Minimally invasive ablation of aorticorenal ganglia for treatment of hypertension

Dr Pierre Qian, University of Sydney

2020 Postdoctoral Fellowship

Years funded: 2021-2022

Hypertension is a common condition that is a strong risk factor for cardiovascular disease. Yet up to half of patients with hypertension do not achieve blood pressure control, and some require multiple medications. Hyperactive kidney nerves have been implicated in driving hypertension, particularly in individuals where multiple blood pressure medications are required. These nerves course around the kidney artery. In recent years, new medical devices that can cauterise (ablate) these nerves using catheters placed within the renal artery have been developed. However clinical trial results have been variable, in part because these nerves are randomly distributed and at varying distances around the artery and many nerves are missed by the ablation. There has also been no way to tell during the procedure that the nerves have been affected by the ablation.

Therefore, renal denervation procedures are currently akin to shooting in the dark and have great variability in their efficacy despite some risk of renal artery injury. We have developed a method to trace the kidney nerves back to a central hub, called the aorticorenal ganglion. By using a catheter with an electrode at its tip inserted through a vein in the groin, it is possible to locate this ganglion with millimetre precision using electrical stimulation. By destroying these ganglia with ablation, the source of the kidney’s nerves can be eliminated without risk of arterial injury. Additionally, we can assure that the kidney nerves are inactivated by testing their function with electrical stimulation. This project will investigate whether ablation of aorticorenal ganglia can safely and effectively destroy the renal nerves to treat hypertension. This procedure has great potential in reducing the risk of cardiovascular disease in hypertensive patients preferring to be on fewer medications or who have poor control despite multiple medications.