A 64-year-old female subject was treated with hypertension and diabetes in out-patient-department of cardiovascular department of Chonnam National University Hospital for 15 years. Her blood pressure was relatively well controlled of 130/80 to 140/80 mmHg at outpatient clinic. However, it had increased about 180/70~200/100 mmHg since 1 year ago despite good drug compliance. Her antihypertensive regimen constituted of loop diuretic, aldosterone antagonist, beta-blocker, alpha-blocker, calcium channel blocker, angiotensin receptor blocker and vasodilator.
The results for evaluation of secondary hypertension were normal. Baseline creatinine was 1.0 mg/dL and abdominal computed tomography (Fig. 1) revealed no renal artery stenosis. Electrocardiography (Fig. 2) showed normal sinus rhythm with left ventricular hypertrophy (LVH). Two dimensional echocardiography showed normal left ventricular (LV) systolic function and mild concentric LVH with about 13mm of LV wall thickness. Based on her clinical history and the results of laboratory and imaging data, her clinical diagnosis satisfied resistant hypertension and offered percutaneous renal denervation therapy (RDT).
She underwent percutaneous RDT under local anesthesia. Fentanyl, morphine and midazolam were used for pain control and sedation. Renal artery angiography revealed no stenosis in both renal arteries (Fig. 3). There was a branch perfusing right kidney from mid to distal portion of right renal artery. We performed five radiofrequency ablations (Fig. 4) to both renal artery avoided the ostium of branch of right renal artery.
Radiofrequency ablations performed from distal to proximal renal arteries and catheter was pulled out spiral shape. Table 1 shows summary screen. There were 2 failed radiofrequency ablations (red color) because unstable contact of electrode against arterial wall.
Final renal angiography showed no spasm and there were no procedure related complications. She visited outpatient clinic after 2 weeks of RDT and blood pressure was 124/64 mmHg. So, we discontinued calcium channel blocker and alpha-blocker.