Episode # 3 • 17 Jan 2025
Renal Denervation Explained: Procedure, Guidelines, & Best Practices
Renal denervation is back in the guidelines, but what does the latest evidence mean for patient selection, technique, and counseling in the cath lab? On this episode of BackTable Cardiology, Dr. Vladimir Lakhter interviews Dr. Dmitriy Feldman, director of endovascular services in the Division of Cardiology at Weill Cornell Medicine, about where renal denervation fits in hypertension care today. They cover the new guideline recommendation, the history behind the procedure's comeback, the referral pathway and pre-procedural workup, and how to counsel patients on what to expect.
Timestamps
00:00 - Introduction
02:42 - Guideline Recommendations for Renal Denervation
05:36 - Lessons From Early Sham-Controlled Trials
12:15 - Referral Pathways and Hypertension Programs
17:16 - Pre-Procedural Workup and Imaging
23:11 - Patient Selection and Counseling
29:09 - Durability of Blood Pressure Reduction
31:46 - Radiofrequency Denervation Technique
42:44 - Ultrasound Denervation Technique
45:38 - Sedation and Pain Management
49:06 - Complication Management
53:10 - Future Directions in Denervation
58:05 - Closing Remarks
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More about this episode
Dr. Feldman, a co-author of the 2023 SCAI position statement on renal denervation, explains why the first large sham-controlled trial missed its primary endpoint and how off-medication trials, ambulatory blood pressure endpoints, and multielectrode catheters changed the picture. He then walks through the procedure itself: CT angiography for anatomic screening, vessel sizing for radiofrequency ablation of the main renal arteries and their branches, wire selection for tortuous anatomy, how the ultrasound balloon system differs, sedation for a painful procedure, and preparation for rare complications. He also shares why he tells patients that renal denervation is not a cure but a one-time treatment with a long-term effect. The episode closes with a look at what may come next, from nerve stimulation and multi-organ denervation to possible metabolic and rhythm benefits, and why hypertension deserves a central place in cardiovascular prevention.
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