Profound Sustained Hypotension Following Renal Denervation: A Dramatic Success?

Introduction

A 67-year-old woman with drug-refractory essential hypertension was admitted for renal sympathetic denervation (RDN). The secondary causes of hypertension were fully investigated in this patient. A 24-h ambulatory blood pressure (BP) monitor documented a mean daytime BP of 172/101 mmHg, a mean nighttime BP of 151/84 mmHg, and an overall mean BP of 167/97 mmHg despite compliance with metoprolol (50 mg twice daily), amlodipine (10 mg once daily), lisinopril (20 mg once daily), prazosin (2 mg thrice daily), and hydrochlorothiazide (50 mg once daily).

The patient was fasted for 4 h. Her usual antihypertensive drug therapy was continued. After the administration of 5,000 international units of heparin and 100 μg of fentanyl, a 7-F Renal Double Curve guide catheter (Cordis Corporation, Fremont, CA ,USA) was inserted into the right renal artery (no accessory vessel). A 0.014-in Runthrough floppy guide wire (Terumo Medical Corporation, Somerset, NJ, USA) was advanced into place. A 6-mm ONESHOT^TM (Covidien, Mansfield, MA, USA) irrigated RDN balloon was advanced into place (), and a single ablation was performed. The procedure was then repeated on the other side. The patient remained hemodynamically stable throughout and at the completion of the procedure with a BP of 150/80 mmHg. Hemostasis was achieved with the Perclose ProGlide Suture-Mediated Closure System (Abbott Vascular, Santa Clara, CA, USA), and the patient was then returned to our ward for monitoring.

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