Distal radial artery access for renal denervation in resistant hypertension: a case report.

Background: Renal denervation (RDN) has emerged as an effective interventional strategy to achieve sustained blood pressure reduction in patients with resistant hypertension. However, conventional access routes, including femoral and proximal radial arteries, may be associated with vascular complications and prolonged compression time. We report the first case of RDN performed via distal radial artery access. Case summary: A 55-year-old man with a 20-year history of poorly controlled hypertension despite quadruple antihypertensive therapy was admitted for worsening symptoms. Baseline imaging confirmed suitable renal artery anatomy. Renal denervation was successfully performed through right distal radial artery access using a 6F sheath. A total of 60 radiofrequency ablation points were delivered to bilateral renal arteries without procedural complications. Haemostasis was achieved with 3 h of compression. Although blood pressure transiently increased at 3 days post-procedure, progressive reduction was observed during follow-up. Mean 24-h blood pressure decreased from 166/92 mmHg at 3 days to 153/89 mmHg at 3 months and further to 134/77 mmHg at 6 months. Antihypertensive therapy was reduced to single-drug treatment at 6 months. Conclusion: Distal radial artery access for RDN is feasible and safe, providing favourable haemostasis and comparable therapeutic effect. This approach may represent a novel and patient-friendly alternative access strategy for the treatment of resistant hypertension.