Michel.Azizi，笛卡尔大学临床研究所高级研究员，主要从事血管疾病方面的研究。
Renal denervation is an interventional procedure to treat a highrisk medical condition. The intervention is technically easier than renal artery stenting. The different steps of the denervation process are as follows: the femoral artery is punctured at the groin， and a global angiogram confirms the renal artery anatomy. (This step can be skipped if preoperative imaging is recent and reliable， and/or if some degree of renal failure is present.) An alternative puncture site will likely be of interest if the intervention becomes routine and outpatient based. However， right now， the system is not designed for brachial or radial puncture. Next， selective catheterization of the renal artery is performed with a soft-tip wire. Caution is required so as to not enter distally into the renal arterial network to prevent damage to the kidney. The use of a guiding catheter or a long sheath is a matter of debate. With the current radiofrequency catheter (Symplicity)， a 5F sheath is large enough. Although it has the advantage of a smaller puncture site， it carries the risk of dissection when repeated control angiograms are performed between each denervation shoot. We currently favor the use of a 6F guiding catheter after insertion of a short 6F sheath into the groin. The three most used shapes are left internal mammary catheter (LIMA)， renal double curve (RDC-1) and BATES. In case of a sharply descending renal artery， a LIMA can be used. With a relatively horizontal first 1 or 2 cm of the renal artery， an RDC-1 is better suited. Permanent flushing of the side port of the sheath/guiding catheter with heparinized saline is recommended， as is injection of a bolus 200 lg of nitroglycerine into each renal artery to reduce spasm. For control angiograms， caution should used when injecting contrast through the side port. If the distal tip of the sheath/guiding catheter is in close contact with the arterial wall， forceful injection of contrast may induce renal artery dissection. The distal blunt tip carries the electrode that will deliver the radiofrequency current. Once in position in the renal artery at the hilum， the handle is activated and the tip deflected toward the arterial wall， ensuring good wall apposition. An angiogram confirms the position of the tip， and the generator can be activated. A drop in impedance as well an increase in temperature will attest to the quality of the energy delivery. After completion of the first 2 minute ablation just proximal to the bifurcation of the renal main artery， the catheter should be retracted at least 5 mm and rotated 45°. The goal is to create an interrupted spiral pattern of four to six ablation points. The same process is performed in the contralateral renal artery. Placement of the skin electrode at the beginning of the case requires specific attention; inappropriate placement can result in a local skin burn. Technician and nurses should undergo brief training to ensure safety.
去神经治疗是治疗高危疾病的介入操作。该手术较肾动脉支架置入术更为简单，其步骤如下：
在腹股沟穿刺股动脉，进行总体血管造影以明确肾动脉解剖。使用软导丝对肾动脉进行选择性插管。是否使用导引导管或者长导引鞘，尚存在争议。对于当前常用的射频导管（Symplicity）来说，5F鞘已经足够大。尽管5F导管造成的穿刺部位损伤较小，但每次行去神经操作时需重复进行的血管造影，会带来血管夹层的危险。目前更倾向于在腹股沟插入6F鞘，使用6F牵引导管。应用最多的导管分别为LIMA导管、RDC-1导管以及BATES导管三种类型。对与走行大幅向下的肾动脉，可以使用LIMA导管，而对于初始端1~2 cm走行相对水平的肾动脉，使用RDC-1导管效果更好。
推荐在导引鞘/导引导管的侧端使用肝素化生理盐水进行持续冲洗，并且对左右肾动脉各推注200 μg硝酸甘油以减少肾动脉痉挛。行造影检查时，应谨慎注射造影剂，如果导引鞘/导引导管的末端已经和动脉壁紧密接触，用力注射造影剂可能会导致肾动脉夹层。
导管的尖端携带发射射频电流的电极。当导管到达肾门位置时，导管尖端向动脉壁偏移，保持与血管壁的良好空间位置。通过血管造影确认尖端位置，从而激活射频信号发生器。阻抗降低与温度升高证实能量输送。
在肾动脉主干分叉处附近进行2分钟消融后，导管应当缩回至少5 mm，并且旋转45°，目的是得到间断螺旋形的四到六个消融点。对侧肾动脉进行同样的操作过程，最开始放置皮肤电极时需要特别注意，不恰当的放置可能会造成局部皮肤灼伤。此外，技师和护士应当接受简单的培训以保证安全。