Comparison of standard renal denervation procedure versus novel distal and branch vessel procedure with brachial arterial access

Safety of catheter‐based radiofrequency renal denervation on branch renal arteries in a porcine model

“…The average number of ablations per patient varied from 14 to 45.9 among clinical studies which investigated the effect of branch treatment . Even considering the variation in clinical studies, the number of ablations seems to be smaller in the present study (14.5–17.5) compared with the clinical studies.…”

“…Elastica Masson's trichrome staining. Scale bars: 1 mm (the first-and third-row panels; 40 μm (the second-and fourth-row panels) [Color figure can be viewed at wileyonlinelibrary.com] treatment 8,10,[12][13][14]. Even considering the variation in clinical studies, the number of ablations seems to be smaller in the present study(14.5-17.5) compared with the clinical studies.…”

“…Importantly, a recent anatomical study showed that the renal sympathetic nerve fibers are distributed closer to the lumen in branch renal arteries (RAs) compared with the main RA, suggesting that RDN that includes the branch RA may ablate more sympathetic nerves than RDN on the main RA alone . This hypothesis was supported in recent animal and clinical studies including the blinded, randomized, sham‐controlled SPYRAL HTN‐OFF MED and ON MED trials . Direct comparison studies in animals and humans clearly confirmed greater efficacy in RDN on both branch and main RA compared with RDN on main RA alone .…”

“…This hypothesis was supported in recent animal and clinical studies including the blinded, randomized, sham‐controlled SPYRAL HTN‐OFF MED and ON MED trials . Direct comparison studies in animals and humans clearly confirmed greater efficacy in RDN on both branch and main RA compared with RDN on main RA alone . Therefore, branch RA is expected to become the treatment site of choice for RF‐based RDN.…”

It's what's inside that matters: Getting to the source in renal denervation

“…Additionally, a number of studies directly comparing RDN of the main RA versus the main RA and its branches have shown greater BP reduction with the latter technique. [8][9][10] There is a risk of RA stenosis with RDN via a peri-arterial approach, which may be increased when ablating smaller branch RAs. 11 We agree with the authors that RDN of branch RAs needs further investigation, and congratulate them on their study demonstrating the safety of radiofrequency RDN on branch renal arteries, specifically in that there was no histopathological evidence of artery stenosis or kidney injury after ablation.…”