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Interventional Radiology
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Vascular
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Renal denervation
The St Jude Medical EnligHTN renal denervation catheter is a monopolar multipoint electrode radiofrequency ablation catheter. There are 4 radiopaque electrodes that are arranged in an expandable basket like configuration with 2 electrodes on opposite sides of the distal basket and two further electrodes more proximally in the same arrangement. The tip of the device features a smooth nitinol cone that allows smooth passage of the catheter into the renal artery.
The generator displays readings for each individual electrode displaying the temperature and impedence. There is a counting timer for each ablation point and the next electrode automatically turns on once the ablation for the previous electrode finishes. The generator is not as modern in appearance and design as other CE marked systems and requires some training/experience to operate properly and to interpret the temperature and impedence readings. The generator is also quite large in size compared to other CE marked devices.
Once the catheter is positioned within the renal artery and the basket expanded injection of contrast is performed to confirm positioning in the renal artery (below). A test run of the generator should demonstrate a small increase in temperature as well as a stable impedence reading to indicate good wall contact. If there is poor wall contact the basket can be collapsed and the catheter slightly repositioned before expanding and repeating the test run. Individual electrodes can be turned off if required.
After the first set of ablations have been performed, the catheter is collapsed and then retracted 1cm before being turned approximately 90 degrees and then re-expanded to ensure different locations for the 8 ablation points. Each ablation lasts 90 seconds per electrode and the company recommends 2 sets of 4 ablations per renal artery, totalling 16 ablation points with a total ablation time of 24 minutes. This is on the longer side compared with the other currently available CE marked devices and generally requires more sedation and analgesia, if no general anaesthetic administered,due to the longer procedure time.
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