Role of Dynamic Road-Mapping in Renal Denervation Procedures

© 2024 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of the Journal of Invasive Cardiology or HMP Global, their employees, and affiliates. 

J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00064. Epub March 22, 2024.

Dynamic road-mapping (DRM) (Dynamic Coronary Roadmap; Philips) offers a real-time, dynamic overlay of the coronary tree on fluoroscopy. Once the roadmap is automatically generated during angiography, it can be used for navigation during percutaneous coronary intervention procedures. However, it may have other interesting applications. We present the first description—to our knowledge—of the role of DRM for renal denervation (RDN).

RDN is a minimally invasive procedure that involves a catheter-based ablation of the sympathetic nerves within the renal artery. DRM projects a highlighted renal angiogram superimposed on a live 2-dimensional fluoroscopic image, creating a colored roadmap (Figure, A & B) that adjusts automatically with a single 5-mL injection of contrast medium. It also provides continuous visual feedback on the positioning of the wire (Figure, C) and the catheter (Figure, D). The use of this coronary tool allows for the reduction of both radiation doses and contrast volume, providing improved safety for patients with resistant hypertension, especially for those at higher risk of contrast-induced nephropathy.

RDN is a technically simple procedure, however, the advancement of the Symplicity-Spyral catheter (SCC) (Medtronic) (Figure, E) can sometimes be challenging due to its helical-shape and stiffness, mainly in angulated or tortuous branches. In these cases, coronary techniques such as buddy-wire (Figure, F) or the use of guide catheter extension (Figure, G [arrow]) can improve the guiding catheter stability, the support, and facilitate SCC navigation to the radiofrequency application site.

Affiliations and Disclosures

From the Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain.

Dr Gonzálvez-García and Dr Jurado-Román share the first authorship as both contributed equally to this work.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Address for correspondence: Ariana Gonzálvez-García, MD, La Paz University Hospital. Paseo de la Castellana 261. Madrid 28046, Spain. Email: arianagonzalvez@gmail.com; X: @ari_gonzalvez; @JuradoRomanAl; @Hemodin_LaPaz