SCAI 2026 Building and Sustaining Your RDN Program-Panel Discussion 2

Video Transcription

Video Summary

The panel discussed practical considerations for renal denervation (RDN), including operator experience, access, guide selection, and wiring. Speakers emphasized that the basic hand skills are familiar to coronary operators, though radiofrequency and ultrasound devices differ in how distal branches are treated. Safety was a major theme: as RDN expands into patients with more atherosclerosis, CKD, or complex anatomy, careful catheter handling, no-touch techniques, and minimizing embolic risk become more important.<br /><br />Imaging was debated, especially QCA versus IVUS/ultrasound. Some favored ultrasound for more accurate sizing, while others noted it increases cost and that QCA often suffices after a learning curve. The panel also discussed treating patients with CKD and even end-stage renal disease, noting limited data but potential benefit in carefully selected cases. No universal eGFR cutoff was endorsed for commercial use, though trial criteria are more restrictive.<br /><br />Patient selection was another focus: most agreed to start with truly resistant hypertension cases rather than patients simply wanting fewer medications. The group also addressed secondary hypertension, including treated hyperaldosteronism and obstructive sleep apnea, suggesting RDN may still be reasonable if hypertension remains uncontrolled. Finally, they noted that blood pressure reduction is accepted as a surrogate for cardiovascular benefit, and then shifted to planning breakouts on program efficiency, reimbursement, and future research.

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Keywords

renal denervation

operator experience

patient selection

imaging guidance

chronic kidney disease

resistant hypertension

safety techniques