Cardiovascular Journal of Africa: Vol 27 No 1 (January/February 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 1, January/February 2016 AFRICA 55
complications and lower hospital costs, and are preferred by
patients. Likewise, the unique geometric anatomy of the renal
arteries relative to the abdominal aorta may make renal artery
access easier from this superior approach.
The Symplycity Spyral catheter measures 117 cm from spiral
tip to shaft end, however, we found that removal of the attached
‘straightening sheath’, increased the usable length to 125 cm,
which was adequate for these cases. Both cases had encouraging
outcomes with no adverse events. During both procedures, we
intentionally targeted the distal portion of the main vessel as well
as the distal renal artery beyond the main bifurcation because the
sympathetic nerves have been shown to be closer to the arterial
lumen in these regions.5
Note that the patients described here did not have so
called ‘treatment-resistant’ hypertension. However, these subjects
received RD therapy as part of a separate clinical trial testing
the hypothesis that RD therapy may reduce recurrence of atrial
fibrillation. Also, note that the system used in these cases was
designed specifically for femoral procedural access and this is
specified clearly in the product labelling. However, we chose to
apply this device in an ‘off-label’ fashion in order to determine
the potential to improve the procedural safety and outcome.
Conclusion
We demonstrated that RD therapy is feasible with the currently
approved multi-electrode RF system with either brachial or
radial access, although larger prospective studies are required
to determine the actual safety and efficacy of this alternative.
Such an approach could perhaps reduce the rate of vascular
complications associated with femoral access and also allows for
same-day discharge. Finally, we suggest that future generations
of RD catheter systems be designed with the goal to allow for
brachial and radial arterial access.
References
1. Bhatt DL, Kandzari DE, O’Neill WW, et al. A controlled trial of
renal denervation for resistant hypertension. N Engl J Med 2014; 370:
1393–1401.
2. Böhm M, Linz D, Urban D, Mahfoud F, Ukena C. Renal sympathetic
denervation: applications in hypertension and beyond. Nat Rev Cardiol
2013; 10: 465–476.
3. Bertog SC, Blessing E, Vaskelyte L, Hofmann I, Id D, Sievert H. Renal
denervation: tips and tricks to perform a technically successful proce-
dure. EuroIntervention 2013; 9: R83–88.
4. Zeller T, Rastan A, Macharzina R, Noory E. Challenging anatomy,
how to treat or not to treat? EuroIntervention 2013; 9(Suppl R): R67–74.
5. Sakakura K, Ladich E, Cheng Q, et al. Anatomic assessment of sympa-
thetic peri‐arterial renal nerves in man. J Am Coll Cardiol 2014; 64(7):
635–643.
Table 1. Comparison: baseline versus follow up
after renal denervation (RDN)
Before RDN
(baseline) Follow up Reduction
Patient 1: right
brachial approach
Office BP (mmHg)
05/02/2015:
159/94
12/06/2015:
137/77
22/17 mmHg
ABPM: mean BP
(mmHg)
137.1/78.1 130.2/74.9
(4 months after
RDN)
6.9/3.2 mmHg
BP meds (3 drugs) Prexum Plus/
Bisocor
Prexum Plus/
Bisocor
no
Patient 2: left
radial approach
Office BP (mmHg)
23/06/2015:
173/94
17/08/2015:
128/73
45/21 mmHg
ABPM: mean BP
(mmHg)
155.5/85 133.2/82
(4 months after
RDN)
22.3/3 mmHg
BP meds (4 drugs) Co-Pritor/Biso-
cor/Spiractin
Co-Pritor/Biso-
cor/Spiractin
no
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