Severe Renal Artery Stenosis After Renal Sympathetic Denervation

JACC: CARDIOVASCULAR INTERVENTIONS

VOL. 8, NO. 11, 2015

ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION

ISSN 1936-8798/$36.00

PUBLISHED BY ELSEVIER INC.

http://dx.doi.org/10.1016/j.jcin.2015.05.022

IMAGES IN INTERVENTION

Severe Renal Artery Stenosis After Renal Sympathetic Denervation Alejandro Diego-Nieto, MD, PHD, Ignacio Cruz-Gonzalez, MD, PHD, Javier Martin-Moreiras, MD, Juan C. Rama-Merchan, MD, PHD, Javier Rodriguez-Collado, MD, Pedro L. Sanchez-Fernandez, MD, PHD

W

e present the case of a 73-year-old

optical coherence tomography showed severe diffuse

woman scheduled for renal angiography

neointimal hyperplasia (Figure 2).

for severe recurrent refractory arterial

Since 2012, several cases of renal stenosis after

hypertension 2 months after sympathetic renal

renal denervation have been reported, demonstrating

denervation

a wide spectrum of clinical presentation, but pre-

catheter

with

system

the (St

EnligHTN

Jude

multielectrode

Medical,

Saint

Paul,

The

angiogram

senting recurrent hypertension as most relevant finding (1).

Minnesota). confirmed

right

renal

artery

In the previous trials HTN-1 (Symplicity Renal

subocclusive stenosis at the site of previous radio-

Denervation in Patient With Refractory Hypertension)

frequency application (Figure 1). After catheter-

(2) and EnligHTN-I (Safety and Efficacy of Study of

balloon dilation to advance the imaging catheter,

Renal Artery Ablation in Resistant Hypertension

F I G U R E 1 Renal Angiogram

Right renal artery angiogram showing the absence of angiographic pre-existing stenosis (A), vessel irregularities immediately after radiofrequency delivery (B), and severe restenosis 2 months after the procedure (C).

From the Department of Cardiology, University Hospital of Salamanca, Salamanca, Spain. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received April 17, 2015; accepted May 7, 2015.

e194

Diego-Nieto et al.

JACC: CARDIOVASCULAR INTERVENTIONS VOL. 8, NO. 11, 2015 SEPTEMBER 2015:e193–4

Severe Renal Artery Stenosis After Renal Sympathetic Denervation

F I G U R E 2 Optical Coherence Tomography of the Right Renal Artery

Optical coherence tomography findings after dilation showing severe concentric neointimal hyperplasia.

Patients) (3), renal artery stenosis had been attributed mainly to pre-existing artery stenosis worsening and

REPRINT REQUESTS AND CORRESPONDENCE: Dr.

not to a de novo procedure-related adverse event.

Alejandro Diego-Nieto, Department of Cardiology,

The increasing reports of the last call into question

Salamanca University Hospital, Paseo de San Vicente

the safety of this procedure and point to this compli-

58, 37007 Salamanca, Spain. E-mail: adiegonieto@

cation as a possible cause of therapy ineffectiveness.

gmail.com.

REFERENCES 1. Cordeanu ME, Gaertner S, Bronner F, et al. Neointimal thickening resulting in artery stenosis following renal sympathetic denervation. Int J Cardiol 2014;177:e117–9. 2. Krum H, Schlaich MP, Sobotka PA, et al. Percutaneous renal denervation in patients with treatment-resistant hypertension: final 3-year

report of the Symplicity HTN-1 study. Lancet 2014;383:622–9. 3. Papademetriou V, Tsioufis CP, Sinhal A, et al. Catheter-based renal denervation for resistant hypertension: 12-month results of the EnligHTN I first-in-human study using a multielectrode ablation system. Hypertension 2014;64:565–72.

KEY WORDS radiofrequency, renal denervation, resistant hypertension, vascular procedures complications