Hi Dr. Topol,

 I have taken care of many patients with intractable hypertension poorly controlled on multiple medications (5+) that do not have demonstrable renal artery stenosis. Would these patients also benefit from ablation of the sympathetic nerves? I have a great deal of hope for this new treatment strategy. When do you think it will become widely available in the US?

Are there any foreseeable negative consequences to this procedure, especially in the long term or in patients who may develop shock or heart failure down the line? While I am very excited about this new treatment, I can see that this may be offered to patients that are non-compliant with medical therapy who are not truly intractable, or to patients because its a billable procedure. I think long-term follow up for these patients probably is needed before it becomes as widely disseminated as an elective procedure like the lap band procedure!

I suspect this is a procedure that many will want to get involved with and I can easily see it being overused in patients that probably don't need it. I can also anticipate that it wouldn't be just cardiologists or interventional cardiologists doing this procedure, but vascular surgeons and interventional radiologists. Heck, I have even heard there are interventional nephrologists, and they probably would want to do these procedures also!

 Thanks!

Rahul Bhardwaj 

Thanks for your comment, Rahul.

This is not related to reanl artery stenosis....just getting at the neural input to the kidney. While there are certainly potential complications of the procedure and your point about it being done unecessarily. Like your idea of interventional nephrologists!