Zero-Contrast Percutaneous Renal Denervation Guided by Multimodal Image Fusion.

As a second-line treatment for resistant hypertension or uncontrolled hypertension, renal denervation (RDN) has been widely adopted globally. Conventional RDN procedures require the use of contrast agents, which pose risks of exacerbating renal impairment and increasing cardiac burden for patients with concurrent renal or cardiac insufficiency. A 43-year-old man, diagnosed with hypertension for >10 years, presents with combined chronic kidney disease stage 3 and heart failure. Despite standardized medication therapy, his blood pressure remains poorly controlled. Due to concerns from the patient and his family regarding the risk of contrast-induced nephropathy, our team successfully performed a zero-contrast RDN procedure by integrating magnetic resonance angiography with digital subtraction angiography imaging, guided by transabdominal ultrasound. This approach is safe, feasible, and reproducible, effectively avoiding the potential hazards associated with contrast agents, thereby aiming to improve patient prognosis more effectively.