By Dr. Sameer Gafoor
The recent TRENDS conference in Frankfurt discussed at length the current status and future of renal denervation. Recent trial data has called this into question. This was discussed extensively.
Friday, February 7
This started with an overview of hypertension (Roland Schmieder) and an understanding of measurement modalities for blood pressure (Guido Grassi), an overlook of the the guidelines (Orfeas Liangos), and an overview of what you need to do to test for secondary hypertension (Stefan Bertog), optimize medical management (Orfeas Liangos) and select patients to implement a renal denervation practice (Oliver Vonend, Thomas Schmitz).
Then it was time to take a step back to discuss the anatomy and physiology by such renowned scholars as Dagmara Hering, Ariel Sverdlik, and Paul Sobotka. We took a look at renal denervation and pulse wave velocity (Kai Mortenson), and clinical endpoints (Robert Melder).
A special first-in-man experience of a new device with impressive results was presented by Dr. van der Heijden, proving how there was still much hope and promise for the future.
After lunch on Friday, it was time to take a deep dive into the different companies and their current updates – Simplicity (Marc Sapoval and Justin Davies), Vessix (Gerard Goh), Enlightn (Vasiolos Papademetriou), Covidien (Stefan Bertog), Paradise Recor Medical (Joost Daemen).
Dr. Darrel Francis came and stole the show with the simple explanations as to why Simplicity 3 turned out the way it did. He explained in depth why the press releases were ill-worded and badly interpreted. This was ‘irrational exuberance followed by unjustified despondency’ and now this was time for an exciting future based on science. This was due to ‘big day bias’, ‘check once more bias’, and ‘i’ll take them now bias’ that had harmed this trial, and there were solutions to all of these issues that future trials would have to pay attention to if they were to have any hope of success.
What are the other effects of renal denervation aside from hypertension? This includes effects on arrhythmias (Jennifer Franke), insulin resistance (Dagmara Hering), chronic kidney disease (Roland Schmieder), sleep apnea (Aleksander Prejbisz), exercise tolerance (Mathias-Christoph Brandt), renovascular hypertension (Yvonne Bausback), and psychometric aspects/quality of life (Dagmara Hering).
Once we learned all of the above, it was time for a step by step approach for the different devices. This started with a lecture on angiography (Mark Wholey), followed by instructions for Symplicity Flex and Covidien One Shot (Martin Bergmann), Vessix (Gerard Goh), EnligHTN (Vasiolos Papademetriou), Recor Medical (Joost Daemen). This was followed by a talk on invasive imaging results after the four different devices (Joost Daemen) and a talk on optimal followup (Peter de Leeuw).
Saturday, February 8
Saturday started with an exciting mix of talks and cases together.
The talks went beyond the earlier companies to discuss the new fields of baroreceptor stimulation, pulmonary artery denervation, new techniques for renal denervation, and more.
This started with an overview of the exciting new field of baroreceptor activation and other new systemic interventions. What is baroreceptor activation was covered by Joern Schmitt, followed by Barostim in renal denervation nonresponders (Hannes Reuter), chronic kidney disease patients (Michael Koziolek), and heart failure (Rolf Wachter).
The kidney nerves are not the only nerves that play a major role in hypertension. Paul Sobotka discussed carotid body ablation, followed by the promise and current status of pulmonary artery denervation for pulmonary hypertension (Alexander Rothman and Yao-Jun Zhang).
New Techniques for renal denervation was broken into two parts because of the wide plethora of devices available. This included overview talks on the advantages and disadvantages of radiofrequency (Justin Davies) and ultrasound (Martin Bergmann) and histopathology after ultrasound (Joost Daemen). Other techniques included Cardiosonic (Michael Jonas), in-stent renal denervation with TIVUS (Michael Jonas), Terumo Iberis renal denervation (Benjamin Honton), Cordis Thermocool (Martin Bergmann), Bullfrog catheter and radiation therapy (Jan Kulow), Medtronic Spyral (Erwin Blessing), and local anesthesia (Simon Lam).
The second part included externally focused ultrasound (Omar Dawood), Denervx Cooled Microwave Technology (Stefan Bertog), Perivascular Chemical Renal denervation (Tim Fischell), Northwind Medical (Mark Wholey), Chemical renal denervation by Vicristine (Christodoulous Stefanadis) and VERVE medical with an invasive non-vascular approach (Richard Heuser).
Other ‘systemic interventions’ included vagus nerve stimulation on arterial hypertension (Sekib Sokolovic), the ROX Medical AV Anastomosis therapy (Paul Sobotka) and future of neurohumoral modulation.
Cases, performed by Dr. Horst Sievert, Laura Vaskelyte, and Sameer Gafoor included live detailed step-by-step discussion of the Recor Medical Paradise, Medtronic Symplicity, Boston Vessix, St. Jude EnligHTN, and Terumo Iberis devices. Live invasive imaging was performed to help with decision management and discussion among the participants was extensive.
For more information about the conference please see the website. Selected lectures will be found online.
Dr. Sameer Gafoor
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