Is an abnormal vascular response after renal sympathetic denervation predictive of permanent damage? An unusual case of late renal artery stenosis after energy delivery.

Objective: To describe the effect of renal sympathetic denervation (RDN) on renal arteries immediately after the procedure and at follow-up.

Methods: A 52-year-old woman with severe resistant hypertension underwent RDN. A transient spasm occurred in the left renal artery immediately after radiofrequency energy delivery, with subsequent complete resolution without any additional therapy. At 6-month follow-up, the blood pressure increased, and imaging revealed a tight stenosis in the left renal artery, which was successfully treated with a stent. In the next days, there was an immediate significant blood pressure reduction.

Conclusions: Renal denervation can be complicated by local tissue injury at the ablation sites that could be a possible trigger of late arterial disease.