Renal denervation represents a novel potent tool for therapy of drug-resistent primary hypertensive patients by reducing renal and sympathic overactivity. Highfrequent electrical transluminal impulses are applied using the Simplicity device (Medtronic). The system is introduced in the renal arteries via the common femoral artery and produces thermo necrosis of sympathic nerve fibers in the adventitia of the renal arteries. The reduction of the crosstalk between the kidneys and subcortical regions of the brain leads to an amelioration of blood pressure which has been proved in...

Design: retrospective, observational study. Computed-tomography images of 102 patients with a mean age of 60±17.2 years were reviewed. 45 patients were woman 45 (44%) and 57 patients were men (56%). All patients were scanned using a 64-slice multi detector CT scanner (GE LightSpeed VCT, General Electric, Milwaukee, Wisconsin, USA). Typical scan parameters for upper abdominal CT-angiography were used: Slice thickness (ST) was 2.5 mm, tube voltage (TV) 120 kV, noise index 21, the scan field of view (SFOV) 22-40, pitch 0.984:1, in helical mode (HM),...

The main renal artery of 19 patients (18.6%) was not longer than 2 cm and in 23 patients (22.5%) the diameter of renal artery was below 4 mm. Two patients with fibromuscular dysplasia and an atherosclerotic renal artery stenosis was found in one patient. Excluding multiple renal arteries 36.2% of patients were unsuitable for RFA, and including multiple renal arteries 51% of all patients. Due to their small diameter right main renal arteries are less amenable to the therapy than left ones. A predictive factor...

In summary, only 49% of our investigated unselected cohort would be suitable by anatomical requirements for renal denervation described by literature. In patients with resistant hypertension this number may be even higher due to an increased risk of atherosclerosis and other co-morbidities. Further investigations have to be performed in order to find out how restrictive anatomical requirements for renal denervation have to be achieved for clinical success.

Symplicity HTN-2 Investigators, Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Böhm M. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet. 2010; 376(9756): 1903-1909 Mahfoud F, Schlaich M, Kindermann I, Ukena C, Cremers B, Brandt MC, Hoppe UC, Vonend O, Rump LC, Sobotka PA, Krum H, Esler M, Böhm M. Effect of renal sympathetic denervation on glucose metabolism in patients with resistant hypertension: a pilot study. Circulation. 2011; 123(18): 1940-1946