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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 1, January/February 2016
54
AFRICA
Case 2: renal denervation via radial arterial
access
The second case was performed on a 63-year-old male with a
history of syncope, obstructive sleep apnoea, hypertension and
baseline blood pressure of 160/100 mmHg. Percutaneous left
radial arterial access was achieved with a 6-Fr introducer sheath
(Terumo), 6-Fr multipurpose guiding catheter (Medtronic) and
a 190-cm, 0.014-inch gage Thunder
TM
guide wire (Medtronic).
The Spyral catheter was then introduced over the guidewire, after
removing the straightening tool, resulting in approximately 125
cm of catheter length (Fig. 3).
The diameter of the main renal artery was approximately
7 and 6 mm on the left and right side, respectively. Adequate
catheter access to the renal arteries was attained and 24 and
20 lesions were performed in the right and left renal arteries,
respectively.
For both cases electrode temperature, impedance and
impedance decreases were in the typical range for all lesions.
Typical generator codes indicating sub‐optimal electrode contact
were occasionally observed and were addressed during the
procedure by successful repeated energy delivery to the specific
electrodes. No procedural complications occurred, and the
arterial access site was managed post procedurally with routine
manual compression.
The patients were discharged the same day as the procedure,
and no further complications have been reported to date. Both
patients will continue to be monitored according to the clinical
protocol (Table 1).
Discussion
To our knowledge, these are the first reported cases of RD
through brachial and left radial access, respectively, using
the second-generation multi‐electrode RF generation system.
Previous case reports have described successful RD via brachial
access with the first-generation monopolar system.
3,4
Compared
to the traditional femoral approach, trans‐radial or brachial
percutaneous procedures for coronary interventions generally
have a lower risk of bleeding complications, fewer access site
Right renal artery
Left renal artery
Fig. 2.
Bilateral renal artery denervation was successfully performed.
Fig. 3.
Left radial access: note how much of the catheter is still
outside the patient.
Fig. 1B.
Symplicity Spyral
®
catheter threaded through the
multipurpose guiding catheter with right brachial
access point.