment is adjusted as needed. For resistant hypertension, additional medications and device-based antihypertensive therapies (for example renal denervation and carotid baroreceptor stimulation) can be considered.

What the procedure involves

This procedure is usually done using local anaesthesia, with sedation and anticoagulation. A catheter is introduced through the femoral artery and advanced into each renal artery under fluoroscopic guidance. The catheter is connected to a generator which delivers radiofrequency or ultrasound energy (depending on the type of system used) from the distal to proximal end of each renal artery. This ablates the renal nerves leading to the kidney, with the aim of disrupting neurogenic reflexes involved in blood pressure control. There are different systems with different technologies in use for renal sympathetic denervation.