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Renal denervation is a huge door, just beginning to open for IRs

Jon G Moss, professor, Department of Radiology, North Glasgow University Hospitals, Glasgow, UK spoke to Interventional News on the opportunities that renal denervation might represent to practitioners of a specialty whose territory other specialties regular poach on.

The technique involves use of radiofrequency energy from within the renal artery to block conduction in the surrounding renal nerves, thereby counteracting chronic activation of the sympathetic nervous system. In addition to blood pressure reduction, this treatment has shown promising results for chronic kidney disease, insulin resistance and heart failure.

Why is there so much attention being paid to renal denervation?Up to a third of the population is hypertensive. Uncontrolled or difficult to control hypertension represents about 10–15% of these. If this new treatment works, then a large number of patients could benefit. If this can be shown to reduce the number of major vascular events such as myocardial infarction and stroke, then we are certainly onto something big and important for healthcare systems in developed countries. Furthermore, a reduction in sympathetic nerve activity may have an impact on renal function, sodium retention, heart failure and other disease entities.

Why does this new procedure represent such an opportunity for interventional radiologists?Interventional radiologists are the obvious players here. They have years of experience of catheterising renal arteries, and more recently using radiofrequency ablation in various organs such as the kidney and liver. Furthermore there is already a natural referral pathway between blood pressure physicians and interventional radiologists through renal artery stenosis and hypertension. Interventional radiology can sometimes feel under pressure with aggressive groups from other specialties “chewing at its underbelly”. This has resulted in several “doors” closing off in some countries, for example EVAR in Australia. Other doors might close because of a lack of evidence— or example, renal stenting for hypertension. However doors open as well as close, and I see renal denervation like a huge airport hanger door which has just started to open. Good quality trials will determine how wide it opens.