Renal Denervation Cases

46 years old Male patient, with systemic hypertension known for 5 years when he debuted with ischemic stroke in the hypertensive emergency setting with BP at 220/120 mmHg. At that time a total occlusion of the Left Common Carotid Artery is diagnosed. He is additionally known to suffer from Insulin Resistance Syndrome, mixed dyslipidemia to hypertriglyceridemia predominance, and moderate obesity. He is treated with: 32 mg Candesartan (Atacand ®), 10 mg Lercanidipine (Lercadip ®), Bisoprolol 10 mg (Concor ®), 1,5 mg Indapamide ( Natrilix AP ®), 25 mg Espirinolactona ( Aldactone ®). Additionaly, 40 mg rosuvastatin (Crestor ®), 100 mg od Ciprofibrate (Hiperlipen ®), 500 mg Mefformine (Glucofage ®), 100 mg vo od Aspirin, 75 mg od Clopidogrel (Plavix®). Diagnosis of Resistant Hypertension is established for continuing with high levels in the doctor’s office in 3 separate doses above to 140/90 mmHg and in a demonstration of Ambulatory Blood Pressure Monitoring of 24 hours (ABPM), an inadequate control of blood pressure with a systolic load of 71% and diastolic load of 55% was shown, besides Non-Dipper condition. He underwent Doppler Renal Eco and Renovascular hypertension was discarded. The renal denervation procedure was performed on the Left Renal Artery greater than 4 mm and the Right renal artery with 2 polar arteries, upper and lower greater than 4 mm and the Main Trunk, making five applications in each artery from distal to proximal upto the upper and / or lower ostium of both main renal arteries. Outpatient control consultation to post-denervation week revealed BP at 120/80 mmHg and the patient had suspended Espironolactone 72 hours before the visit. Evolution is expected in the medium and long term.Se establece diagnóstico de HTA resistente por continuar con cifras elevadas en el consultorio en 3 tomas separadas mayor de 140/90 mmHg y demostración en Monitoreo Ambulatorio de Presión Arterial de 24 horas ( MAPA) de inadecuado control de presión arterial con carga sistólica de 71 % y carga diastólica de 55 %. Además condición Non-Dipper. Se le practicó Eco Doppler Renal y se descartó hipertensión Renovascular. El procedimiento de denervación renal se practicó en Arteria Renal Izquierda mayor de 4 mm y en Arteria renal Derecha con 2 arterias polares, superior e inferior mayor de 4 mm y en Tronco Principal, realizando 5 aplicaciones en cada arteria de distal a proximal hasta el ostium superior y/o inferior de ambas arterias renales principales. El control ambulatorio en la consulta a la semana post-denervación reveló Presión Arterial en 120/80 mmHg y el paciente había suspendido por su cuenta Espirinolactona 72 horas antes de la visita. Se espera evolución a mediano y largo plazo.

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Together, we will take care of your health.