Wednesday, May 18, 2011


When I first read of Renal denervation, or what I then called the Ardian Procedure ( after the company who developed the device ), I was quite impressed and decided that the GPs should hear about it as it was hot off the press from AHA, in the fall of 2010. I listed the topic in my program for the "Weekend seminar in Cardiology for GPs 2011". I asked one of our senior cardiologist to speak about it, of course, just a brief undertanding, under the section on "Hot Topics in Cardiology". The Cardiologist decline stating that he had no knowledge of this topic, so I had to teach on it myself, just from researching the topic and understanding it.
Well, EuroPCR, currently on in Paris, just gave the Melbourne boys ( pioneers in the technique ), center stage, by allowing them to show a live demo from Germany, on Renal denervation, and also a presentation of the evidence to date.
Of course, we are all viewing this revolutionary procedure for the management of hypertension from different angles.
I suppose the Melbourne and German boys are trying to see how to perfect the technique for routine use, so that good longterm results can be obtained. They are also trying to conduct more, large scale trails ( SYMPLICITY HTN-3) is scheduled to be launched in USA soon, so that they can begin to work towards FDA approval.
We are all looking to see, if the early results will hold up, and even more importantly, what role it will play in the whole scheme of management of hypertension. Not to forget that this is a multi-million dollar drug industry item, and the renal / hypertension physicians are not going to let this area go to interventionist without a fight ( I hope not literally ).
We interventionist seeing that this technique is rather simple and safe, wonder whether it can be more widely applied, like in pre-hypertension and patients who wish their hypertension "cured".
I am sure that we can all agree, that more studies needed to be done, and we simply need more studies, from multi-center, and well as across countries and continents. Hypertension is a very common problem, and there is a great potential that renal denervation, may be mis-used.
For our country, I have gently and strongly hinted to the company owning Ardian ( in this case Medtronic International ), to quickly identify a young and eager interventionist ( we are too old now ), to go study this procedure in Melbourne, and become an expert, to initiate a program here, as we are seeing a growing number of hypertensives and strokes, and many of our patients are not compliant on drugs, and so suffer numerous complications of strokes and renal failure. I certainly hope that they will do for renal denervation in Malaysia, what we did coronary angioplasty and stenting in Malaysia. All this while waiting for the long term results of SIMPLICITY HTN 1, 2 to come. We need improvement in hard end points in hypertension treatment ( when compared to medical therapy ), before we can finally say that Renal denervation is ready for prime time. For the moment, renal denervation should remain as a treatment modality for chronic resistant hypertension.

No comments: