Stenting for Both Renal Artery Stenosis Manifested as Uncontrolled Hypertension
- Operator: Krishna Rocha-Singh, MD
Clinical presentation
A 64-year old woman was admitted with chest discomfort and uncontrolled hypertension in spite of meticulous medical therapy. Five months ago, she visited at other hospital and was diagnosed as both renal artery stenosis by CT angiogram. Laboratory finding showed no azotemia. Baseline ECG showed nonspecific ST-T changes. Echocardiography showed concentric LVH without regional wall motion abnormality.
Baseline coronary angiogram
1. Coronary angiogram showed diffuse proximal to mid-LAD 80-90% narrowing and diffuse distal LCX 80-90% narrowing. Four months ago, two DESs were deployed four months ago at those lesions.
2. CT angiogram showed focal stenosis of both renal artery orifice (Figure
1 and Figure 2).
Procedure
A 7F sheath was inserted through right femoral artery, and 7 Fr RDC1 guiding catheter was positioned at intima of aorta above origin of renal artery via 0.032 inch J-tipped Terumo wire (No-touch technique) (Figure 3 and Figure 4). A 0.014 inch BMW wire passed the stenosis of left renal artery to the distal portion of renal artery (Figure 5). After removal of Terumo wire (Figure 6), the lesion was predilated with Powerflex balloon 5.0 X 20 mm at 10 atm (5.0 mm) (Figure 7 and Figure 8). And then, a renal Palmaz Genesis stent 6.0 X 18 mm was deployed at 10 atm (6.0 mm) (Figure 9 and Figure 10). Left renal angiogram showed no residual narrowing of stenosis (Figure 11). Then, the catheter was engaged into the right renal artery using no-touch technique (Figure 12). After insertion of a BMW wire into the distal portion of the right renal artery, predilation was performed using Ultra soft 5.0 X 20 mm at 6 atm (5.0 mm). Another 5.0 X 18 mm renal Palmaz Genesis was deployed at 12 atm (5.15 mm) (Figure 13 and Figure 14). After additional balloon with Powerflex balloon 6.0 X 20 mm at 10 atm (6.0 mm), the final angiogram showed no residual narrowing of stenosis (Figure 15).
