Introduction: Arterial hypertension is the most common correctable risk factor for death worldwide. Achievement of therapeutic goal is hampered by multiple factors including non-adherence to drug therapy and individual physiological resistance. Objective: We aimed to determine the efficacy of renal denervation in lowering SBP and DBP at 1st and 6th month, in patients at high cardiovascular risk, in whom lowering BP would possibly also result in risk reduction and lower incidence of future cardiovascular events. Methods: The procedure was performed in 39 patients with resistant hypertension admitted to the University Hospital „Acibadem City Clinic – Cardiovascular Center“ (Sofia) for the period January 2017–June 2020. Access was via brachial artery and the Simplicity Spiral catheters were used, at an average of 19.5 ablation points per artery. The number of complications, as well as the mean systolic and diastolic BP values at 1st and 6th month were recorded. Baseline, risk profile and follow-up medical treatment of the study group was monitored. Results: In the study group, the predominant risk factors were dyslipidemia, age, diabetes mellitus, with 21 patients (53.84%) already having clinically significant atherosclerosis – a realized heart attack, stroke, peripheral or coronary revascularization. At follow-up, a significant reduction in both systolic and diastolic BP (blood pressure) values was observed. At the first month, the fall in SBP (systolic blood pressure) was –17.8 mm Hg, with a persistent reduction in the range of –14.5 mm Hg at 6th month. In terms of DBP (diastolic BP), the mean reduction at the first month was –8.9 mm Hg and at the 6th month it was –7.2 mm Hg. Regarding antihypertensive treatment, there was a mild reduction in the intake of antihypertensive drugs. Conclusion: Substantial proportion of people with hypertension have uncontrolled hypertension (both treatment resistant and due to non-adherence to treatment or due to additional pathophysiological mechanisms). Renal denervation has proven effective and safe in patients with uncontrolled hypertension and high cardiovascular risk profile

The most common localizations for upper extremity atherosclerosis are the subclavian artery and the brachiocephalic trunk. Significant stenosis of the subclavian artery occurs in 2% of the population and in 7-11% of patients with manifest cardiovascular disease. Revascularization is indicated in symptomatic or asymptomatic patients with coronary disease with planned surgical revascularization. In addition to atherosclerosis, other causes of the appearance of subclavian artery stenosis include dissection, radiation-induced inflammation of the fibromusculature, and various vasculities, especially Takayasu arteritis. The left subclavian artery is about four times more commonly affected than the right. It usually occurs over the age of 50 years and in 1.5-2 times more common in men than in women. Disease of the subclavian artery is usually focal and the lesion is predominantly in the first 2 cm proximal to the origin of the aorta. Between 2016-2021 in the clinic of cardiology and angiology we treated endovascularly 81 patients (41 men and 40 females, median age 64 ± 11) with either intraluminal balloon dilatation and/or primary stent implantation followed by balloon post dilatation. We achieved a high technical success rate (93.8%) and immediate clinical success, with only a few minor complications.