Extravascular Approach to Renal Sympathetic Denervation "Presentation" - Aymon Ali
September 16, 2025
At the World Congress of Endourology and Uro-Technology, Aymon Ali presented the first US experience with the HyperQure extravascular renal denervation system for treatment-resistant hypertension, targeting the 10% of hypertensive patients who remain uncontrolled despite maximum medical therapy. The robotic retroperitoneal procedure uses circumferential electrode contact from outside the renal artery to deliver radiofrequency ablation, with preoperative planning enhanced by 3D virtual reality modeling of renal anatomy.
Biographies:
Aymon Ali, MD, Endourology Fellow, Department of Urology, University of California, Irvine, Orange, CA
Biographies:
Aymon Ali, MD, Endourology Fellow, Department of Urology, University of California, Irvine, Orange, CA
Read the Full Video Transcript
Aymon Ali: Good morning everyone. My name is Aymon Ali. I'm an endourology fellow at the University of California, Irvine. Today I'll be presenting our initial US experience with a novel HyperQure extravascular renal denervation system for treatment resistant hypertension. Hypertension is the most common chronic condition worldwide affecting nearly half of US adults. That's about 120 million people, yet only one in five achieve adequate blood pressure control. Roughly about 10% of these patients have what's termed as treatment resistant hypertension, meaning uncontrolled blood pressure, despite the use of three anti-hypertensive drugs and maximally tolerated doses. Renal denervation, or RDN, targets the renal sympathetic nerves and has shown promise in the treatment of treatment resistant hypertension. Most current systems are intravascular. The novel HyperQure system takes a different approach. This procedure is performed extravascularly, typically laparoscopic robotic-assisted procedure and is designed for precise circumferential electrode contact from the outside of the artery.
Our aim is to describe the first US case using the HyperQure system and share initial results. The primary outcome of our trial is a decrease in 24-hour ambulatory systolic blood pressure. Also, we are tracking the incidence of major adverse events, which is defined as a composite of events through a one-month period post procedure. To describe our methods, our patient was a 47-year-old male with treatment resistant hypertension on Carvedilol, Furosemide and Losartan, and no identified secondary causes of hypertension. Our approach was a robotic retroperitoneal single port surgery, which was performed bilaterally. Preoperative planning included a 3D interactive VR model of the renal anatomy and vasculature. The procedure involved traditional hilar dissection, deployment of the HyperQure instrument circumferentially and delivery of radio frequency ablation energy at 50 degrees centigrade for 70 seconds. This was performed at two sites per artery and the sites were at least three millimeters apart.
Here you can see two videos highlighting our preoperative planning using an IVR model. This is done with a MediQuest headset, so things do appear 3D, and as you can see, the renal vasculature is highlighted to a high degree of precision. On the right, we actually show the deployment of the instrument over the left renal artery. On the left is the proximal ablation site, and on the right is the distal ablation site, and as you can see, the instrument deploys completely circumferentially with 360 degree contact of the electrode around the artery. Our results were as follows: the operative time excluding setup was 195 minutes with a minimal blood loss of 20 CC's.
The patient stayed four days in hospital. The only perioperative issue was mild non-postural dizziness, which resolved by day two. Our blood pressure results were reassuring. Preoperatively, the patient on screening was identified to have a mean blood pressure of 149 over 109 and 163 over 107 millimeters of mercury on two separate screenings. By postoperative day five, the blood pressure decreased to 139 over 96 millimeters of mercury, and at one month our results were sustained at 123 over 80 millimeters of mercury. Importantly, these improvements occurred without changes to the patient's baseline medications, which previously left him with an uncontrolled blood pressure. In conclusion, in our first case, the HyperQure extravascular renal denervation system was safe, well tolerated, and produced a meaningful short-term blood pressure reduction. We look forward to completing our early feasibility study to ensure durability for our results. Thank you.
Aymon Ali: Good morning everyone. My name is Aymon Ali. I'm an endourology fellow at the University of California, Irvine. Today I'll be presenting our initial US experience with a novel HyperQure extravascular renal denervation system for treatment resistant hypertension. Hypertension is the most common chronic condition worldwide affecting nearly half of US adults. That's about 120 million people, yet only one in five achieve adequate blood pressure control. Roughly about 10% of these patients have what's termed as treatment resistant hypertension, meaning uncontrolled blood pressure, despite the use of three anti-hypertensive drugs and maximally tolerated doses. Renal denervation, or RDN, targets the renal sympathetic nerves and has shown promise in the treatment of treatment resistant hypertension. Most current systems are intravascular. The novel HyperQure system takes a different approach. This procedure is performed extravascularly, typically laparoscopic robotic-assisted procedure and is designed for precise circumferential electrode contact from the outside of the artery.
Our aim is to describe the first US case using the HyperQure system and share initial results. The primary outcome of our trial is a decrease in 24-hour ambulatory systolic blood pressure. Also, we are tracking the incidence of major adverse events, which is defined as a composite of events through a one-month period post procedure. To describe our methods, our patient was a 47-year-old male with treatment resistant hypertension on Carvedilol, Furosemide and Losartan, and no identified secondary causes of hypertension. Our approach was a robotic retroperitoneal single port surgery, which was performed bilaterally. Preoperative planning included a 3D interactive VR model of the renal anatomy and vasculature. The procedure involved traditional hilar dissection, deployment of the HyperQure instrument circumferentially and delivery of radio frequency ablation energy at 50 degrees centigrade for 70 seconds. This was performed at two sites per artery and the sites were at least three millimeters apart.
Here you can see two videos highlighting our preoperative planning using an IVR model. This is done with a MediQuest headset, so things do appear 3D, and as you can see, the renal vasculature is highlighted to a high degree of precision. On the right, we actually show the deployment of the instrument over the left renal artery. On the left is the proximal ablation site, and on the right is the distal ablation site, and as you can see, the instrument deploys completely circumferentially with 360 degree contact of the electrode around the artery. Our results were as follows: the operative time excluding setup was 195 minutes with a minimal blood loss of 20 CC's.
The patient stayed four days in hospital. The only perioperative issue was mild non-postural dizziness, which resolved by day two. Our blood pressure results were reassuring. Preoperatively, the patient on screening was identified to have a mean blood pressure of 149 over 109 and 163 over 107 millimeters of mercury on two separate screenings. By postoperative day five, the blood pressure decreased to 139 over 96 millimeters of mercury, and at one month our results were sustained at 123 over 80 millimeters of mercury. Importantly, these improvements occurred without changes to the patient's baseline medications, which previously left him with an uncontrolled blood pressure. In conclusion, in our first case, the HyperQure extravascular renal denervation system was safe, well tolerated, and produced a meaningful short-term blood pressure reduction. We look forward to completing our early feasibility study to ensure durability for our results. Thank you.